bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the Prevalence of Spondylolysis and Spina Bifida Occulta Observed in Pediatric Patients Remain Stable in Adults?
Authors: Urrutia Julio , Zamora Tomas , Cuellar Jorge
Published: May 2015

Introduction

The prevalence of spondylolysis reported from radiograph-based studies in children had been questioned in computed tomography (CT)–based studies in adults; however, our group recently confirmed the previously reported data in pediatric populations in a CT-based study. Spina bifida occulta (SBO), which has been associated with spondylolysis, has demonstrated a decreasing prevalence with increasing age during childhood and adolescence. No studies have compared the prevalence of spondylolysis and SBO in pediatric and adult patients using CT as a screening method. The aim of this study was to compare the prevalence of lumbar spondylolysis and SBO in pediatric and adult populations.

Patients and Methods

We studied 228 pediatric patients (4–15 years' old) and 235 adults (30–45 years' old) who consecutively underwent abdominal and pelvic CT scans at a tertiary care University Hospital for reasons not related to the spine. The entire lumbosacral spine was evaluated to detect the presence of spondylolysis and SBO. We compared the prevalence of spondylolysis and SBO in pediatric patients and adults.

Results

The mean age of our pediatric patients was 11.2 ± 2.7 years; 107 patients were males (46.9%) and 121 were females (53.1%). The mean age of the adult patients was 37.46 ± 4.5 years; 95 patients were males (40.4%) and 140 were females (59.6%). Among pediatric patients, the prevalence of spondylolysis was 3.5%, 95% CI: 1.1 to 5.9% (eight patients); the prevalence of spondylolysis in adults was 3.8%, 95% CI: 1.7 to 6.8% (nine patients), p = 1. In pediatric patients, males exhibited a 4.7% (95% CI, 0.6–8.7) prevalence of spondylolysis (five patients) compared with a 2.5% (95% CI, 0.3–5.3) prevalence in females (three patients), p = 0.48. In adults, males had a 3.2% (95% CI, 0.0–7.2) prevalence of pars defect (three patients), whereas females exhibited a 4.3% (95% CI, 1.4–8.1) prevalence (six patients), p = 0.74. The prevalence of SBO in pediatric patients was 41.2%, 95% CI: 34.8 to 59.2% (94 patients), while it was 7.7% in adults, 95% CI: 4.3 to 11.5% (18 patients), p < 0.01. The prevalence of SBO decreased with increasing age. Among pediatric patients, SBO was found in 51.4% of males (95% CI, 41.8–61) and in 32.2% of females (95% CI, 23.8–40.7), p < 0.01. In adults, we observed SBO in 8.4% of males (95% CI, 3.3–14.7) and in 7.1% of females (95% CI, 3.1–11.6), p = 0.80.

Conclusion

The prevalence of lumbar spondylolysis remained constant from pediatric age through adulthood. The prevalence of SBO decreased from 41.2% in children to 7.7% in adults. This finding suggests that SBO may not represent a pathological condition or an anatomic variant; the closure of the vertebral arch may be a continuous process that is completed through adulthood in many patients, which is in opposition to the usual theory that vertebral arch ossification should be completed during early childhood.
Efficacy and Risk Factors, for Complications Associated with Growing Rods, in the Management of Progressive Early-Onset Scoliosis
Authors: Meneses David , Montero Carlos , Alvarado Fernando , Godoy Wilmer , Alcalá Gabriel
Published: May 2015

Introduction

Growing-rod spinal instrumentation systems are a valuable option for managing progressive early-onset scoliosis. However, some studies had suggested that its efficacy may be lost over a period time and could be counterbalanced by a high rate of complications. The objective of this study was to determine the efficacy and safety of growing rods for the treatment of progressive early-onset scoliosis.

Materials and Methods

An Institutional Review Board approved cross-sectional study was performed, including patients with early-onset scoliosis treated with growing rods between 1997 and 2012. A retrospective review of the chart and radiographic data were performed. Risk factors for complications were explored using univariate and multivariate analyses.

Results

Records of 35 patients were included. The mean age at implantation of the rods was 5.8 ± 2.3 years. Overall, 18 patients had a diagnosis of idiopathic scoliosis, 11 with congenital scoliosis, and 6 with neuromuscular scoliosis. The mean Cobb measurement for the preoperative major curves was 66.7 ± 14.4 (range, 42–98) degrees. After a mean of 4 ± 1.4 lengthening procedures, there was a statistically significant improvement in the coronal plane deformity to a mean of 34.9 ± 11.2 degrees ( p < 0.001), resulting in an average decrease of 31.8 ± 14.6 degrees. Following complications have occurred in 11 patients (31.4%): implant failure/fracture (22.9%), surgical site infection (5.7%), and transient brachial plexus injury (2.8%). The only risk factor associated with the presentation of postoperative complications was the total number of lengthening procedures (OR = 2.79).

Conclusion

Growing rods are effective for reduction of the magnitude of the spinal deformities in patients with progressive early-onset scoliosis before the definite fusion. However, this treatment is related with a relatively high rate of postoperative complications. Those complications appear to be associated with the total number of lengthening procedures previous to the definitive fusion. Therefore, it is advisable to reduce the frequency of lengthening as much as needed for maintaining the correction and allow the longitudinal growing of the spine.
Modification of Goel–Harms Technique in the Surgical Treatment of Atlantoaxial Subluxation after Grisel Syndrome
Authors: Corredor Santos José Alfredo , Alvarado Fernando , Morales Luis Carlos , Rodriguez Munera Andres
Published: May 2015

Introduction

Many etiologies can lead to atlantoaxial subluxation. In Grisel syndrome, this subluxation occurs spontaneously after inflammatory processes of the head and neck. Nonsurgical treatment most often resolves the symptoms; however, in some cases, surgical treatment is necessary to repair the subluxation. Various surgical techniques and instrumentation systems have been used to treat atlantoaxial subluxation, although there is no consensus regarding the best treatment method for the pediatric population. We aim to describe a modified surgical technique for the treatment of atlantoaxial subluxation in a child with Grisel syndrome. Patient and Methods: Our case study involves a 5-year-old female patient with a 6-month history of unresolved Fielding type II atlantoaxial subluxation because of the Grisel syndrome. Despite conservative treatment, the patient's symptoms continued to progress. After two failed closed reduction attempts, open reduction and C1–C2 fusion with a modified Goel–Harms technique was performed with atlas laminar hook and axis pedicle polyaxial screws. A literature review of the surgical treatment of the Grisel syndrome was also performed.

Results

After surgery, the patient exhibited full clinical and functional recoveries with complete resolution of symptoms. At the 24-month follow-up examination, there was continual evidence of satisfactory reduction and fusion. No complications were observed. On completion of the literature review, seven Grisel syndrome cases were found to have been treated surgically with the minimum patient age being 9 years.

Conclusion

Conservative management of Grisel syndrome is the most common and effective treatment; however, a few surgical cases have been reported in the literature with good results. We exhibit a safe, new surgical construct for pediatric patients in the treatment of atlantoaxial subluxation and instability, with satisfactory clinical results and solid fusion at 24 months postsurgery.
Vertebral Fracture and Sternum Fracture
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Salgado Castillo Santiago
Published: May 2015

Introduction

The association of the sternum and vertebral fractures has been described previously in the literature. These injuries are frequently overlooked in the initial evaluation. The purpose of this study was to analyze and discuss the diagnostic methods used for these injuries and to highlight the importance of the early recognition of these fractures.

Patients and Methods

This study is a retrospective analysis of four patients who concomitantly suffered vertebral and sternum fractures by analyzing the clinical histories and imaging tests.

Results

All the patients were diagnosed with sternum fractures in the initial evaluation, but only one was diagnosed with a vertebral fracture.

Conclusions

Not recognizing these fractures in the initial evaluation may be associated with the difficulty of exploring the upper thoracic region. In the presence of sternum fractures, a vertebral fracture must be ruled out, whether there are major injuries or not. CT and MRI must be obtained in the event of clinical suspicion, even if the normal X-ray does not show any injuries.
Occipital Condyle Fracture: Clinical Report and Literature Review
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Salgado Castillo Santiago , Roman Veas Javier
Published: May 2015

Introduction

The purpose of our study is to draw attention to the existence of the occipital condyle fracture and the ease with which it can go unnoticed when treating a polytraumatized patient. An injury must be taken into consideration in the event of a cranial trauma with cervical pain because of its potential consequences if such a fracture is not treated correctly.

Materials and Methods

A retrospective study of four clinical cases in the emergency service, reporting posterior cervical pain, radiating to the base of the neck, slowly progressive, not related to a traumatic event. The clinical evaluation, physical examination, imaging studies, and treatment were done for all the patients.

Results

Good functional results were obtained with no neurological sequelae.

Conclusion

The knowledge and suspicion of this rare condition and its correct diagnosis and treatment are crucial to securing a good functional result, thereby avoiding the potential neurological injuries associated with it.
Degenerative Elderly Acute Lumbar Symptoms
Authors: Ricciardi Daniel Oscar , Garfinkel Ignacio , Carrioli Gabriel , Guillermo Ricciardi
Published: May 2015

Introduction

A total of 10 patients with a chronic degenerative spinal stenosis, showed acute signs of compressive radicular compromise. Surgical treatment was deemed necessary for adequate management of acute segmental pain. We think this type of patients should be taken separately, as a different group with clinical and surgical implications.

Patients and Methods

This study reports 10 patients with lumbar spinal stenosis, that in the course of the natural history, showed acute symptoms correlated to herniated discs, facet joint cyst, and curling flaval ligament compressing neural tissue. Motor deficit was frequent and required urgent decompression. Fusion was added in cases of mechanical concurrent instability. Oswestry disability index and visual analogical scale was measured pre- and postoperatively.

Results

Clinical and radiologic acute compressive signs were detected in chronic degenerative lumbar stenosis patients. These patients had a good response to surgical treatment according to ODI and VAS records. We propose the acronyms DEALS (degenerative elderly acute lumbar symptoms) to denominate this type of acute clinical presentation.
The Use of Translaminar Subaxial Cervical Screws in Complex Cranio-Cervical Malformations: Two Cases and Review of the Literature
Authors: Weissmann Karen , Costa Marcelo , Mora Samuel , Huaiquilaf Carlos , Correa Cristian , Luna Felipe
Published: May 2015

Introduction

In complex cervical malformations, sometimes we need to make long occipitocervical fusions, even in children. Fixation techniques include the use of wires, hooks, and screws. In C1–C2 instability, we might choose transarticular screws. All these techniques have life-threatening complications and require wide surgical expertise. In complex craniocervical malformations anatomical variations may play a significant role in complications, the safest method to avoid vascular or neurological complications in these cases is yet to be determined. Translaminar screws were first described in the C2 posterior arch as a safe way to place C2 screws and their use has extended to the subaxial spine. In complex malformations, we might find anatomical variations that play to our advantage when using this technique, such as very wide laminas in complex fused vertebral blocs.

Aim

The aim of this study is to report the use of cervical subaxial translaminar screws in patients with complex craniocervical deformities and review the literature.

Patients and Methods

We present two female patients with complex craniocervical malformations. The first case is a 21-year-old girl with basilar invagination, posterior occipital malformations, and a type II Chiari who arrived to the ER with a transitory hemiparesia and was deemed hysteric. The second patient is a 13-year-old girl who was referred to us with a mild scoliosis. On further examination, we found a complex Klippel–Feil syndrome, cervicothoracic dysgraphia without meningocele, basilar invagination, type II Chiari, and other symptoms that made us consider a genopathy, still being studied. Both girls presented altered dynamic-evoked potentials. Both patients underwent posterior cervicomedullary decompression and occipitocervical fusion, with subaxial translaminar screws. In the younger girl, C1 posterior arch resection was also necessary.

Results

Both the patients are asymptomatic and with no complications to report at last follow-up.

Discussion

Published case series have reported the use of axial and subaxial translaminar screws in atlantoaxial instability, to our knowledge, there have been no reports of their use in complex craniocervical malformations.

Conclusion

Translaminar screws are a good alternative for subaxial cervical spine fixation in patients with complex occipitocervical malformations. We need longer follow-up and prospective studies to reach further conclusions. Trauma
Assessment of Medial Malpositioning during Thoracic Pedicle Screws Placement with a Contemporary Intraoperative Neurophysiological Monitoring Method
Authors: Cabrera Cousiño Juan Pablo , García Rudy , Lastra Luis , Vigueras Sebastián , Torche Vélez Máximo
Published: May 2015

Introduction

Thoracic pedicle screws placement remains being a challenge despite modern technologies available. To assess neural integrity during these surgeries, intraoperative neurophysiological monitoring (IOM) is indicated. Motor-evoked potentials (MEP) and somatosensory-evoked potentials (SSEP) give valuable information regarding spinal cord function, and pedicle screws stimulation could evaluate medial malpositioning. However, the accuracy of thoracic pedicle screws stimulation is still controversial, using single-pulse stimulation, recording from intercostal and abdominal muscles, and with high false-positive rate.

Objective

This article aims to demonstrate the superiority of a recently validated IOM method by Blair Calancie, and share our experience with it.

Material and Methods

Prospective collected and reviewed study since March to October 2014. During T1–T12 level surgeries, we stimulated medial wall of pedicle track before screw placement with a ball-tipped probe using pulse-train stimulation, and recording from lower limbs muscles. MEP and SSEP were performed, and a postoperative computed tomography (CT) scans in all the cases.

Results

In 21 patients, 240 thoracic pedicle screws were analyzed. In 36 screws of them (17.6%), a medial pedicle breach was informed, and 19 of 36 were redirected correctly more lateral; 8 of 36 pedicles were skipped; and 7 of 36 screws were placed regardless IOM warning criteria (3.4%), with a CT scan confirming medial misplacement > 2 mm. Fluoroscopy and manual pedicle palpation evinced a medial breach in 3 of 36 and 1 of 36 trajectories, respectively, but after pedicle track stimulation was done and informed. We did not observe any MEP or SSEP change during all these screws. Fortunately, no patients developed a new neurological deficit. CSF leak was not reported in this series. Our sensitivity with this method was 93.9%, specificity 97.6%, positive predictive value 86.1%, and negative predictive value was 99.0%.

Conclusion

Pulse-train stimulation of pedicle track before screw placement has huge superiority over traditional IOM techniques, avoiding spinal cord encroachment and new neurological deficit. This IOM method is highly accurate during thoracic pedicle screws placement.
Multiple Extended Vertebrectomies (41 Cases): Indications, Techniques, and Results
Authors: Luzzati Alessandro , Giuseppe Perrucchini , Scotto Gennaro , Mauri Orietta , Alloisio Marco
Published: May 2015

Introduction

The technical challenges facing the spinal surgeon performing a wide vertebral resection are the relationship of proximity, contiguity, and sometime invasion of great vessels, the parenchymal organs, chest wall, and the central, and peripheral nervous system.

Materials and Methods

Over the past 14 years (1998–2008), we performed 41 hemi or total multilevel vertebrectomy (two to five vertebrae in a single block), 2 cervical, 25 thoracic, and 14 lumbar, with spine resection varying from a minimum of 3.6 to a maximum of 15 cm. The tumors treated consisted of 28 primary malignant bone lesions (five chondrosarcomas, eight chordoma, four osteosarcomas, four malignant schwannomas, three synovial sarcoma, one fibrosarcoma, one Ewing sarcoma, and two hemangioendothelioma), 7 single metastases from adenocarcinoma (four kidney clear cell, two breast carcinoma, and one thyroid adenocarcinoma), and 6 cases of lung adenocarcinoma. These operations have been often performed in multispecialized team, with a thoracic/vascular/plastic surgeon.

Results

Thoracic locations have often obliged to partial lung resection associated with extended resections of the chest, two or more ribs, for obtaining surgical margins in healthy tissue. These resections required reconstructions with Marlex nets associated with acrylic cement. In one case, a free microvascularized large latissimus dorsi muscle flap was used. In one case of lower lumbar synovial sarcoma (L3–L4), an associated resection in a single stage of the aortic bifurcation involved by the tumor with the two vertebrae was required. Major vascular axis was so replaced with an aortoiliac bypass. We have systematically performed a 360-degree circumferential reconstruction, linking the short anterior reconstruction to the long posterior hardware, than giving to the entire instrumentation the final compression. The final stability over time has been systematically performed with an anterior interbody fusion between the vertebrae adjacent to the resection, obtained with the iliac autograft with which we have filled different anterior devices (carbon cages, titanium cages, and massive homograft bank) used over the years. The serious complications that we had were as follows: mechanical remote (two cases of kyphosis with severe instability), infectious (six cases, five of which healed with revision surgery), iatrogenic (four cases of injuries to the thoracic duct, all resolved without surgical revision), neurological (five cases of paraparesis, including three with partial recovery at a distance), three local recurrences, one major vascular complication (rupture of an aorta previously irradiated at 25 days postsurgery), and two deaths in the first 30 days

Discussion

The high-complication rate in our series is explained by the complexity of this type of surgery, which however allows oncological results close to those that we gain in complex reconstructions of the upper and lower limbs.
Suggested Criteria regarding Effectivity of a Posterior Approach for Intradural Extramedullary Spinal Tumors
Authors: Lozano Lady
Published: May 2015

Introduction

Intradural extramedullary spinal tumors are uncommon, with a reported incidence 3 to 10 per 100,000 people, the majority of these lesions are benign (WHO grades I and II) and that are treated by posterior approach with conventional laminectomy. However, there are some factors that influence the surgical success of these tumors, which if not taken into account may change the prognostic patient. We have investigated what are these factors and their influence on surgical outcomes.

Patients and Methods

We performed a retrospective review of 31 consecutive patients, who presented with intradural extramedullary spinal tumors that was removed by posterior approach with conventional laminectomy between January 2011 and May 2014, the neurological findings obtained during the preoperative stage, and the postoperative follow-up were evaluated according to the Nurick grade with a minimum follow-up time of 6 months. The axial and sagittal anatomical location, the tumor occupancy rate, and tumor extension (evaluated in MRI), as well as histopathological diagnosis, tumor–cord interface, age, and sex were analyzed in relation to the postoperative neurological status (assessed by Nurick grade).

Results

The group was predominantly female with a ratio female:male, 4.2:1; with a mean 49.5 years (range, 16–85 years). The most common histologic diagnoses were schwannoma and meningioma, with a ratio 1.7:1. Of all the patients, in 64.5% of patients tumor–cord interface was found. The mean tumor occupancy rate was 66.3% ± 16.9. The postoperative neurological status is positively related with the following: age, female sex, dorsolateral axial location, cervical and thoracic sagittal location, tumor occupancy rate, tumor extension three or more levels, tumor–cord interface, and histopathological diagnosis meningioma ( R  = 0.776). Those with greater strength to explain the event of postoperative neurological status are as follows: age, tumor extension three or more levels, and cervical sagittal anatomical location ( p < 0.05). At the postoperative period, Nurick grade was improved from 3 ± 1.2 to 2.5 ± 1.8 [ T (31) = 2.590, p = 0.015]; and from 3 ± 1.2 to 1.7 ± 1.8 [ T (30) = 5.163, p < 0.01) at follow-up time of 6 months.

Conclusion

Intradural extramedullary tumors can be safely and effectively removed using posterior approach with conventional laminectomy, if it satisfies the following conditions. It has tumor–cord interface, histopathological diagnosis of meningioma, tumor < 3 segmental levels in extension, male sex, lower tumor occupancy rate, lower age, less cervical tumors, and less dorsolateral axial anatomical location.
Lumbar Neural Foraminal Extradural Lipoma: Case Report, Literature Review
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Roman Veas Javier
Published: May 2015

Introduction

Extradural lipoma is a rare condition of which few cases have been described in the literature, and a low percentage of these appear in the lumbar spine. The purpose of our presentation is to describe a new case of this entity, to deepen understanding of the clinical and imaging findings of this condition as well as its treatment.

Materials and Methods

Retrospective study of a clinical case that arrived for consultation presenting a clinical picture of long-term lumbar pain for 2 years. For 9 months there was bilateral lumbosciatic pain, intermittently more severe on the right side, S1 sensory deficit right side. Clinical evaluation, physical examination, and imaging studies were performed.

Results

The following were evaluated: history, clinical picture, age, gender, type of images requested and their results, treatment undertaken, and time of evolution of the symptoms. A literature review of this condition was made, comparing what has been published with our experience.

Conclusion

The lumbar extradural spinal lipoma is a rare benign tumor lesion that can produce backache and neurological compression. When the patient consults because of the appearance of neurological disorders secondary to compression phenomena, MRI is the test of choice for the evaluation of this pathology. Recovery from the symptoms occurs in most cases after surgical decompression.
Mini Open Extreme Lateral Lumbar Corpectomy to Complete 360 Decompression and Stabilization due to Malignant Fibrous Histiocytoma
Authors: Arias Pesantez Carlos Fernando
Published: May 2015

Introduction

Some spine extradural tumors can be able to compress the anterior and posterior aspect of the cord canal and the correct approach allows the total decompression as well as the final construction and stabilization. Patient and Methods: We present the case of a 17-year-old woman with conus medullaris syndrome symptoms. We initiate the posterior approach to achieve decompression, a tumor diagnosis and initial stabilization with transpedicular screws, and for the second time a lumbar corpectomy with extreme lateral miniopen approach to complete the tumor resection, and final 360 grades construction to allow total stability and fusion.

Results

This patient was discharged after 46 hours of surgery without neurological deficit.

Conclusion

The mini open lateral and posterior approaches are able to work together conserving the basic principles of total decompression and stabilization with short hospitalization and quick return to normal activities.
Early Onset Scoliosis: A Novel Technique for Treatment of a Progressive Scoliosis using Dual Growing Rod and Posterior Apical Convex Fusion
Authors: Pantoja Samuel , Chahin Andres , Valenzuela Carlos , Arriagada Gonzalo , Chamorro Marcela
Published: May 2015

Introduction

Several different growing rod techniques have been described in the literature to treat progressive scoliosis in young children. The purpose of this retrospective clinical study is to evaluate the effect of dual growing rod and posterior apical convex fusion in early onset scoliosis (EOS).

Material and Methods

This study retrospectively reviewed the clinical records and radiographs of the 11 children with progressive EOS who failed to respond to conservative treatment and underwent fusionless surgery using dual growing rod and posterior apical convex fusion.

Results

Fusionless dual growing rod and posterior apical convex fusion allowed maintaining scoliosis correction in all the patients. At an average of 3.1 ± 0.8 years after initial surgery, 11 patients showed a correction of 39. 9% in the magnitude of the original curvature (the average preoperative Cobb angle was 56 [range, 40.96–89.5] and postoperative was 34.27 [range, 24.69–58]). Trunk height increase was documented in all patients. Rod failure was found in three patients.

Conclusion

Preliminary results from these series of patients show that the presented fusionless dual growing rod and posterior apical convex fusion allows maintaining correction of progressive EOS while permitting spinal growth with a low-complication rate. This procedure is efficacious as long as some guidelines are respected.
New Strategies Surgical Complications in Scoliosis Surgery in Children with Mielomeningocele
Authors: Costa Marcelo , Weissmann Karen , Mora Samuel , Huaiquilaf Carlos , Cristian Correa
Published: May 2015

Introduction/Aim

Over the years, we have changed strategies regarding scoliosis surgery in myelomeningocele. We compare complication incidence in our previous and current cases.

Materials and Methods

Medical files of patients with spinal dysgraphia who underwent surgery for neuromuscular scoliosis because of the myelomeningocele were recovered and analyzed. Between 2002 and 2007 (group A), we found 32 patients but 18 with complete records and between 2010 and 2013 (group B) other 10 patients. Group A had 72% women, aged 3 to 25 (average, 11.7 years); and group B had 80% woman, 11 to 15 years of age (average, 13.5 years). We have changed our policies in the last 3 years in neuroprophylaxis, use of urinary catheter, anti-biotherapy, use of hemostatic during surgery, surgical approach, muscle flaps, skin management, use of drains, and others.

Results

Surgical approaches were anterior, posterior, or both in group A and posterior only in group B. Surgical time averaged 5 hours, in both the groups. Intraoperatory bleeding was 1,445 mL in group A and 1,996 mL in group B. Postoperative intensive care unit stay ranged between 1 to 30 days and 3 to 5 days in groups A and B, respectively, and mechanical ventilation was used between 24 to 72 hours in anterior approaches only. Total hospitalization time averaged 24 days (maximum 62 days) in group A and 10 days (maximum 15 days) in group B. Overall, two incidental durotomies were repaired intraoperatively in group A. Postoperatively, the most common complication was infection, one superficial and four deep ones. One patient presented hypokalemia and edematous syndrome in group A. In group B, one screw was malpositioned and required replacement, one patient had a wound dehiscence, and one deep infection that required implant removal. One patient had a severe screw pullout after a wall fell over her during the 2010 earthquake. In the long term, two patients presented screw loosening, one hardware failure, one screw pullout, and one nonunion in group A. In group B, one patient's screw inners became loose and needed replacement.

Discussion

We studied correlation between long- and short-term complications, surgical time and blood loss, and found less complications and shorter hospital stays in group B. We discuss the different techniques and strategies currently in use for these patients.

Conclusion

Scoliosis surgery in patients with spinal dysgraphia has a high incidence of complications, in our series (25%). New strategies have developed in recent years to decrease them.
Analysis of Results and Complications in Patients with Scheuermann Disease Treated with Posterior Fixation
Authors: Tavolaro Trombetta Celeste , Legarreta Carlos , Rosito Gabriel , Escalada Maria , Reviriego Juan , Lutzky Lazaro , Krekun Walter , Medina Sebastian , Cirillo Juan
Published: May 2015

Introduction

The selection of fusion levels in thoracic kyphosis been controversial, the incidence of juvenile kyphosis ranges from 1 to 8% being more common in males.

Patients and Methods

This study is a retrospective study case series type, level of evidence IV. We evaluated 15 patients with Scheuermann disease treated with posterior transpedicular fixation and osteotomies. Overall, two cases were excluded for not meeting the minimum monitoring time 2 years. The average age at time of surgery was 16.2 years. Patients were evaluated clinically and radiologically pre- and postsurgery to assess results and determine common factors of complications.

Results

In the series studied found that the percentage correction achieved was 49%, with a loss of correction 3 degrees at follow-up, the incidence of PJK was 23%, two of three patients presented the following factors in common: apex above T5, cervical hyperlordosis, SVA more than 4 cm, increased pelvic incidence, stiffness deformity, proximal fixation with hooks above T3, in the third case ended with pedicle screws.

Conclusion

Transpedicular fixation system and posterior spinal osteotomy is effective for the treatment of kyphosis by Scheuermann disease; the power of this type of correction techniques may arise in the pediatric population increased incidence of proximal junction kyphosis in patients with highest apex, curve stiffer, cervical hyperlordosis, and lower percentage of correction.
Cross-Sectional Study Evaluating Nonoperative and Surgical Treatment for Lumbar Degenerative Spondylolisthesis
Authors: Corredor Santos José Alfredo , Meves Robert , Silber Caffaro Maria Fernanda , Astur Nelson , Góes Medéa de Mendonça Rodrigo , Flores de Araujo Fernando
Published: May 2015

Introduction

Nonoperative treatment is the first prerogative for patients with degenerative spondylolisthesis without neurological deficit. In cases where persistent pain or neurological deficit becomes prevalent, surgery becomes an option. In this cross-sectional study, we evaluated clinical and functional results of patients with lumbar degenerative spondylolisthesis treated nonoperatively or surgically.

Patients and Methods

Patients with degenerative spondylolisthesis treated either nonoperatively or surgically from 2004 to 2014 were selected from databases and a cross-sectional evaluation was applied. Outcome measures included back and leg visual analog scales (VAS), Fischgrund criteria, short form-36 (SF-36) physical function, and the modified oswestry disability index (ODI).

Results

Of the 85 patients who met the inclusion criteria, we evaluated 43 in total: 20 with nonoperative treatment and 23 with surgical treatment. Baseline characteristics were similar without significant differences. The mean follow-up time was 43 months (range, 10–72 months) for nonsurgically and 36 months (range, 6–80 months) for surgically treated groups. The surgical group displayed better scores in back VAS (8 vs. 4), leg VAS (6 vs. 3), SF-36 physical function (35 vs. 77), and ODI (46 vs. 17). On the basis of the Fischgrund criteria, only 10% of patients reported excellent or good health post nonoperative treatment versus 83% for those treated surgically.

Conclusion

Symptomatic patients with lumbar degenerative spondylolisthesis treated surgically obtained better clinical and functional scores than patients treated nonoperatively. The limitations of the study do not permit statistical analysis and hence further review is necessary to draw firm conclusions.
Cauda Equina Syndrome in Patients with Lumbar Disc Herniation: Postoperative Results of a Series of 10 Cases
Authors: Urzúa Alejandro , Lecaros Javier , Zamorano Juan Jose , Mandiola Sergio , Munjin Aleksandar , Medina Fabián , Ilabaca Francisco
Published: May 2015

Introduction

The Cauda Equina Syndrome (CES) is a rare clinical entity with potentially devastating consequences. Usually, patients complain concealed history of back pain and acute presentation of red flags, as severe back pain, sensory alteration in saddle or genital tract, and bladder, bowel, or sexual dysfunction. Early surgical decompression is mandatory to reduce neurological sequels. The objective of this study is to describe the clinical picture and postoperative results of patients with CES.

Materials and Methods

Data of 10 patients diagnosed with CES because of lumbar disc herniation (LDH) between 1994 and 2013 were collected. All of them were studied with magnetic resonance imaging or computed tomography and subsequently submitted to emergency decompressive surgery with a postoperative follow-up from 5 months to 3 years.

Results

The patients had an average age of 38 years (range: 19–58 years), on a male/female ratio of 8/2. Overall, 70% reported no medical history, while the remaining 30% were diabetic. Nine patients had presented a massive primary LDH and one patient was secondary to a posttraumatic LDH. All the patients had neurologic compromise ASIA D at hospital admission, but in the postoperative, 50% improved to ASIA E. The main sequel was sphincter dysfunction, present in the 50% of the patients.

Conclusion

Unlike what was previously reported, the majority of the patients presented immediate improvement in relation to radicular pain and motor recovery. The literature describes neurologic sequels in those patients with chronic low back pain and/or late consultation. Although our series is small, it gives us valuable information about this pathology.
Evolution of Neurological Complications in Spine Deformities Surgery in Children
Authors: Godoy Miguel Angel , Tello Carlos A. , Francheri Ida Alejandra , Noel Mariano A. , Galaretto Eduardo , Remondino Rodrigo G. , Bersusky Ernesto
Published: May 2015

Study Design

This study is a retrospective descriptive study, and Evidence Level IV.

Objective

This study aims to assess the evolution of neurological complications because of kyphosis or scoliosis surgery in children.

Introduction

Neurological complications after deformities surgery although not very frequent could be evolved in terrific outcomes. These can come after simple approach, instrumentation, and because of correction techniques through direct or indirect mechanism. Modern surgeries techniques count with neurophysiology monitoring. Nonetheless, radicular and spinal cord injury may arise.

Patients and Methods

Nine patients who suffered neurological complication during kyphosis and/or scoliosis deformity surgery from May 2003 to June 2013 at the Garrahan Pediatric Hospital Spine Department.

Results

Etiologies observed were as follows: four idiopathic scoliosis (44.4%), two congenital scoliosis (22.2%), one associated with neurofibromatosis type I (11%), one idiopathic kyphosis (11%), and one myofibrosarcomatosis post laminectomy surgery (11%). The mean follow-up was 4.3 years (range, 0.6–10.5 years). We performed posterior only instrumented fusion in seven cases (77.7%) and two double approach instrumented fusions (22.3%). Five patients presented intraoperative neurological changes (55.5%). All the patients needed at least a second surgical intervention to solve the spine deformity. The topographic classification of the neurological injury was as follows: one patient with radicular injury (11.1%); eight patients with spinal cord injury (88.8%), six of those presented bilateral paresis (75%) and two patients (25%) presented monoparesis. The patient with radicular injury remained asymptomatic after the second-staged surgery; three patients remained with minimum secuelas (ASIA D) and three patients, with major disability secuelas (ASIA C), all patients preserved aptitude to stroll. Four patients (44.4%) who presented disorders in the sphincters control during the immediate postoperatory, only two patients stayed with neurogenic bladder.

Conclusion

Early detection of a neurological complication, its etiological diagnosis, and surgical resolution improve neurological outcome of the patient, avoiding or reducing its severity sequel.
Immature Skeleton Thoracolumbar Fractures
Authors: Cabrera Jorge , Sanchez Felix
Published: May 2015

Introduction

Lesions in children have increased in the general population; yet, thoracolumbar fractures in childhood are uncommon. Very few studies in immature skeleton patient's thoracolumbar fractures have been made.

Patients and Methods

A nonexperimental, transversal, and retrospective research was performed, having patients aged between 0 and 18 years' old, who had presented thoracolumbar fracture and needed medical–chirurgical treatment, throughout a period of time between 2006 and 2013 in two traumatology hospitals, being both third level attention hospitals. Evidence level III.

Results

A total of 100 patients who met the inclusion criteria were used for this study. The most affected age group was the young–adolescent group, prevailing male patients in a 2:1 relation. The most affected zone was the thoracolumbar union, and 89 were treated with surgery, 41 patients presented associated lessons.

Conclusion

The main cause was falls, it was found a poorly described cause (PPAF), which affected the 7% of the series. There is no predominant lesion type as there is in adults. Ligament injuries do heal up in children aged 11 years or less. A 36% of the cases presented multiple fractures. Overall, 22.47% of operated patients were treated with fixation without arthrodesis and a single posterior boarding as surgical management in 92%. Neurological recovery percentage was 8%.
With the Foot to the Neck
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Salgado Castillo Santiago
Published: May 2015

Introduction

The surgical resolution of a cervical spine fracture dislocation is well known; however, there are certain difficulties when the right instrumentation is not available at the right time. We present an alternative solution for a cervical injury with complete medullary involvement. Patient and Methods: A patient, 45 years old, suffered a fall from a height (tree), arriving at the emergency service with tetraplegia. Imaging study reveals a C6–C7 fracture dislocation. Orthopedic reduction was performed and stabilization occurs in the first 6 hours postaccident. It is reduced manually and stabilized with a compact foot H-plate 2.7.

Results

The surgical and neurological evolution of the patient was favorable. Currently, the patient is autonomous, has sphincter control, and walks with a cane.

Conclusion

The management of upper cervical spine fractures presents an interesting challenge given the complexity and possible complications derived from these injuries. Their management is not usually difficult if the proper equipment is available. We present a possible solution when the correct spinal instrumentation is not available that can help solve such injuries with favorable results.
Anterior Percutaneous Fixation of Odontoid Fractures
Authors: De Jongh Enrique , Rubinos Rene , Fleites Ernesto , Santos Carlos , Rodriguez Norberys , Betancourt Josue
Published: May 2015

Introduction

In some fractures of the odontoid process of the axis, the gold standard is anterior transaxial fixation if there is slight or none displacement. To minimize the damage of an opened surgery, we developed anterior percutaneous approaches.

Patients and Methods

From 1995 to 2014, 10 patients with traumatic fractures of the odontoid process of axis classified as type II and type III (according Anderson and Alonzo classification) underwent surgery. The anterior approaches fixation were performed using 1 cm incision. Cannulated instruments and screws were necessary to fix the odontoid process. In all patients, surgery was image guided.

Results

In eight patients (80%) the only one symptom when admitted was cervical pain without neurological deficit. Two patients (20%) also presented also quadriplegia. The unique complication concerning surgery was retropharyngeal pain in all patients during 2 or 3 days. In later evaluations, consolidation of the fracture was confirmed in all patients (100%). One patient admitted with quadriplegia improved. The other one never improved spontaneous ventilation and died 8 months later (10%).

Conclusions

The knowledge and development of some percutaneous techniques can be employed in patients with fractures of the dens of the axis. The use of cannulated screws and instruments is mandatory to perform the operation. This kind of surgery must be always under imaging guidance.
Facet Joint Capsular Laxity in Degenerative Lumbar Spondylolisthesis Associated with the Increased Expression of Fractalkine (CX3CL1)/CX3CR1 Chemokine
Authors: Ha Kee-Yong , Oh In-Soo
Published: May 2015

Introduction

CX3CL1 and its receptor (CX3CR1) are part of a chemokine system involved in leukocyte recruitment and adhesion in chronic inflammatory disease. From previous study, the CX3CL1 and CX3CR1 activity has been investigated in ligamentum flavum, synovial membrane, and intervertebral discs, but not with the facet joint capsule-related issue. The purpose of this study is to investigate the following: (1) The role of fractalkine (CX3CL1)/CX3CR1 chemokine on facet joint capsular laxity in degenerative lumbar spondylolisthesis (DLS); (2) Correlation between expression of CX3CL1/CX3CR1 chemokine and degree of slippage by lumbar spondylolisthesis.

Method

The mRNA concentrations of CX3CL1/CX3CR1 chemokine were analyzed in the surgically obtained facet joint capsule specimens from grade 1 spondylolisthesis ( n = 12), grade 2 spondylolisthesis ( n = 12), and more than grade 3 spondylolisthesis ( n = 11) by real-time PCR. Grade 1 to 3 is being decided on degree of slippage which is, less than 5 mm, between 5 to 10 mm, and more than 10 mm. The localization of CX3CL1/CX3CR1 chemokine within the facet joint capsule was determined using immunohistochemical study. Plasma level of soluble fractalkine (sFKN) was measured by enzyme-linked immunosorbent assay (ELISA), respectively.

Result

The cells that shows higher CX3CL1/CX3CR1 chemokine expression ratio in the facet joint capsule are observed in tissues acquired from patients with higher degree of slippage by lumbar spondylolisthesis ( p = 0.000, 0.000). In ELISA, the plasma levels of sFKN was significantly higher in the group with more severe degree of slippage ( p = 0.002). There was greater CX3CL1/CX3CR1 expression in higher grade spondylolisthesis as quantified by RT–PCR ( p = 0.000, 0.003). Degree of slippage in patients with DLS were significantly correlated with serum CX3CL1 level ( R2 = 0.451, p = 0.000) and with mRNA expression of CX3CL1/CX3CR1 ( R2 = 0.360, p = 0.000) ( R2 = 0.205, p = 0.006).

Conclusion

This study identified for the first time that increases in CX3CL1 and CX3CR1 expressing cells are significantly related to facet joint capsular laxity, which may provide new conceptual and therapeutic approaches for treating spinal spondylolisthesis.
Biomechanical Stability of Transverse Connectors in the Setting of a Thoracic Pedicle Subtraction Osteotomy
Authors: Kang Daniel , Lehman Ronald , Wagner Scott
Published: May 2015

Introduction

The biomechanical effect of augmentation of a longitudinal constructs with one or two transverse connectors (TC) after a thoracic pedicle subtraction osteotomy (PSO) has not been evaluated previously. Previous investigations have suggested the role of transverse connectors for long segment thoracic constructs in enhancing torsional rigidity. We set out to evaluate the biomechanical contribution of TC to the stability of a long-segment pedicle screw–rod construct after a thoracic PSO.

Methods

Seven human cadaveric thoracic spines were prepared and instrumented from T4 to T10 with bilateral pedicle screws/rods and a PSO was performed at T7. Intact range of motion (ROM) testing was performed with nondestructive loading and analyzed by loading modality (axial rotation, flexion/extension, and lateral bending). ROM analysis was performed in the unaugmented construct, the construct augmented with one TC, and the construct augmented with two TC. No outside funding sources were utilized for this study. The authors have no potential conflicts of interest to report.

Results

Following PSO and an unaugmented longitudinal pedicle screw–rod construct, T4–T10 (overall construct) and T6–T8 (PSO site). ROM was significantly reduced in all planes of motion compared with intact condition ( p < 0.05). Augmentation of longitudinal construct with either one or two TC did not significantly increase construct stability in flexion-extension or lateral bending compared with the unaugmented construct ( p > 0.05). In contrast, during axial rotation, global ROM was significantly reduced by 43% and by 48% at T6–T8 following addition of two TC ( p < 0.05). One TC did not significantly reduce torsional ROM.

Conclusions

Two transverse connectors significantly improved torsional rigidity of the entire construct and at the PSO site, with no differences in stability for flexion-extension and lateral bending, or with the addition of only one transverse connector. In the setting of a PSO and long segment pedicle screw–rod construct, augmentation with at least two transverse connectors should be considered to improve torsional rigidity.