bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Early Onset Scoliosis using Growing Spine Profiler (GSP)
Authors: El-Sharkawi Mohammad , Koptan Wael , Shawky Ahmed , Mostafa Amer , Tammam Hamdy , Gad Wael , Aboloyoun Nariman
Published: April 2016

Introduction

Achieving adequate surgery for early onset scoliosis (EOS) is difficult because of many challenges including the need to correct the deformity, the need to allow adequate spine growth, to allow adequate lung development, and the need to minimize complications. GSP system was found to solve these troubles with minimal complications in comparison with other techniques. This is a preliminary analysis and report about the efficacy and safety of GSP system in treating patients with early onset scoliosis

Patients and Methods

This is a combined prospective and retrospective study of 15 patients (9 females and 6 males) with EOS. The age ranged between 3.5 and 7 years old. All patients were treated with GSP system in our hospital and were prospectively followed for a minimum of 1 year. The following parameters were measured both preoperatively and posteoperatively and at each follow up visit. 1- Cobb's angle correction. 2-T1-S1 height. 3-apical vertebral translation (AVT). 4-space available for the lung (SAL) ratio. 5-shoulder and pelvic balance. Also all surgical details were recorded including, single or dual rod technique used, operative time, blood loss, and intraoperative complications. Post-operative follow up schedule at 8 weeks and every 6 months for serial lengthening and assessment of the previous parameters after each lengthening. Any complication during follow up is recorded. This group was compared with a similar historical cohort treated earlier by Growing Rods.

Results

Surgical details -blood loss 90ml (80–300). -operative time 1.5 hours. -number of rods (3 cases single rod and 7 cases dual rods). -number of lengthening procedures 0–4 times. -number of additional procedures 4. Follow up - Mean follow up 4months (3–18) months. - Cobb's angle corrected from (90.4) to (44). -AVT improved from 54mm to 34mm -T1-S1 height improved from 210mm to 305mm. -SAL ratio improved from 89% to 84%. Intraoperative complications. -pleural injury 5 cases. -others 0. Postoperative complications -Screw pull-out 2 cases. -hook dislodgement 0. -neurological injury 0. -infection 2 cases (superficial wound infection). -prominent metal 1 case. -metal failure 2 cases (single rod group)

Conclusion

GSP seems to be a good and economic option for management of EOS with proper patient selection and proper surgical technique
Posterior Selective Fusion with Pedicle Instrumented Correction in Thoracolumbar Adolescent Idiopathic Scoliosis (AIS)
Authors: Debnath Ujjwal K. , McConnell Jeffrey R.
Published: April 2016

Introduction

To evaluate clinical and radiological outcome of selective fusion for adolescent idiopathic scoliosis (AIS) in thoraco-lumbar curves i.e., Lenke 5C curves.

Material and Methods

Twelve(12) patients with Lenke 5C curves were operated through posterior approach for AIS. Risser stage at the time of operation was 0–3 in 6patients and more than 3 in 4patients. Mean age was 13.5 years. Not every vertebra was instrumented with pedicle screws. Apical vertebral derotation and translation on the concave side were performed for correction. All patients underwent a selective fusion (5C only thoracolumbar/lumbar curve fused). The data were prospectively collected preoperatively and at 6 weeks, 1year and 2years post-operatively. Cobb angle, sagittal and coronal balance, and lowest fused vertebral tilt were documented at all time-points. Uninstrumented compensatory curves were measured at all time points.

Results

The average thoracolumbar/lumbar (TL/L) preoperative Cobb angle in Lenke5C curves was 46° ± 8° which was corrected to 14° ± 7° (70% correction) at a 2-year follow-up. 25% of the uninstrumented thoracic curve had spontaneous correction. The coronal balance improved significantly ( p < 0.05) and remained stable from the first postoperative visit to the 2-year follow-up visit. The SRS-22 total scores improved significantly from before surgery to 2years after surgery ( p < 0.0001). No pseudarthrosis or reoperation was observed.

Conclusion

Posterior correction of thoracolumbar AIS with pedicle screw instrumentation is safe and produces a long-term stable correction and high patient satisfaction. In Lenke 5C AIS deformity patterns fused selectively, the uninstrumented compensatory curves do not seem to progress. Selective fusions, when successfully performed, will optimize mobile segments of the spine in AIS patients.
A Comparison of Stryker Xia3 and Depuy Expedium FAS Instrumentation for the Correction of Adolescent Idiopathic Scoliosis
Authors: Khan Almas , Fragakis Angelo , Loughenbury Peter , Ong Jeffrey , Husein Rodwan
Published: April 2016

Introduction

In 2012, our institution held a tender for the supply of its instrumentation which resulted in a majority supply being awarded to Stryker for Xia3 spinal instrumentation. Prior to this we had been using Depuy Expedium FAS for the preceding 5 years. As the surgeons would have to go through a learning curve for the use of the instrumentation system, we felt it important to demonstrate that the correction of curve obtained and the intraoperative risks were the same for each from the outset of the change.

Material and Methods

We examined the post-operative X-rays of our patients who had adolescent idiopathic scoliosis corrected in our institution using Expedium FAS and Xia3 instrumentation between 2011 and 2014. We excluded curves that had previously had growing rods, previous pseudarthrosis or other spinal complication, anterior spinal surgery, implant removal, and incomplete records. Patients were identified using our hospital's theater management software. We measured the pre- and postoperative and 1 year follow up Cobb angle on our PACS system. Blood loss and transfusion requirements were obtained from our cell-saver and blood bank database, and other information was obtained from the clinical notes.

Results

173 patients were identified. 53 had incomplete datasets. 22 were excluded due to having previous growing rod, combined anterior/posterior procedure, or a Skagg's Procedure. 63 cases using Expedium FAS and 35 of Xia3 were found. Expedium had 59 (21–99)% curve correction, 5.40 (2–12.5) hours operative time, 0.87 (0.2–1.5)l intraoperative blood loss and 8.5 (5–42) days hospital stay. The Xia3 group had 63 (34–90) % curve correction, 4.87 (3–7.5) hours operative time, 1.6L (0.4–2.5)l blood loss, and 10 (5–42) days LOS. Only the difference in blood loss reached statistical significance, however transfusion rates were the same.

Conclusion

Despite being at different parts of the learning curves with each instrumentation systems, a group of 4 experienced scoliosis surgeons were able to achieve equal correction of scoliosis using either instrumentation systems in all variables except for blood loss. Moving instrumentation systems can be daunting, however can be done safely if managed in a proactive manner.
Pedicle Subtraction Osteotomy in Management of Rigid Thoracolumbar Kyphosis in Adults
Authors: Negm Mohammad
Published: April 2016

Introduction

Thoracolumbar kyphosis represent a big challenge for spine surgeons specially if the case is of significant deformity which may affect patients life, Pedicle subtraction osteotomy (PSO) is one of the best methods that cane correct the deformity and give satisfactory result to the patients as it corrects the deformity and allow the patients to gain near normal daily activity.

Material and Methods

Four patients were treated by this method by PSO of lumbar 2 vertebra, 3 of them complaining of ankylosing spondylitis and one post traumatic, all patients are neurologically stable. All are assisted by X-ray and MRI preop. PSO is carried through a posterior midline approach with fixation of D12 to L4

Results

All patients are satisfied with near full correction average 90%.

Conclusion

PSO is an excellent method for management of rigid thoracolumbar kyphosis in adults
Prevalence and Complications of Post-Operative Transfusion for Cervical Fusion Procedures in Spine Surgery; an Analysis of 11,588 patients from the ACS-NSQIP Database
Authors: Aoude Ahmed , Aldebeyan Sultan , Fortin Maryse , Nooh Anas , Jarzem Peter , Ouellet Jean , Weber Michael H.
Published: April 2016

Introduction

Cervical spine fusion have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications and acceptable results. The purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect, if any on complication rates.

Material and Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion surgery from 2010 to 2013. Univariate and multivariate regression analysis was used to determine post-operative complications associated with transfusion and cervical fusion.

Results

We identified 11,588 patients who had cervical spine fusion between 2010 and 2013. The overall rate of transfusion was found to be 1.47%. All transfused patients were found to have increased risk of: venous thromboembolism (TBE) (OR 3.19, CI: 1.16–8.77), myocardial infarction (MI) (OR 9.12, CI: 2.53–32.8), increased length of stay (LOS) (OR 28.03, CI: 14.28–55.01) and mortality (OR 4.14, CI: 1.44–11.93). Single level fusion had increased risk of: TBE (OR 3.37, CI: 1.01–11.33), MI (OR 10.5, CI: 1.88–59.89), and LOS (OR 14.79, CI: 8.2–26.67). Multilevel fusion had increased risk of: TBE (OR 5.64, CI: 1.15–27.6), surgical site infection (OR 16.29, CI: 3.34–79.49), MI (OR 10.84, CI: 2.01–58.55), LOS (OR 26.56, CI: 11.8–59.78) and mortality (OR 10.24, CI: 2.45–42.71). ACDF surgery had an increased risk of: TBE (OR 4.87, CI: 1.04–22.82), surgical site infection (OR 9.73, CI: 2.14–44.1), MI (OR 9.88, CI: 1.87–52.2), LOS (OR 28.34, CI: 13.79–58.21) and mortality (OR 6.3, CI: 1.76–22.48). Posterior fusion surgery had increased risk of: MI (OR 10.45, CI: 1.42–77.12) and LOS (OR 4.42, CI: 2.68–7.29).

Conclusion

Our results demonstrate that although cervical fusions can be done as outpatient procedures special precautions and investigations should be done for patients who receive transfusion after cervical fusion surgery. These patients are demonstrated to have higher rate of MI, DVT, wound infection and mortality when compared with those who do not receive transfusion.
Stand Alone Anterior Multiple Levels Cervical Cage
Authors: Khattab Mohamed , El Ghamry Sherief , El-Hawary Youssry
Published: April 2016

Introduction

Anterior cervical discectomy and fusion is common surgical procedure for treatement of cervical spondylotic radiculopathy and or myelopathy after failure of conservative management. Previous studies of multilevel cervical discectomies and fusions have shown decrease fusion rates with increase number of surgical levels. fusion rate and sagittal contour is better with anterior plating but complications like increase dysphagia rates, tracheoesophageal lesions, plate malposition and accelerated adjacent disc degeneration, even when low-profile plates are used. Further To avoid the adverse effect of autograft harvesting techniques Allograft can be used. Cages were used to add stability and prevent graft complications. Stand alone PEEK cages filled with Allograft were used in 3–4 levels anterior cervical discectomy and fusion.

Material and Methods

33 patients 18 males 15 females 28 with cervical spondylotic radiculopathy and 5 With cervical spondylotic myelopathy was treated with multiple levels anterior cervical discectomies and fusion using stand alone PEEK cages filled with Allograft. Total numbers of levels114, 18 patient operated for 3 levels ACDF and 15 patients operated for 4 levels. Clinical evaluation using visual analogue scale (VAS), neck disability index (NDI), and patient satisfaction were analyzed. Cervical lordosis, cervical fusion and complications were assessed.

Results

Improvement of the clinical outcome and the radiological parameters were detected

Conclusion

3–4 levels anterior standalone PEEK cages filled with allograft is very good option for treatment of degenerative cervical disc disease with low complication rate, good clinical and radiological outcomes.
Change in Impairment following Operative Treatment of Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis
Authors: Shamji Mohammed , Tetreault Lindsay , Kurpad Shekar , Brodke Darrel , Smith Justin , Arnold Paul , Brodt Erika , Dettori Joseph , Fehlings Michael
Published: April 2016

Introduction

The primary objective of this work was to define the neurological benefit conferred by surgical intervention to patients with degenerative cervical myelopathy (DCM). Secondary objectives included assessing how preoperative disease severity and duration impacted on that benefit and defining the surgical complications encountered by these patients.

Material and Methods

A search was undertaken for articles published until May 2015 evaluating the operative treatment of DCM using electronic databases. Prospective studies of adult surgical myelopathic patients were included. Extracted data included study design, patient demographics, diagnosis, surgical approach, preoperative and postoperative neurological status (mJOA, NDI, Nurick, VAS), and complications. Preoperative disease severity and duration of symptoms were recorded. Risk of bias (Newcastle-Ottawa Scale) and quality of evidence (Grades of Recommendation Assessment, Development and Evaluation) were assessed. Primary outcomes included assessment of change in neurological (graded by mJOA, NDI, and Nurick scores) and pain (graded by VAS score) following surgical intervention for myelopathic patients. Secondary outcomes were also assessed for dependency on preoperative duration of symptoms and preoperative disease severity. Safety of surgery was assessed by pooled estimates of perioperative complications encountered.

Results

Among 32 included studies, surgical intervention for DCM patients provided clinically-significant improvement in neurological dysfunction and pain. This improvement occurred at short-term assessment (fewer than 12 months) and was durable in longer-term (greater than 36 months), consistent over several different scoring systems. Shorter duration of symptoms may be associated with a higher likelihood of neurological recovery.

Conclusion

Surgical intervention for DCM is an appropriate evidence-based therapy with an acceptably low rate of perioperative complication. Further work is important to define optimal surgical approach and timing.
Influence of Lumbar Lordosis Restoration on Clinical Outcome in Degenerative Lumbar Patients from the “Pre-Balance” Period: Ex Post Analysis of Spinal Parameters Restoration and Clinical Outcome in a Medium Follow-Up
Authors: Martini Carlotta , Pieracci Edoardo Maria , Lepori Paolo
Published: April 2016

Introduction

Restoration of spinal balance is a widely accepted principle of spinal surgery planning. There is a huge amount of data supporting the correlation of clinical outcome and the restoration of theoretical physiological curves of the spine. Flat or hypolordotic fixations are rarely seen today, but there is someone who claims that spinal balance principles are too often pushed to extremes and, surprisingly, there is still some resistance to accept the routinary application of these concepts in the “simple” degenerative surgery, claiming that in short fixations for degenerative lumbar spinal disease it is not mandatory to be strict in the restoration of correct, theoretical spinal parameters to achieve satisfactory clinical results. In this study we present a homogeneous population of patients, operated by a single surgeon in a 3 years time, 7 to 10 years ago, with homogeneous degenerative pathology and similar constructs (2 to 4-level fixations). The peculiarity of this study is that all the patients have been operated regardless to spinal parameters restoration, because at the time of surgery the presurgical planning of spinal curves was not being sistematically adopted. The population is therefore a kind of spontaneous randomization, with patients with a good restoration of spinal theoretical curves and patient who didn't get any correction of sagittal curves.

Material and Methods

36 patients with homogeneous diagnosis of degenerative spinal disease, operated by a single surgeon with a 2 to 4-level fixation until 2010 has been selected. ODI and Prolo scales has been used for direct clinical evaluation. The mean last follow-up was 4 years 4 months, with a minimum of 3 years. Radiological assessment has been performed by lumbar standing XRays AP and LL pre and postop, and PI-LL mismatch and the difference between theoretical lordosis and effective postoperative lordosis have been calculated. Statistical evaluation used Spearman correlation test between PI-LL mismatch and clinical scales values.

Results

Statistical correlation exists between clinical scale values and PI-LL mismatch. As a qualitative result, we observed that the higher is the difference between theoretical lordosis and effective postsurgical lordosis, the higher is the incidence of construct failure.

Conclusion

According to the results of this study, respect of the spinal balance principles seems to be helpful to achieve good clinical results in a medium follow-up for lumbar degenerative patients. These results come from a dataset that is not culturally influenced by spinal balance principles, coming from the past. Additionally, the single-surgeon, single-observer and single-center experience is somehow minimizing the confounding factors that usually affects this kind of studies.
Lumbosacral Parameters and Intervertebral Disc Changes in Adult Patients with Pars Defects
Authors: Baco Abdul Moeen , Mukhtar Khalid , Khan Nasser Mehrab , Ghouri Syed Imran , Shaikh Emad Salman
Published: April 2016

Introduction

Pars defect refers to fracture in the pars inter articularis and is believed to be one of the leading cause of back pain. Pars defects usually acquired and caused by microtrauma. Spondylolysis is seen in 4–6% of population. 82% occur at L5/S1 and 11% occurs L4/5 (11%).

Materials and Methods

Between March 2013 and April 2014, we collected particulars of all patients presenting with low back pain with pars defects on standing erect lumbosacral spine X-rays. Patients were excluded if they had (1) Deformity, (2) Non availability of MRI. 57 patients were included. Their X-rays and MRI were studied by two orthopedic surgeons measuring: Lumbar lordosis and Sacral slope on Plain Xrays; Lumbar slip according to meyereding grading; Intervertebral disc status on MRI: (1) Disc degeneration according to Pfirmann's grading, (2) Degree of disc prolapsed.

Results

57 subjects had their data reviewed: 30 males, 27 females; ages ranged between 15 and 65 years (mean age = 40 years). Data was collected and cleaned using Microsoft Excel. Then analysis done using SPSS ver.17.characteristics of the sample population were displayed in frequency tables while testing for correlations as wellas student t-testwere taken as significant for P values < 0.05. There's a significant difference between males and female ages (p-value 0.01); males were younger with a mean age of 37 years versus 45 years. Sacral Slope: Ranged between 17 – 64 degrees (Mean = 38 degrees). Lumbar Lordosis: ranged between 15 – 77 degrees (Mean = 52 degrees). Slip degree according to myerdings grading: Grade 0 = 38%, Grade 1 = 58%, and Grade 3 = 4%. On MRI disc changes according to Pfirmann's grading was grade 1 26%, grade 2 5%, grade 3 24%, grade 4 32%, grade 5 11%. And finally the disc prolapse severity wasas under: (1) No bulge 32%, (2) Bulge 29%, (3) Extrusion 34%, (4) Sequestration 4%. Statistically significant correlation found between: (1) Age and degenerative disc changes; cor. coefficient 0.43 and p value 0.001; (2) Age and prolapsed disc; cor. coefficent 0.39 and p value 0.003; (3) Degenerative disc changes and prolapse; cor. coefficient 0.83 and p value < 0.001; (4) Between sacral slope and lumbar lordosis; cor. coefficient 0.72 and p value < 0.001.

Conclusions

There is increased prevalence of disc degeneration in patients with pars defect. There is direct correlation between age and disc degeneration plus degree of disc prolapse. Severity of degeneration is directly related to degree of disc prolapse. The lumbar lordosis and sacral slope were not found be statistically related to degree of spondylolisthesis. The disc is not protected in patients with defect.
Stand Alone ALIF for Degenerative Lumbar Spine Diseases
Authors: Elbanna Yasser
Published: April 2016

Introduction

With progress continuing in the development of anterior lumbar constructs, the need for complete anterior access to the lumbar spine continues to increase.

Material and Methods

The study included 18 patients with various types of degenerative lumbar spine diseases as degenerative disc lesions with or without hernias (15), degenerative spondylolisthesis (2) and degenerative stenosis (one case). The follow up period was 6 months.

Results

Back and leg pain have been markedly improved and assessed by ODI.

Conclusion

With various techniques evolving over the years, the mini-open retroperitoneal approach is becoming the standard, with decreased complication rate, better cosmesis and less abdominal wall disruption to provide exposure to the lumbar spine.
Unplanned Reoperation of Lumbar Spinal Surgery during the Primary Admission: A Multicenter Study Based on a Large Patient Population
Authors: Liu Jiaming , Liu Zhili , Huang Shanhu , Deng Huilin
Published: April 2016

Introduction

Unplanned reoperation is suggested to be a useful quality indicator for spinal surgery. However, the rates of unplanned reoperation in patients underwent lumbar spinal surgery during the primary admission are not well established. The purpose of this study was to identify the rates and reasons, also the risk factors for unplanned reoperation of lumbar spinal surgery during the primary admission in terms of a multicenter and a large patient population study.

Materials and Methods

A retrospective study was performed to review all the patients who underwent lumbar spinal surgery at three institutions from January 2010 to April 2015. Patients with unplanned reoperations after primary surgery during the same admission were included in this study. The demographics, diagnosis, surgical procedure and complications of patients were reviewed and statistical analysis was performed to investigate the incidences and risk factors of unplanned revision.

Results

A total of 3936 patients who underwent lumbar spinal surgery from three institutions were reviewed, and 82 (2.08%) required unplanned reoperation during the primary admission because of wound infection (0.94%), screw misplacement (0.53%), cerebrospinal fluid leakage (0.27%), wound hematoma (0.18%) and neurologic deficit (0.15%). For the diagnosis, patients with lumbar spinal spondylolisthesis had a much higher rate of reoperation (4.3%) than those of lumbar stenosis (2.3%), vertebral tumor (2.2%), vertebral fracture (1.2%) and disc herniation (1.1%) with a significant difference ( P < 0.001). The revision rate was significantly higher in patients underwent posterior lumbar interbody fusion (PLIF) than those received transforaminal lumbar interbody fusion (TLIF) ( p = 0.007).

Conclusions

Unplanned reoperation rate of lumbar spinal surgery was 2.08% and the most common reasons for it were wound infection and screw misplacement. Patients with a diagnosis of lumbar spinal spondylolisthesis or who underwent PLIF were more likely to required unplanned reoperation during the primary admission.
Clinico-Radiological Evaluation of Unilateral Single Cage filled with Local Morselized Bone Graft in Posterior Lumbar Interbody Fusion (PLIF) for Degenerative Lumbar Disc: Retrospective Study
Authors: Kumar Suresh
Published: April 2016

Introduction

Retrospective clinico-radiological evaluation of 200 patients who underwent posterior lumbar interbody fusion(PLIF) using unilateral single cage filled with local morselized Bone graft for degenerative lumbar disc.

Material and Methods

200 patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft of which 182 patients were single level and 18 patients two levels, during the year, january 2010 to january 2015 were enrolled in this study. The average follow-up duration was 2years. The clinical outcomes were evaluated with, using the visual analogue scale (VAS) and Oswestry Disability Index at the pre-operative period, and Oswestry Disability Index at 1month, 3 months, 6 months, 12months and 24 months year post-operative period. The radiological outcomes were evaluated according to bone fusion and bony bridging, the radiolucency, the instablity and the disc height.

Results

Clinical outcome for pain was evaluated using the visual analogue scale (VAS) and Oswestry Disability Index along with functional evaluation showed excellent results and radiological outcomes were evaluated according to bone fusion, disc height, instability and bony bridge, showing no cage back out or implant loosening or screw back out or implant breakage.

Conclusion

PLIF using a unilateral single cage filled with a local morselized bone graft was found to be good and has the advantages of a shorter operation time, less blood loss and a shorter hospital stay, low cost, less complications like dural tear, as compared with the PLIF using bilateral cages, for treating degenerative lumbar spine disease. This technique also provides excellent outcomes according to the clinical and radiological evaluation.
Predicting Factors for Patient Reported Satisfaction after Transforaminal Lumbar Interbody Fusion: A Two-Year Follow-Up
Authors: Lim Beng Teck Jason , Chen Li Tat John
Published: April 2016

Introduction

Transforaminal lumbar interbody fusion (TLIF) is an effective treatment of degenerative lumbar spine conditions, to reduce pain and improve function. Understanding predictors of post-operative patient satisfaction is important for better management of patient groups at high risk of dissatisfaction. This study aims to determine the pre-operative predictors of post-operative satisfaction in TLIF surgery.

Material and Methods

We retrospectively reviewed prospectively collected data on patients who underwent open TLIF for degenerative scoliosis, spondylolisthesis and spinal stenosis from the database of a tertiary hospital between 2008 and 2012 with 2 years follow-up. Clinical outcome was evaluated using Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom Score (NSS), SF-36 (mean Physical and Mental Health scores), numerical pain rating scale (NPRS) for back and leg pain and two questions from NASS Questionnaire: ((1) Has the surgery met the patient's expectations? (2) How would the patient rate the overall results of treatment?). Paired t-test was used to compare the clinical scores pre-operation and post-operatively at 6 months and 2 years. Univariate and multivariate analyses were conducted to determine significant pre-operative predictors of patient satisfaction at 2 years.

Results

217 patients underwent TLIF by a single surgeon during the 5-year period. Mean pre-operative age was 61 and BMI was 25.9. 182 and 35 patients underwent primary TLIF and revision TLIF respectively. 140, 68 and 9 patients underwent single-level, two-level and three-level TLIF respectively. Significant improvement was seen in the post-operative ODI ( p < 0.001), NSS ( p < 0.001), SF-36 (mean physical score; p < 0.001 and mean mental health scores; p < 0.001) and NPRS (back pain; p < 0.001 and leg pain; p < 0.001) scores at 2 years follow-up. 86.8% of patients had their expectations of surgery met and 94.7% of patients were satisfied with the results of treatment at 2 years. Possible indicators identified by univariate analysis for post-operative patient satisfaction ( p < 0.2) were pre-operative scores (NPRS leg pain score, SF-36 Physical Function score, mean Physical Health score and ODI). From multivariate regression model, patients with higher pre-operative NPRS pain score (OR, 1.323; 95% CI, 1.071–1.633; p = 0.009) was more likely to be satisfied at 2 years.

Conclusion

TLIF surgery provided significant health-related quality of life scores and symptoms improvement in terms of SF-36, ODI, NSS and NPRS (both back pain and leg pain). However, patient reported satisfaction is multi-factorial and their post-operative satisfaction may be largely influenced by expectations of surgery being met and improvement of pain. This highlights the importance of managing patients' expectation pre-operatively as a means of improving post-operative patient satisfaction.
Annulo-Nucleoplasty using Disc-FX® in the Management of Lumbar Disc Pathology: Early 2 Year Results
Authors: Kumar Naresh
Published: April 2016

Introduction

Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. Several minimally invasive procedures have also been developed in the recent past for its management. Disc-FX® is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification.

Methods

We studied 22 consecutive patients who underwent Disc-FX for lumbar disc pathology non-responsive to non-operative treatment for at least 6 months. Based on MRI, these patients fell into 2 groups – 11 with degenerative disc disease (DDD) and 11 with a contained lumbar disc herniation (CLDH). They were evaluated using Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preand postoperatively.

Results

Overall rate of re-intervention for persistent symptoms was 18.18% (4/22) - all in CLDH subgroup (4/11, 36.36%). At 6 months, mean pre-op VAS improved from 6.1 (2–8) to 3.42 (0–7), ODI reduced to 28.21 (2–68.9) from 37.64 (2–71.1) and SF-36 improved from 35.57 (24.1–56.8) pre-op to 40.463 (24.1–56.8). 9 (42.85%) patients (4 with CLDH, 4 with DDD and 1 with both) said that they were not satisfied with the treatment and would not recommend it. 8 (38.09%) patients (5 with DDD, 2 with CLDH and 1 with both) who had partial to complete pain relief were satisfied and would recommend the procedure. 4 (19.04%) patients (1 with DDD and 3 with both) were not sure. 3 were advised fusion or disc replacement. The only complication of this procedure was inability to access the L5-S1 disc space in 3 patients.

Conclusions

Our study suggests thatDisc-FX®is a reasonable treatment option for patients with back pain due to lumbar disc disease, especially with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement. Longer term prospective studies are needed to prove its role in treatment of patients with CLDH.
Risk Factors for Adverse Events and Reintervention after Surgery for Lumbar Spine Stenosis. A 10-Year Experience of Clinical Practice in a Third Level Hospital from Bogotá, Colombia
Authors: Alvarado Fernando , Saenz Luis Carlos Morales , Munera Andres Rodriguez , Farfan Miguel Andres , Buitrago Andres Felipe Rodriguez , Victoria Daniela Tafur , Viana Luis Jesus Vásque , Rodriguez Camilo Gutierrez
Published: April 2016

Introduction

Degenerative lumbar spinal stenosis is present in patients around 50 to 60 years old. It is the most common spinal surgical indication in patients over 65 years old. The aim of this study was to determine the risk factors associated with adverse events and reintervention after surgery for degenerative lumbar spinal stenosis, based on a 10-year retrospective analysis of clinical records in a third level hospital in Bogotá, Colombia.

Material and Methods

An analytical prevalence study was developed through 429 clinical records of patients who underwent surgery for degenerative lumbar spinal stenosis.

Results

429 clinical records were reviewed. 55% were female; the mean age was 55 years +/−16,5. The average follow up was 33,8 months. Adverse events were present in 17,2% of patients. Dural lesion was the most frequent complication (9.8%). Multivariate analysis showed a relation between complications and BMI (OR 1,8; p = 0,029), duration of symptoms (OR 1,08; p = 0,047), length of stay (OR 1,67; p = 0,023) and multi level surgery (OR: 2.99; p = 0,015). 4.7% of patients required early reintervention after surgery and 16,1% required it during follow-up. The most common late reintervention cause was re-stenosis of the same segment (7%). Adjacent segment disease was present in 6,1% of patients.

Conclusion

BMI, duration of symptoms, length of stay and multi level surgery were identified as risk factors for adverse events and reintervention after surgery for degenerative lumbar spinal stenosis. Mitigation of these risk factors before surgery for degenerative lumbar spinal stenosis, may decrease the proportion of complications and reinterventions in our institutions.
A CT-Based Analysis of Implant Position of Sacroiliac Joint Fusion: Is There a Learning Curve for Safe Placement?
Authors: Herseth Jonathan , Ledonio Charles , Polly David W.
Published: April 2016

Introduction

Diagnosis of degenerative sacroiliitis and surgical interventions are increasing. Open and minimally invasive sacroiliac joint (MIS SIJ) techniques exist. Optimal rod placement requires adequate training to minimize risk of breaching vital structures such as sacral anterior cortex (AC) and neural foramina (NF). CTbased image guidance navigation increases accuracy of rod placement. This study describes a retrospective singlesurgeon postoperative assessment of implant position in navigated MIS SIJ fusion procedures over a 5-year period.

Materials and Methods

Early (1st 3 years) versus late (past 2 years) cases were evaluated to assess learning curve of implant placement accuracy. Grading scheme was created to assess SIJ fusion rod placement and potential risk of guide pin breaching either AC and/or NF. Grade 1 denotes least risk of breach; Grade 2 denotes partial risk of breech by the implant but not the guide pin; Grade 3 denotes risk of breach of both pin and implant; Grade 4 denotes actual breach. Rod fixation grading was based on bony purchase ratio between iliac and sacral side of the joint where: Grade 1: > 50% of rod occupies sacral side; Grade 2: 50% of rod is fixed on sacral side; Grade 3: < 50% of rod is fixed on sacral side and Grade 4: rod does not cross SIJ.

Results

From 2010 to 2014, 110 implants in 39 SI joint fusions in 33 patients were assessed. Of these 55% were placed atS1 level, 40% were S2 and 5% were in S3. Majority of rods were placed in optimal position (Grade 1 40%68%). The position of 48 rods in 1st 3 years were compared 62 rods in past 2 years. Greater percentage of rods were classified as Grade 1 in the last two years (68%, 65%) compared with the first 3 years (56%, 33%, 25%) indicating a learning curve and improved safety profile of rod placement over time.

Conclusions

This study demonstrates that a learning curve exists with the use of 3D CT guidance for SI joint implant placements. This proposed grading system can be used to aid in optimal placement of SI joint implants.
Sacral Bone Mineral Density Using Opportunistic CT Scans: A Retrospective Cross sectional Analysis
Authors: Hoel Ryan , Ledonio Charles , Polly David W.
Published: April 2016

Introduction

Sacral bone mineral density may play a role in the rate successful sacroiliac and lumbosacral fusions. There are currently no easy methods for evaluation of sacral bone mineral density. Lumbar CTattenuation has previously been shown to relate to bone mineral density as assessed by DXA. This study aims to establish an accessible method for sacral bone mineral density analysis.

Study Design/Setting

A retrospective review of renalprotocol CT scans performed for any indication over a three-month period in 2014. CTattenuation was analyzed at several regions of interest within each scan.

Materials and Methods

A retrospective review of renalprotocol CT scans performed for any indication over a three-month period in 2014. A series of 223 consecutive renalprotocol CT scans were analyzed using basic image viewing software. Sacral CTattenuation at multiple regions of interest (ROI) were compared with the L1 attenuation to determine if a correlation existed. The sacral ROI were analyzed to determine regions of higher and lower attenuation. Sacral attenuation was also analyzed by age and sex.

Results

All sacral ROI had strong correlations with lumbar spine attenuation values, and these values became even stronger when transitional vertebrae were excluded. Sacral attenuation values varied predictably by location. Sacral attenuation was inversely related to age. No difference was found in sacral attenuation by sex.

Conclusions

Sacral CTattenuation can be used in opportunistic CT scans to determine sacral bone mineral density. This method can be used in the future to evaluate the impact of sacral bone mineral density on successful sacroiliac and lumbosacral fusions.
Evaluating Sagittal Balance with Lumbopelvic Parameters: A Single-Center Performance Improvement Project
Authors: Chiappini Alessio , Cunningham Michael , Mariani Luigi , Jost Gregory
Published: April 2016

Introduction

Neutral sagittal balance is key for painless upright posture and a large offset of sagittal balance may cause low back pain and correlates with impaired quality of life. Lumbar sagittal balance can easily be assessed on a standing X-ray, however, it is still a new concept to many spine specialists and radiologists.

Materials and Methods

A performance improvement program was developed to enable radiologists and neurosurgeons to quickly assess lumbar sagittal balance. Baseline knowledge and reporting were analyzed. Clinical tools to measure lumbar sagittal balance were taught with a 30-minute presentation. Following this, a spine surgeon helped colleagues measure their first patients.

Results

At baseline, 42% of 75 patients showed problems with lumbar sagittal balance but basic knowledge of sagittal balance was low: only 10% of pre- and post-treatment X-ray reports and only 1% of neurosurgical reports included information on sagittal balance. The 30-minute presentation empowered the target audience with the clinical skills to measure, interpret, and report lumbar sagittal balance on a standing X-ray. Intermittent encouragement and support from a spine surgeon helped colleagues to evaluate lumbar sagittal balance in their patients. In the first three months following the presentation, the neurosurgeons documented pelvic parameters in 48% of patients (14 of 29) and the radiologists reported the pelvic parameters on all new lumbar X-rays. Assessing and reporting sagittal balance has become a routine procedure beyond the study period and has led to more profound understanding of deformity induced pain and disability, not only by doctors, but also by patients to whom the origin of their back pain can be explained.

Conclusions

A short teaching presentation on a poorly known yet important clinical concept enables radiologists and spine specialists to easily measure and interpret heretofore underused information from the standing lumbar X-ray. Performance improvement programs are a valuable educational intervention for surgeons and to engage teams in interdisciplinary learning.
Spinopelvic Parameters Evaluation in a Brazilian Population Sample: A Systematic Review
Authors: Junior Charbel Jacob , Maia Thiago Cardoso , Brazolino Marcus Alexandre Novo , Cardoso Igor Machado , Junior José Lucas Batista
Published: April 2016

Introduction

The morphology of the spine is variable within a population and its maintenance in appropriate values implies a decrease in the energy expended. We need to know their normal values in population. This study aims to carry out a literature review and evaluate published papers on spinopelvic parameters in a Brazilian population sample.

Methods

11 potentially eligible papers were initially identified for inclusion in this review: 3 papers from Pubmed and 8 from Medicine®. Out of these, only 5 papers contained methodology and relevant significance level, and therefore they were included in the final analytical run.

Results

According to a Brazilian study, Pratali mentions no significant difference in the average values of spinopelvic balance in the Brazilian population and those found in the literature; there was also no significant difference comparing Brazilian and Korean population, however, was found difference in comparison with European population regarding PI parameters and SS, but the latter with higher values. According to Kulcheski in 2013, the values of pelvic tilt in the Brazilian population evaluated in his research were 19° (10–35°) and the sacral inclination was 38° (30–55°), presenting similar values concerning the European population. In another Brazilian paper, Oliveira reports that the researched population had PI average of 45° (41.9 to 48.1°).

Conclusions

The values obtained are relatively minor when compared with the European population. However, all of these are within the normal margin considered in the worldwide literature.
Comparative Analysis of Evaluation of Lumbar Lordosis Measured in the Standing Positions Radiography and Magnetic Resonance Imaging
Authors: Junior Charbel Jacob , Cardoso Igor Machado , Junior José Lucas Batista , Maia Thiago Cardoso , Brazolino Marcus Alexandre Novo , Debom Tadeu Gervazoni , Roncaglio Bruno
Published: April 2016

Introduction

Research of degenerative diseases of the spine it is recommended performing radiographs and magnetic resonance imaging (MRI). Physiological curvature of the lumbar spine varies from 35 to 50. Changes sagittal alignment can lead to changes in the lumbar spine kinematics, having influence on the support and load distribution on the spine, causing low back pain.

Methods

100 patients with chronic low back pain (51 men and 49 women), being evaluated degree of lumbar lordosis by three independent examiners by radiography in the standing position and MRI in supine position with flexed lower limbs. Measurement of lumbar lordosis by the Cobb method (L1 to L5 levels) in lumbar radiographs in profile and in the sagittal plane in lumbar MRI.

Results

Average of lumbar curvature on X-rays and the MRI cushion was 42,2° and 31,5°, respectively (p value < 0.001). Average angles of lumbar lordosis by MRI underestimates by 25% compared with lumbar radiographs.

Conclusion

MRI is insufficient for evaluation of lumbar lordosis, it underestimates the true lumbar lordosis. Thus, the lumbar radiological evaluation is essential in assessing the true lumbar lordosis.
Sacro-pelvic Tilt as a Predictor for Optimal Lumbar Lordosis
Authors: Mukhtar khalid , Baco Abdul Moeen , Khan Nasser , Alhammoud Abduljabbar , Arbash Mahmoud
Published: April 2016

Introduction

Spino-pelvic parameters are crucial to address the spinal sagittal balance; such measurements require standardized lateral x-ray views that include the spine as well as the hips, which are not always available upon referral of cases, where instead, shorter films for the lumbo-sacral spine are requested. We aimed to describe a pelvic radiological reference points that could provide comparatively sound sagittal balance estimates, from conventional lumbo- sacral lateral x-ray views. The iliopectineal line was addressed as a radiological reference in the pelvis, that along with the horizontal line, and the upper endplate of the first sacral vertebra, provide two angles, the Iliopectineal inclination (Doha angle; DA), and the Sacro-pelvic tilt (Baco angle; BA), respectively. Material and Method: Radiological images for 96 adult subjects, aged between 20 – 80 years, with suspected or established diagnosis for spine problem. Readings were taken from the institute's digital radiology library, blinded to personal and clinical data. Frequency tables, correlations and test of difference were tested, taking (p-value < 0.05) as cut-off for significance. Correlation to the conventional Pelvic Incidence (PI), Pelvic tilt (PT), and the Sacral slope (SS), measured for the same patients, and from the same standardized standing lateral views that include the femoral heads.

Results

Readings of the new angles were found to be practically easy and reproducible. The iliopectineal inclination (Doha angle) readings averaged 61 +/- 9 degrees, indirectly proportional to the pelvic tilt (r = −0.46, P-value 0.000), along with its averaged 7 degree difference from the mean Pelvic incidence (54 +/- 8.9 degrees), DA (practically the sum of SS + BA) corresponded to the described lumbar lordosis values in the literature, as well as the estimated lumbar lordosis by Schwab's formula for the study sample. On the other hand; the Sacro-pelvic tilt (BA) had readings of 24 +/- 8 degrees, and a highly significant, yet weak negative correlation with the sacral slope (P-value = 0.001, r = −0.266). Having the Sacral slope as a common component for both DA and PI; those 7 degrees difference seem to reflect an actual upper sacrum retroversion, relative to the pelvis, which had a significant difference in age terms; those with sacral retroversion >7 and <7, for average age of 31 yrs, 40 yrs, respectively (P-value = 0.000) and seem to contribute to maintaining the spinal sagittal balance, that becomes more profound by the age of 50 years (averaged 2 degrees for over 50 years, in comparison to 8 degrees for youngers).

Conclusion

The iliopectineal lines provide reproducible readings, closer values to the lumbar lordosis, and addresses sacroiliac contribution to the sagittal balance, that regresses by middle age.
Kyphotic Deformity Associated with Acute Tubercular Spondylodiscitis Treated by Single Stage Posterior only Surgery
Authors: Rajasekaran S. , Shetty Ajoy Prasad , Dian Arief , Das Gurudip , Kanna Rishi
Published: April 2016

Introduction

Acute tuberculous spondylodiscitis with thoracic kyphosis is conventionally treated by anterior or combined reconstruction techniques. Posterior based sagittal correction in active tubercular infection is an emerging alternative technique. Our aim was to evaluate posterior only deformity correction technique in acute tuberculosis kyphosis for safety and outcomes.

Methods

Sixty-seven patients with acute thoracic kyphosis due to tuberculosis were treated by all-posterior deformity correction with or without an anterior cage. Peri-operative complications, neurological improvement, pain scores, kyphosis correction, final deformity at last follow up and fusion were studied pre-operatively, immediately after surgery and at last follow up.

Results

The mean age was 47.6 ±12.2 years. Indications for surgery were persistent pain ( n = 12), neurological deficit ( n = 27) and kyphosis ( n = 28). The mean follow-up was 36.4 ± 12.1 months. The mean VAS improved from 7.2 ±1.2 to 1.6 ±0.9. The mean kyphotic angle improved from 26.4 ±4.6° to 12.4 ±2.4°. There was loss of correction by 2.7° and the final kyphosis was 15.2 ± 1.8°. Neurology improved in all patients by at least one ASIA grade. The mean vertebral body loss was 0.8 ± 0.4 (where 1=one vertebral body). Thirty seven patients with vertebral loss > 0.5 or pre-operative kyphosis > 30 degress had transpedicular/transformaninal reconstruction of anterior column with a cage while the remaining thirty had posterior shortening only. Bony fusion was obtained in all patients. There were no implant failures. Post-operative complications included dural tear ( n = 2), temporary neural deficit ( n = 2), wound infection ( n = 4), girdle paresthesia ( n = 3), lumbar hernia ( n = 2), disease recurrence ( n = 1).

Conclusion

All-posterior single stage kyphosis correction and global reconstruction in acute tuberculous kyphosis is a safe technique with good functional and radiological outcomes. The use of titanium cages and pedicle screws in the infected vertebral body milieu was observed to be safe.