bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical Stability of the Stalif-C Stand-Alone Spacer in Multi-level and Hybrid Cervical Fusion Constructs
Authors: Kang Daniel , Lehman Ronald , Wagner Scott
Published: May 2015

Introduction

Anterior plate constructs for cervical discectomy and fusion have been linked to postoperative dysphagia, increased operative times, and wider surgical exposures. Several “low profile” integrated stand-alone spacers (SAS) have been developed. While these spacers have demonstrated successful clinical outcomes and similar biomechanical stability to anterior plate constructs in single-level fusions, their biomechanical stability in multi-level constructs has not yet been established.

Methods

Twelve human cadaveric cervical spines (C2-T2) were nondestructively tested with a six-degree-of-freedom simulator under axial rotation (AR), flexion-extension (FE), and lateral bending (LB) loading. After intact analysis, each specimen underwent sequential instrumentation and testing: (A) C5-6 spacer/plate with C6-7 SAS; (B) C5-7 SAS; (C) C5-7 spacer/plate. Range of motion (ROM) data was obtained and analyzed with paired t-tests and Bonferroni correction.

Results

The 2-level plate construct significantly reduced flexion-extension ROM compared to the 2-level SAS (5.6 ± 3.4 degrees versus 11.6 ± 4.6 degrees, respectively; p < 0.05). There was a significantly increased segmental ROM in the 2-level SAS construct compared to the 2-level hybrid construct in flexion-extension as well (11.6 ± 4.6 degrees versus 7.2 ± 2.4 degrees, respectively, p < 0.05). There was no significant difference in lateral bending and axial rotation ( p > 0.05) between the three different 2-level constructs.

Conclusions

Our study found that hybrid and 2-level SAS constructs are comparable to conventional anterior plate constructs in lateral bending and axial rotation, but there was an increase in flexion-extension motion allowed with constructs that incorporated a SAS. Stand-alone cervical spacers with integrated screws for hybrid and 2-level SAS constructs are reasonable alternatives to two-level plate fixation; however, clinical trials are necessary to determine if the increased ROM in flexion-extension noted in the SAS constructs translates to clinical outcome.
Dorsal and Lumbar Posterior Fixation by Minimally Invasive and Traditional Open Techniques: Comparison of Safety and Efficacy
Authors: Carla Reizinho , Casimiro Miguel , Luis Ana , José Cabral
Published: May 2015

Introduction

The use of minimally invasive techniques for spinal stabilization (MISS) is now widespread because of the theoretical advantage of lesser surgical aggression. However, there is no definitive evidence of its real advantage comparing to traditional open surgery (TOS). In this study, the authors compare both techniques according to safety and efficacy for the treatment of spinal instability.

Patients and Methods

This is a retrospective cohort study analyzing the records of the patients submitted to posterior dorsal or lumbar stabilization by MISS or TOS as treatment of instability because of trauma, infection, or tumor in a single center in the last 5 years (2009–2013). We compared both techniques according to efficacy (postoperative pain and deformity correction) and safety (accuracy of screw insertion, surgical and length of surgical time and hospital stay, complication occurrence Đ mortality, infection, neurological deterioration, instrumentation failure). Statistical analysis was performed with SPSS(R)17.0 surgeon preference dictated the technique chosen for each case.

Results

A total of 69 patients were treated, with a median follow-up of 21.6 ± 15 months. The populations (MISS/TOS) were not significantly different in the following: age, general medical status (ASA score), instability score (TLICS and SINS), osteoporosis incidence, lesion location, type of pathology, previous neurological state, or nonfusion risk factors. There was no statistical difference in postoperative pain ( p = 0.715) and immediate and late deformity correction ( p = 0.577 and p = 0.689). Screw insertion accuracy was significantly less in TOC ( p = 0.001) leading to more cases of revision surgery. Surgical time was not significantly different ( p = 0.08). Hospital stay was significantly shorter in MISS. Complication incidence was rare, but postoperative infection and neurological worsening was more frequent in TOS.

Conclusion

MISS is as effective as TOS and significantly safer than the later in what concerns to screw insertion accuracy and need for revision surgery. It does not take more OR time; and the length of stay at the hospital is shorter.
Utility of the Ultrasound in the Diagnose of Posterior Ligamentous Complex Injury of Thoracic and Lumbar Spine Fractures
Authors: Ilabaca Francisco , Lecaros Javier , Urzúa Alejandro , Ballesteros Vicente , Azócar Patricio , Arancibia Germán , Azolas Cristián , Lukoviek Andrés , Bustos Rubén , Góngora Carlos , Arriagada Víctor
Published: May 2015

Introduction

In posterior ligamentous complex injury (PLC), surgery is indicated in the treatment algorithms of thoracic and lumbar fractures. That is why its research is of a great importance, taking into consideration the magnetic resonance imaging (MRI), as historical “gold standard.” As the MRI is not always available or at times it is contraindicated, the use of ultrasound is proposed. Our purpose is to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasound to diagnose PLC injuries in thoracic and lumbar fractures.

Patients and Methods

A protocol is designed before the start of the study, being approved by the Ethics Committee, deciding to perform an ultrasound to all of the patients with PLC admitted with fractured thoracic and lumbar spine, between April 2013 and July 2014. Patients with neurological and life-threatening risks were excluded. The ultrasound and MRI reports were performed by different radiologists without knowledge of the results of other studies. The result of the MRI is considered “gold standard,” and in case of operated patients, there were intraoperative findings. Data were analyzed with STATA 12.

Results

A total amount of 56 patients were recruited, with 7 cases of PLC injuries according to our “gold standard.” The ultrasound as diagnostic tool obtained the following results: sensitivity 0.9999 (95% CI, 0.59–1), specificity 0.9608 (95% CI, 0.8603–0.9966), PPV 0.7778 (95% CI, 0.4427–0.9465), and NPV 0.9999 (95% CI, 0.9131–1).

Conclusion

The ultrasound would be useful to diagnose the PLC injuries in thoracic and lumbar fractures.
Effects of Fusion and Conservative Treatment on Disc Degeneration and Rates of Subsequent Surgery after Thoracolumbar Fracture
Authors: D'Oro Anthony , Buser Zorica , Cohen Jeremiah , Smith Lance , Spoonamore Mark , Wang Jeffrey
Published: May 2015

Introduction

Studies have shown that lumbar fusion may lead to increased degeneration at the adjacent level. However, the issue of further degeneration around the fusion area is controversial. There is debate whether it is the natural history of progressive degeneration or increased stress from the fusion which causes the further degeneration. Goal of our study was to compare the incidence of progressive degeneration and need for subsequent surgery between patients who were treated nonsurgically or with fusion for a thoracic or lumbar level fracture.

Material and Methods

The commercially available PearlDiver database and insurance billing codes were used to identify 3,699 patients diagnosed with thoracic fracture and 5,016 patients diagnosed with lumbar fracture in 2007. For both the thoracic and lumbar fracture cohorts, patients were divided into subgroups based on procedural codes: those who underwent fusion surgery and those who were treated nonsurgically. Each of those subgroups was further divided into patients who were diagnosed with intervertebral disc degeneration within1, 2, and 3 years from their initial treatment, and of those patients, how many had a follow-up surgery. We used chi-squared statistical analysis to compare incidences of disc degeneration and follow-up surgery between the fusion and nonsurgical groups.

Results

Of the 3,699 patients diagnosed with thoracic fracture, 3,215 (86.9%) were treated nonsurgically and 117 (3.2%) underwent thoracic fusion surgery within 90 days. Within 3 years, 147 patients from the nonsurgical subgroup and fewer than 11 from the fusion subgroup were diagnosed with thoracic disc degeneration. From the nonsurgical subgroup, 11 (0.3%) patients underwent a thoracic surgery related to disc degeneration, compared with zero from the fusion group ( p > 0.05). From 5,016 patients diagnosed with lumbar fracture, 4,371 (87.1%) were treated nonsurgically and 150 (3.0%) underwent lumbar fusion. Within 3 years, 503 (11.5%) patients from the nonsurgical and 35 (23.3%) from the fusion subgroup were diagnosed with lumbar disc degeneration ( p < 0.05). From the nonsurgical subgroup, 42 went on to have lumbar surgery related to disc degeneration, compared with fewer than 11 from the fusion subgroup (exact number suppressed because of the privacy limitations).

Conclusion

In the thoracic region, fusion surgery as treatment for thoracic fracture does not appear to increase the likelihood of disc denegation and future surgery compared with conservative treatments. On the contrary, in the lumbar region, initial fusion surgery appears to increase the incidence of disc degeneration and future surgeries, as well as nonsurgical procedures.
Pregnancy after Lumbar Total Disc Replacement
Authors: Owusu Anthony , Zigler Jack , Ohnmeiss Donna , Guyer Richard
Published: May 2015

Introduction

There is much literature addressing back pain and pregnancy, often attributing the pain to changing loads and stresses on the spine. There is much less information available on pregnancy after lumbar spinal surgery. Many women considering surgery or who have undergone surgery are of child-bearing age. They may have concerns about the safety of pregnancy after surgery. This may be particularly true of procedures performed through an anterior approach, such as lumbar total disc replacement (TDR). The purpose of this study was to evaluate the course of back pain and safety of pregnancy after lumbar TDR.

Patients and Methods

From a single center, 18 patients were identified who became pregnant after lumbar TDR surgery. Data were recorded from clinic records and mailed questionnaires. Questionnaire data were collected for 15 of 18 patients, although not all patients responded to all questions. For the remaining three patients, as much data as possible were collected from charts. The mean patient age at the time of surgery was 28.2 years, ranging from 25 to 35 years. The majority of patients (77.8%) had a single level operation with L5–S1 being the most common.

Results

Information related to back pain during pregnancy was available for 16 patients. Eight (50%) reported no increase in back pain during pregnancy, while the remaining eight did report increased back pain. Among the eight patients with increased back pain, it resolved postdelivery in all but one. There were no pregnancy-related complications. The mean time from surgery to delivery was 38.7 months (range, 9–102 months). Of the 15 patients for whom delivery method information was available, 10 (66.7%) had caesarian delivery while 5 (33.3%) had vaginal delivery. Of the 15 patients, 13 carried to term. The remaining two patients delivered twins prematurely. The mean birth weight was 7.4 pounds with the exception of the two sets of twins who had a mean weight of 4.4 pounds (range, 3.9–4.9 pounds). Three patients experienced two pregnancies post-TDR. Data for the first pregnancy are included earlier. In all the three patients, the second pregnancy was carried to term; one had a cesarean delivery, and the other two had vaginal delivery. One of the three had increased back pain during pregnancy which resolved after delivery.

Conclusion

Although based on a small patient sample, this study found that pregnancy after lumbar TDR surgery followed a typical course with no spine-related complications. The percentage of women delivering via cesarean delivery was greater than the 32.8% reported in the Center for Disease Control and Prevention's National Center for Health Statistics for 2012. It is hoped that this study may provide reassurance to women who were pregnant after TDR surgery that they should not be unduly concern about the safety of pregnancy and delivery because of their spine surgery.
Does anterior Column Reconstruction Works in the Surgical Management of Tuberculosis of the Spine?
Authors: Akinjolire Akinwande , Ukunda Frederick
Published: May 2015

Introduction

Drug therapy still remains the main stay in the treatment of TB spine. However, surgery is indicated in some patients. According to the MRC guidelines, radical ventral debridement, fusion, and the reconstruction of the spinal column remain the gold standard of surgical treatment for tuberculous spondylitis as popularized by Hodgson and his coworkers as the “Hong Kong” procedure. The lack of resources such as theater time, and the dual impact of HIV disease and TB pandemic led to the development of other surgical management techniques. Thus, the anterior debridement and anterior column reconstruction has evolved as a method of surgical intervention. The aim of this study is to report on the adequacy and outcome of patients treated with this surgical technique.

Patients and Methods

This is a retrospective study of 54 TB spine patients (25 males and 29 females) who had anterior decompression and interbody fusion over a 3-year period (from 2012 to 2014). The indications for surgery were essentially the same as for 360 degrees decompression and fusion. The average age of our patients was 38.6 years and the disease was thoracic in 49 cases and thoracolumbar in only 5 cases. Except for six cases of single vertebral body involvement, all of our cases have two contiguous vertebral bodies involvement and required a four-body fusion. In four cases, we used fibular strut graft, while the titanium mesh cage with a mixture of allograft and autograft (the cut rib) was used in majority of the cases. The mean follow-up period was 13 months (ranging from 6 to 30 months).

Results

The average preoperative kyphosis was 30 degrees; this improved to an average of 21 degrees postoperatively but falls to 27 degrees on the last follow-up (overall 10% improvement in the kyphosis angle). The mean Frankel neurology grading at the last follow-up was D (improvement from B to E). No loosening or breakage of implants occurs and no graft/mesh displacement recorded.

Conclusion

Early results of the anterior decompression and interbody fusion indicates that the method is adequate and the outcome gratifying. We therefore conclude that the procedure is an effective and adequate surgical technique for treating TB spine, but with possible risk of major complications.
Is there a Regional Difference in Morphology Interpretation of A3/A4 Fractures among Different Cultures?
Authors: Schroeder Gregory , Kepler Christopher , Dvorak Marcel , Chapman Jens , Fehlings Michael , Aarabi Bizhan , Rajasekaran Shanmuganathan , Kandziora Frank , Schnake Klaus , Bellabarba Carlo , Vialle Luiz , Reinhold Maximilian , Oner Cumhur , Vaccaro Alexander
Published: May 2015

Introduction

The AOSpine Thoracolumbar Spine Injury Classification System was recently published, but before establishing a treatment algorithm to accompany the classification, further investigation on the cause of current regional treatment variations is required. The objective of this study is to determine if the ability of a surgeon to correctly classify A3 (burst fractures with a single endplate involved) and A4 (burst fractures with both end plates involved) fractures were affected by either the region or the experience of the surgeon.

Material and Methods

A survey was sent to 100 AOSpine members from all six AO regions of the world (North America, South America, Europe, Africa, Asia, and the Middle East) that had no prior knowledge of the new AOSpine Thoracolumbar Spine Injury Classification System. Respondents were asked to classify 25 cases, including 6 thoracolumbar burst fractures (A3 or A4). The current analysis focuses on the effect of region and experience on surgeons' ability to properly classify these controversial fractures.

Results

All 100 surveyed surgeons completed the survey, and no significant regional variability in the ability to correctly classify burst fractures was identified ( p > 0.50). Further analysis demonstrated that no region predisposed surgeons increasing the severity of burst fractures. Similarly, experience did not affect surgeons' ability to correctly classify burst fracture ( p > 0.21).

Conclusion

Regional variation in the treatment of thoracolumbar burst fractures (A3 and A4) is not because of the differing radiographic interpretation of the fractures.
AOSpine Subaxial Cervical Spine Injury Classification System
Authors: Vaccaro Alexander , Kepler Christopher , Koerner John , Dvorak Marcel , Chapman Jens , Fehlings Michael , Aarabi Bizhan , Rajasekaran Shanmuganathan , Schroeder Gregory , Kandziora Frank , Schnake Klaus , Bellabarba Carlo , Vialle Luiz , Reinhold Maximilian , Oner Cumhur
Published: May 2015

Introduction

The purpose of this project is to describe a morphology-based subaxial cervical traumatic injury classification system. Similar to the effort put toward the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra and interobserver reliability to be used for clinical and research purposes.

Material and Methods

A subaxial cervical spine injury classification system was developed using a consensus process. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients ( κ) were calculated for interobserver and intraobserver reliability.

Results

The classification system is based on the following three injury types: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Interobserver and intraobserver reliability was substantial for all injury subtypes ( κ = 0.64 and 0.75, respectively).

Conclusion

The AOSpine subaxial cervical spine injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for patient care and for research purposes.
Evaluation of Use of Video Telescopic Operating Microscope with Operative Microscope in Cervical Spine Surgery
Authors: Younus Aftab
Published: May 2015

Introduction

In cervical spine surgery, it is essential to use the magnification, however, the surgical operating microscope can be expensive, cumbersome, and difficult to set up. Whereas the use of no magnification may lead to failure in removing the disc completely with no improvement of the patient condition. VITOM is an exoscope, which is used in place of operation microscope. It is easy to use and it gives same size magnification as operation microscope. This is a prospective cohort study form July 2013 to February 2014 at Helen Joseph Hospital. This study aims to evaluate the efficacy of video telescope operating microscope (VITOM) as an alternative to operative microscope (OM) in cervical spinal surgery.

Patients and Methods

Patients undergoing spinal surgery were enrolled in a prospective cohort study between July 2013 to February 2014 at Helen Joseph Hospital. The age, sex, and operation-matched patients undergoing surgery using the standard OM served as the control group. During surgery, the VITOM system was used in place of the OM in 20 patients. Operative time, length of postoperative hospital stay, and intraoperative complications were assessed.

Results

A total of 10 patients were studied in two equal cohorts of 10 patients each. Within each cohort, patients underwent single-level and two-level cervical spine surgery. There were no significant differences in age or sex between cohorts. There were no statistically significant differences in mean operative room time for single-level decompressions and two-level decompressions. Postoperative length of hospital stay averaged 4 days for the VITOM group versus 5 days for the traditional OM group. Subjectively, surgeon opinion was the quality of image was much higher as compared with operating microscope.

Conclusion

The VITOM system provides as good a result as compared with operating microscope. However, there was no statically difference in the duration of patient stay in hospital and length of operation and interoperative complications. However, VITOM provide good visualization and better picture quality because of the high-resolution image. It is convenient also for teaching the purpose as well.
Influence of Clinical and Histopathological Parameters in the Management of Metastatic Disease of the Spine Secondary to Lung Cancer: A Systematic Review
Authors: Batista Nuno , Fisher Charles
Published: May 2015

Background

Determining optimal treatment of metastatic disease of the spine is difficult. Decision making revolves around neurological status, stability, and patient factors; histology the most important as specifically linked to life expectancy. Traditionally, limited life expectancy eliminated surgery as an option, but with minimally invasive techniques this paradigm is changing. Metastatic lung cancer generally has poor life expectancy and most patients are not offered surgery; but are there some patients with lung cancer who would benefit from surgery? Recently, molecular sequencing has led to better specificity than the traditional small cell, non-small cell (NSCLC) dichotomy and thus betters prediction of life expectancy. The purpose of this study is to identify histopathological and clinical parameters related to life expectancy that would help guide optimal surgical decision making for metastatic disease of the spine secondary to lung cancer.

Methods

A systematic review was conducted to answer the following questions: Q1. Determine the current survival patterns in the lung Ca population. Q2. Identify prognostic factors influencing survival and outcome in patients with lung Ca.

Results

A total of 20 studies met the preset inclusion criteria. All included studies were retrospective series with a level of evidence of IV. The overall survival of patients with metastatic lung carcinoma is poor ranging from 5 to 17.8 months. Included studies consistently showed a better prognosis for patients with adenocarcinoma. The presence of EGFR mutation was also associated with a mild increase in life expectancy compared with the other histological subtypes.

Conclusion

Although life expectancy in patients with metastatic lung Ca is still in general not good, a subset of patients with adenocarcinoma and patients with EGFR mutations seem to have a better overall survival. Previously identified clinical and imagiological prognostic factors are still valid, but histology and specific mutations should be factored in the decision making when dealing with patients with lung Ca and MESSC.
Are MAGEC Rods a Contraindication to MRI: An In-Vitro Study Evaluating the Effect of MRI on Rod Growth, Temperature, and Image Interpretation
Authors: Budd Henry , Hutton Mike , Stokes Oliver , Clarke Andrew , Fulford Jon , Meakin Jude
Published: May 2015

Introduction

The management of early-onset pediatric deformity has been revolutionized by the development of adjustable growing rods. These rods contain a rare-earth magnet that rotates when triggered by an externally applied magnetic field resulting in rod elongation. This patient group includes those with underlying neuromuscular conditions who occasionally require further MRI of the neuraxis during development and, given the magnetic properties of the rod, they are conventionally contraindicated for this imaging modality once implanted. We have investigated the behavior of the MAGEC (Ellipse Technology) rod to determine whether MRI adversely affects the elongation properties of the rod or indeed directly causes any detrimental consequences, including rod elongation, shortening, heating, or significant artifact to outline implications for this patient group.

Materials and Methods

We designed an in-vitro experiment using two MAGEC rods secured in an MRI compatible restraint system to investigate MRI behavior of magnetic growing rods during scanning. We used a 1.5T Philips MRI and a restraint system designed to secure the rods within this environment. Repeated gradient echo multiscan sequence MRI of the neuraxis was performed to evaluate whether the rods elongated, contracted, or rotated during scanning, while we used MRI compatible heat-sensors attached to the outer housing of the rods to assess temperature changes. We also assessed the ability of the rods to lengthen after completion of the MRI and a phantom model to evaluate the amount of artifact induced by the rare-earth magnet.

Results

During repeated MRI of the neuraxis, the MAGEC rod mechanism was not triggered; however, the rods did rotate to bring the internal rare-earth magnet in line with the surrounding electromagnetic field, while only small forces were generated causing rod movement within the restraint system. The ability of the rods to lengthen after MRI was not enhanced or impaired and no significant heating effect on the external rod housing was demonstrated. The assessment of imaging with a phantom model did reveal a significant degree of artifact up to 30 cm because of the presence of the magnet within the electromagnetic field and, therefore, only MRI of the head and cervical spine could be interpreted with normal placement of MAGEC rods within the pediatric patient.

Conclusion

This study demonstrated that there are no detrimental effects of MRI on the MAGEC rod. In addition, while the degree of the artifact demonstrated prohibits imaging of the thoracolumbar spine, the MRI images of the head and cervical spine remain unimpaired. Finally, we did not demonstrate any significant force acting on the rod by the electromagnetic field that would cause implant dislodgement or loosening during MRI.
Minimally Invasive Stereotactic Separation Surgery for Resection of Metastatic Spine Lesion: A Feasibility Study
Authors: Nasser Rani , Yassari Reza , Sharan Alok
Published: May 2015

Introduction

The current treatment of spinal metastasis consists of algorithms combining reconstructive surgical and radiation modalities. Recently, the concept of separation surgery followed by adjuvant stereotactic radiosurgery (SRS) was shown to be a safe and effective treatment to achieve long-term local tumor control. We examined the possibility of a minimally invasive approach to separation surgery first in a cadaveric feasibility study and then in a patient cohort with spinal metastasis in conjunction with intraoperative computer-assisted navigation.

Methods

A cadaveric study using standard minimally invasive access systems examined the feasibility of spinal cord decompression in the thoracic and lumbar spine. Subsequently, 10 patients (7 males and 3 females) with spinal metastasis underwent minimally invasive separation surgery (MISS) and percutaneous pedicle screw fixation using intraoperative navigation or standard fluoroscopy. The O-arm three-dimensional imaging with stereotactic navigation was used intraoperatively to localize and guide the resection of the metastatic spinal tumors. All patients were at least 3/5 strength in the lower extremities preoperatively. Pre- and postoperative CT scan and CT myelography were used to evaluate the degree of decompression. Endpoints included neurological function, operative time, estimated blood loss, incision length, hospital stay duration, and complications.

Results

The cadaveric study demonstrated a proof of principle with a wide decompression of the spinal cord. For the operative cases, the postoperative imaging demonstrated excellent separation that meets the requirements for safe SRS. All patients remained at/or improved their neurological baseline with excellent pain control. One patient incurred a perioperative complication (pulmonary embolism). The mean estimated blood loss was 290 mL. The mean incision length was 4.9 cm. The operative time mean was 5.2 hours and the mean length of stay was 7.5 days.

Conclusion

MISS for spinal metastasis allows for a circumferential decompression of the spinal cord and safe postoperative SRS. In addition, we demonstrated the efficacy of intraoperative navigation in guiding the resection. Future prospective enrollment of patients can help to determine which patients would be ideal candidates for MISS and if the smaller incision and an enduring faster healing process can allow a faster start of radiation and chemotherapy.
Functional Recovery and in Vivo Cell Tracking after Human Adipose Tissue-Derived Stem Cells Therapy for Experimental Spinal Cord Injury
Authors: Vialle Emiliano , Kuniyoshi Rebelatto Carmen Lúcia , Barchiki Fabiane , Fracaro Letícia , Lamartini Antonione , Hamamoto Lucas , Argenton Soraya , Arruda André , Conrad Samuel , Brofman Paulo Roberto , Vialle Luiz Roberto
Published: May 2015

Introduction

The use of human adipose tissue-derived stem cells (hADSC) as therapy in spinal cord injury (SCI) is a promising approach for the recovery of motor function of injured patients. This study aims to evaluate the effects of hADSC, applied to the cauda equina in an animal model of blunt spinal trauma, on their motor function. A secondary aim is to analyze cell migration toward the injury site.

Method

All samples were collected after an informed consent had been obtained in accordance with guidelines for research involving human subjects, and with the approval of the ethics committee (approval number 769). A total of 40 Wistar rats were anesthetized, injured at Th10 using the NYU impactor device and randomly divided into four groups: Group A, animals were submitted to one culture medium injection immediately after injury; group B, animals were submitted to two culture medium injections, immediately after and 7 days postlesion; group C, animals were submitted to one cell injection (1 × 106 cells) immediately after injury and group D, animals were submitted to two cell injections, immediately after and 7 days postlesion. Standard animal care, according to the university's protocol was maintained for 40 days with motor analysis every 72 hours using the Basso, Beattie, and Bresnahan (BBB) scale. Some animals were transplanted with luc gene-transduced cells to evaluate cell migration, which was assessed by in vivo bioluminescence images of animals in groups C and D (IVIS Lumina II).

Results

A statistically significant recovery of motor function was observed in animals transplanted with hADSC compared with the control group ( p = 0.007 for one injection protocol, p = 0.005 for the two injection protocol). No differences were observed between one and two injection protocols ( p = 0.13). Bioluminescence analysis revealed cell migration to the injury site after injection.

Conclusion

hADSC injected at the cauda equina migrate toward the injury site and promote significant motor recovery.
Association between BMP-2 and COL6A1 Gene Polymorphisms with Susceptibility to Ossification of the Posterior Longitudinal Ligament of the Cervical Spine in Korean Patients and Family Members
Authors: Kuh Sung-Uk , Kim Kyung-Hyun , Park Jeong-Yoon , Kang Moo-Sung , Ryu Dal-Sung , Lee Won-Chul
Published: May 2015

Introduction:

COL6A1 and BMP-2 genes have been implicated in ossification of the posterior longitudinal ligament (OPLL) susceptibility in Japanese and Chinese Han populations. However, no study has yet investigated the DNA of unaffected family members of patients with OPLL. This study investigated differences in genetic polymorphisms of BMP-2 and COL6A1 between Korean patients with OPLL and their family members (with and without OPLL).

Patients and Methods

A total of 321 patients (110 patients with OPLL and 211 family members) were enrolled in the study. Associations between two single nucleotide polymorphisms (SNPs) of the BMP-2 gene (Ser37Ala and Ser87Ser) and two SNPs of COL6A1 (promoter [−572] and intron 33 [+20]) with susceptibility to OPLL of the cervical spine were investigated between the two groups (OPLL+ and OPLL − ).

Results

Of the 321 patients, 162 had cervical OPLL (50.4%; 110 patients, 52 family members). There was a familial tendency of OPLL in 34 of the 110 families (30.9%). Allele and haplotype frequencies of the four SNPs in the BMP-2 and COL6A1 genes did not differ significantly between the OPLL+ and OPLL− groups, even when excluding participants over 50 years of age.

Conclusions

This is the first report identifying SNPs of COL6A1 and BMP-2 in Korean patients and family members with OPLL. Although allele and haplotype frequencies were similar to those of a previous study in Japanese and Chinese patients, unaffected family members also showed similar rates of these SNPs in the present study. These results suggest that these SNPs may not directly influence the expression of OPLL.
Multilevel Cervical Arthroplasty versus Multilevel Fusion in Three-Level Cervical Disc Disease (Clinical and Radiological Outcomes)
Authors: Vorsic Matjaz , Bunc Gorazd , Velnar Tomaz , Ravnik Janez
Published: May 2015

Introduction

The surgical treatment for cervical disc disease increased in the last decade using different surgical techniques. The percentage of the patients being surgically treated for three-level cervical disc disease remains small therefore the optimal surgical approach for these patients remains the subject of discussion. Multiple cervical disc arthroplasty, multilevel fusion, and hybrid procedures are among the options using the anterior approach. The aim of the study was to compare the multilevel cervical disc arthroplasty and multilevel fusion and compare clinical as well as the radiographic results in patients treated for three-level symptomatic cervical degenerative disc disease 2 years after the surgery.

Methods

Overall, 23 patients with three-level symptomatic cervical degenerative disc disease were treated with complete anterior cervical discectomy and either with ProDisc-C disc arthroplasty or with fusion using Cervios chronoOS prostheses (ACDF) or standalone cervical cages. Overall 8 multilevel arthroplasty and 14 ACDF's procedures were performed. Clinical outcomes were assessed before and 12 and 24 months after the procedure using neurological examination, the neck disability index (NDI) and visual analogue scale (VAS) for neck and arm pain, with 15% improvement in NDI and 20% in VAS defined as clinically significant. Comparison between both groups (arthroplasty and fusion group) was based on clinical outcomes using neurological examination, VAS, NDI, and patient's satisfaction. Preoperative and postoperative ROMs (range of motion) were evaluated by measuring the lateral and flexion–extension radiographs.

Results

Both groups had a statistically significant improvement in NDI and VAS for neck and arm pain ( p < 0.05), 2 years after the surgery and the arthroplasty group had a slightly better improvement according to NDI (71.4% of patients in the arthroplasty group achieved ≥ 15% improvement in NDI and 67.5 of patients in ACDF group). The arthroplasty group showed faster recovery of C2 to C7 range of motion. There was a statistically significant difference in the C2 to C7 ROM between the two groups at 12 and 24 months postoperatively ( p < 0.05). The ROM of the arthroplasty group approached the preoperative value at 12 months however it decreased again at 24 months.

Conclusions

Disc arthroplasty can be an effective alternative in the surgical treatment for the multilevel cervical disc disease, preserving segmental motion after surgery and providing improvement in pain and functional outcome for the patients. The right surgical treatment for the three-level disc disease remains the subject of discussion and more long-term follow-up studies will be needed to determine the definitive treatment.
Histological Analysis of Degenerate Discs (Disc Study)—is there Support for Infection as a Possible Etiology for Disc Degeneration?
Authors: Ganko Renata , Rao Prashanth , Salisbury Elizabeth , Lambert Neil , Mobbs Ralph J.
Published: May 2015

Introduction

A controversial study implicated bacterial factors in chronic back pain and reported a potential treatment option with long-term antibiotics. Currently, a multicentric case–control study is being conducted looking at bacterial in surgical disc specimens: Is growth a true infection or a contaminant? A histopathological arm has been added to aid in this differentiation. The aim of this study was to look for histopathological evidence of degeneration and inflammation and to identify histological differences in surgically excised disc samples of patients who grew bacteria on disc cultures compared with those that did not.

Material and Methods

A subset of patients as a part of a DISC study operated at Prince of Wales Public and Private Hospitals, Sydney were included in the study. The study was approved by HREC 13/218 started in 2013 and is ongoing. Cervical and lumbar disc samples were sent for both bacterial culture and histopathology. Histopathology was graded by two independent pathologists (blinded to culture results) using the previously evidenced histologic degeneration score (HDS) and a newly devised disc inflammatory score (DIS). Demographic factors, surgical factors and MODIC changes on MRI were correlated with histopathology data.

Results

There were 125 samples from 104 patients. Of the patients, there was a 54:50, male to female ratio. Discs levels from the cervical and lumbar regions were sampled (45:80, respectively). Of the total number of samples 33/125 (26.4%) grew bacteria, and 57.6% (19/33) of these grew Propionibacterium acnes. Using the HIS, only disc degeneration was found, with no significant evidence of inflammation in disc specimens.

Conclusion

In our histopathological study, there was no evidence of inflammation in degenerate discs and no differences in histopathology between positive and negative disc cultures. This raises a strong possibility of contamination in positive cultures of disc samples. In addition to this, there is further validation required of the new DIS score.
Neuronavigated Percutaneous Treatment of Thoracolumbar Spine Fractures
Authors: Conti Carlo , Carletti Sandro
Published: May 2015

Introduction

Treatment goals of amielic thoracolumbar spine fractures are the stabilization of traumatized segment, possibly restoring the physiological spine curvature, and vertebral healing or fusion of the affected segment. Percutaneous minimally invasive techniques are becoming a viable option in the treatment of selected thoracolumbar fractures; intraoperative neuronavigation of biplanar fluoroscopy associated with preoperative CT scan allows precise pedicle insertion and reduces intraoperative X-ray exposure.

Materials and Methods

Over a period of 2 years, 43 patients with thoracolumbar fractures at our institution were elected for minimally invasive surgery using neuronavigated technique. All patients experienced one or two thoracolumbar fractures (varying from A3.1 to B2.3, according to the AO/Magerl classification) without neurological deficits. Pain profile was assessed by visual analog scale (VAS) and all radiological findings were evaluated with vertebral body index (VBI), vertebral body angle (VBA), and Cobb angle. Procedures used for treatment include kyphoplasty alone and short segment percutaneous pedicle screw fixation with or without vertebral body augmentation. All the procedures were performed under general anesthesia, but for collaborating patients who need kyphoplasty analgosedation was used. Clinical mean follow-up was 15 months (2–24 months) and has been assessed with VAS and the ability to return to their original lifestyle and/or occupation; radiographic postoperative evaluation consisted of X-ray for kyphoplasty patients and CT for those instrumented to determine the accuracy of screw placement.

Results

The mean surgical duration was 92 minutes (passing from 32 minutes for the fastest kyphoplasty to 170 minutes for the slowest fixation). There was no case of screw or needle malposition during kyphoplasty. Total radiation exposure was 54 seconds. Postoperatively, almost all the patients improved their symptoms and nobody needed reoperation because of postoperative complications, except for a case in which an initial screw pull-out was stopped with a second stage kyphoplasty.

Conclusion

Neuronavigation in minimally invasive spine surgery represents a viable solution for the treatment of amielic thoracolumbar fractures. Minimal invasive techniques have been shown to reduce blood loss, postoperative pain, and hospitalization; with the neuronavigated support, there is also a sensible reduction in X-ray exposure of patients and operative room operators.
Effects of Single versus Hypofractionated Focused Radiation Therapy on Vertebral Structure and Biomechanical Integrity
Authors: Holmes Christina , Elder Benjamin , Lina Ioan , Liauw Jason , Lo Sheng-Fu Larry , Mao Annie , Naumann Matthew , Theodros Debebe , Puvanesarajah Varun , Witham Timothy
Published: May 2015

Introduction

Stereotactic radiosurgery has shown great promise in the treatment of metastatic lesions within the spine. However, recent clinical studies have indicated that the procedure may increase the risk of developing vertebral compression fractions, particularly in osteoporotic patients (Rose et al, 2009. J Clinical Onc. 27(29):5075; Boehling et al, 2012. J Neurosurg Spine. 16:379). There is thus a critical need for research examining the effects of focused radiation on bone quality and mechanical properties. We have developed a rabbit model which enables the analysis of the effects of focused radiation on vertebral osteonecrosis, structure, and biomechanical integrity. Using this model, we are testing the hypothesis that fractionation of radiation dosing can reduce radiation osteonecrosis and preserve structural and biomechanical integrity of the spine.

Material and Methods

The L5 vertebral body of New Zealand White (NZW) rabbits was treated, under computerized tomography (CT) guidance, with either a single 24 Gy dose of radiation or three fractionated doses over 3 consecutive days of 8 Gy radiation via the small animal radiation research platform (SARRP) (Wong et al, 2008. Int J Radiat Oncol Biol Phys. 71(5): 1591). Effects of radiation treatment on L2, L4, L5, and L6 vertebral osteonecrosis, structure, and biomechanical integrity were evaluated 6 months postirradiation via high-resolution CT imaging (Skyscan, Bruker, Belgium), histology, and nondestructive biomechanical compression testing and were compared with nonirradiated controls. Vertebral bone volume over total volume (BV/TV), trabecular thickness (Tb.Th.), and trabecular spacing (TB.Sp) were evaluated from CT images via CTAn software (Bruker, Belgium). Result/Conclusion: Results till date suggest that a localized single dose of 24 Gy radiation leads to loss of vertebral bone volume and trabecular number and a subsequent increase in trabecular spacing. Similarly, hypofractionation of the radiation dose (3 × 8 Gy) leads to reduced trabecular number and increased trabecular spacing, yet preserves normalized bone volume. Whether these changes in bone morphology translate into reduced mechanical integrity is currently under analysis. Future work will utilize this model to evaluate the efficacy of various therapies, such as teriparatide (PTH [1–34]), in the prevention of radiation-induced osteonecrosis.
Cosmetic and Radiological Outcome after Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis Patients: A Comparison of Anterior versus Posterior Approaches
Authors: Liu Hao , Liu Zhen , Zhu Zezhang , Qian Bang-Ping , Wang Bin , Yu Yang , Zhu Feng , Sun Xu , Qiu Yong
Published: May 2015

Introduction

Improving cosmesis is an important aim of the AIS surgery. Anterior and posterior instrumentations are two established methods of correcting Lenke 5C AIS. Both methods have respective advantages and disadvantages. However, there was no detailed report in the literature focusing on the comparison between the cosmetic and radiographic outcomes of these two methods. The objective of this study is to evaluate and compare the cosmetic and radiographic outcomes of anterior versus posterior instrumentation in Lenke 5C AIS.

Materials and Methods

A retrospective analysis was conducted in 68 consecutive female Lenke 5C patients who had surgery between 2006 and 2010. Thirty-two patients had anterior surgery (Group A) and 36 patients had posterior surgery (Group B). Patients were evaluated at a minimum follow-up of 2 years. Cobb angles, apical vertebral translation (AVT), and apical vertebral rotation (AVR) were measured in the standard long-standing posteroanterior radiographs. Waistline height index, waistline depth index, waistline area index, waist area index, and hump index (α) were measured clinically and the five parameters combined into a composite cosmetic index (CCI). Cosmetic and radiologic outcomes of both Groups A and B were evaluated and compared.

Results

The mean age, preoperative CCI, major curve magnitude, number of levels involved in the major curve, AVT, and AVR were similar for the anterior and posterior groups (age: 16.25 vs. 16.00 years; CCI: 53.76 vs. 52.65; curve size: 45.67 vs. 46.33 degrees; number of levels: P50 = 5 vs. P50 = 5; AVT: 17.39 vs. 18.40%; AVR: 2.13 vs. 2.24 degrees). There were significant increases noted in terms of correction of CCI before and after surgery in both groups ( p < 0.001). Average coronal correction of major curves was 89% at follow-up in Group A and 87% in Group B. No significant differences were observed regarding correction of CCI, Cobb angle, and AVT at last follow-up between both groups ( p > 0.05). However, significant differences were noted in Group A with regard to shorter fusion levels ( p < 0.001) and improved correction of AVR ( p < 0.05). There were no complications in either group which extended hospital stay or required an unplanned second surgery.

Conclusion

Anterior versus posterior surgery comparison in treating Lenke 5C AIS did not show any significant differences with regard to cosmetic and lumbar/thoracolumbar curve correction, but demonstrated shorter fusion levels and improved correction of vertebral rotation in anterior instrumentation group.