bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Dynamic Stability of Lumbosacral Fixation using L5/S1 Pedicle Screws between with and without a Transverse Connector: A Finite Element Analysis Study
Authors: Kumano Yoh
Published: May 2015

Introduction

Fixation failure and pseudoarthrosis at the lumbosacral junction continue to be a big problem for spine surgeons. The poor bone quality of the sacrum, relative displacement between a screw and a screw head of a polyaxial screw and between a screw head and a rod and the substantial biomechanical forces at the lumbosacral junction are major risk factors for the high rates of instrumentation failure. It has already been believed that a transverse connector is necessary to achieve lumbosacral fusion. The purpose of our study is to investigate the dynamic stability of lumbosacral fixation using L5/S1 pedicle screws and a transverse connector with CT/finite element analysis quantitatively.

Material and Methods

CT Dicom data including L4, L5, and pelvis was obtained from the patient who had kyphoscoliotic spine and prepared for the correction surgery. The data were changed to the biomechanical model for analysis. On the computer, four pedicle screws (6 × 40 mm) were applied to L5 and S1 (PS) of the model. In addition to PS, a transverse connector was applied to bilateral rods (PS–TR). The flexion, extension, bending, and rotation force was loaded on L4 and the displacement of L5 was calculated with finite element analysis. The larger displacement was defined as the lower stability. The software of finite element analysis was MechincalFinder7.0EE.

Results

As to flexion, the displacement of L5 was reduced to 82% (PS–TR) compared with PS. As to extension, the displacement of L5 was reduced to 85% (PS–TR) compared with PS. As to right bending, the displacement of L5 was reduced to 77% (PS–TR) compared with PS. As to right rotation, the displacement of L5 was reduced to 13% (PS–TR) compared with PS.

Conclusion

As to flexion, extension, bending, and rotation, PS–TR tended to have higher stability than PS. As to rotation, the displacement of L5 (PS) is remarkably larger than that of PS–TR and it indicates that as to L5/S1 pedicle screw fixation, a transverse connector plays a significant role for lumbosacral stability and L5/S1 pedicle screw fixation without a transverse connector may be one reason for the higher rate of pseudoarthrosis.
Assessing the Impact of Thoracolumbar Deformity on Cervical Disability and Pain: How the Back Affects the Neck
Authors: Clark Aaron , Oh Taemin , Saigal Rajiv , Li Carol , Ryan Devon , Klineberg Eric , Hart Robert , Kim Han Jo , Schwab Frank , Smith Justin , Protopsaltis Themistocles , Lafage Virginie , Ames Christopher
Published: May 2015

Introduction

Patients with thoracolumbar deformity employ compensatory mechanisms to maintain horizontal gaze, which may result in cervical malalignment. However, the effects of these reciprocal changes on regional cervical disability have not been well-studied in this pt population. The objective of this study is twofold: (1) to report baseline regional neck disability in adult spinal deformity (ASD) and (2) to define the relationship between neck disability and degree of cervical deformity.

Patients and Methods

This is a single center retrospective analysis of consecutive patients with ASD. Preoperative radiographs were analyzed for cervical, thoracic, lumbar, and spino-pelvic parameters. Preoperative disability was assessed using indices for neck disability (NDI), Oswestry disability (ODI), neck pain (VAS-neck), and back pain (VAS-back). Patients were also grouped into mild sagittal plane deformity (C7 SVA < 5 cm) and severe (> 10 cm). Correlations were made by linear regression, and comparisons between groups were made using student's t test.

Results

A total of 61 patients were assessed. Mean preoperative disability indices were as follows: NDI = 32, ODI = 49, VAS-neck = 3.2, and VAS-back = 6.9. Significant correlations were found between ODI and NDI ( p < 0.001, R = 0.61), ODI and VAS-back ( p < 0.001, R = 0.68), NDI and VAS-back ( p = 0.004, R = 0.39), and NDI and VAS-neck ( p < 0.001, R = 0.61). There were significant correlations between ODI and C7 sagittal vertical axis (SVA; p = 0.005), pelvic tilt ( p = 0.004), and pelvic incidence/lumbar lordosis mismatch ( p = 0.03). No other significant correlations were found between disability indices and radiographic parameters. No differences were found between patients with mild or severe sagittal deformity in NDI (31.8 vs. 31.5, respectively; p = 0.96) or VAS-neck (3.1 vs. 3.3, respectively; p = 0.80).

Conclusion

Patients with thoracolumbar deformity have moderate neck disability (NDI) and mild–moderate neck pain (VAS) preoperatively. There is a correlation between neck and low back regional disability, and NDI was highly correlated to back and neck pain. However, neither cervical disability nor severe sagittal deformity appears to correlate with neck disability or pain.
Disc and Vertebral Responses in the Unfused Lumbar Curve to Selective Thoracic Fusion in Lenke 1B/1C Scoliosis
Authors: Chen Xi , Sun Xu , Qian Bang-Ping , Chen Zhong-hui , Zhu Zezhang , Wang Bin , Zhu Feng , Yu Yang , Liu Zhen , Qiu Yong
Published: May 2015

Introduction

Several previous studies have reported spontaneous lumbar curve correction for both anterior and posterior selective fusion in patients with Lenke 1B or 1C; however, the mechanism for this phenomenon remains unclear. The objective of this study is to analyze the detailed response of compensatory lumbar curve to selective thoracic fusion in patients with adolescent idiopathic scoliosis (AIS) with Lenke 1B/1C curve.

Patients and Methods

This study included patients with AIS with Lenke type 1B or 1C curves treated with posterior selective thoracic fusion (LIV at L1) from 2006 to 2008 in our institution. They had a major right thoracic curve and a compensatory lumbar curve. They were followed for at least 24 months. Radiographic measurements including disc angle and vertebra tilt in the lumbar region were compared before surgery, after surgery, and at latest follow-up.

Results

A total of 20 patients (7 boys and 13 girls) with a mean age of 15 years were included in this study. The thoracic curve was corrected from 46 ± 7.2 degrees preoperatively to 8 ± 4.7 degrees postoperatively, and to 9 ± 5.1 degrees at the latest follow-up. The mean lumbar compensatory Cobb angle was 36 ± 6.9 degrees before surgery, spontaneously correcting to 12 ± 5.3 degrees at latest follow-up. The most significant change of vertebral tilt occurred at LIV and the L4 vertebra in the coronal plane. Change in disc angle was 6.4 ± 3.1 degrees at L1/L2, 3.2 ± 2.3 degrees at L2/L3, 1.0 ± 1.3degrees at L3/L4, −2.3 ± 1.9 degrees at L4/L5, and −0.7 ± 0.5degrees at L5/S1. L1/L2 disc ranks highest among all the discs in the contribution to correction of the lumbar curve.

Conclusion

LIV and the L4 vertebra have a trend to be horizontal after selective thoracic fusion. Spontaneous correction of the unfused lumbar curve relies on the compensatory changes of lumbar disc angle, which are mainly at the junctional disc right below LIV. This study suggests that the disc right below LIV assumes the greatest portion of correction force transmitting therefore is prone to degenerate earlier than normal.
Does Disc Wedging Contribute to the Flexibility of Thoracic Curve in Adolescent Idiopathic Scoliosis?
Authors: Liu Hao , Liu Zhen , Zhu Zezhang , Qian Bang-Ping , Wang Bin , Yu Yang , Sun Xu , Zhu Feng , Qiu Yong
Published: May 2015

Introduction

The appreciations of curve flexibility and segmental mobility in patients with adolescent idiopathic scoliosis (AIS) are important for determining structural curves, defining the safe range of correction, selecting the segment length for fusion, determining the most appropriate surgical procedure, and predicting the results of correction. However, the role of disc wedging in predicting spinal flexibility has not been well defined. The objective of this study was, therefore, to investigate the effect of disc wedging on curve flexibility and gain insight into segmental mobility by comparing disc wedging in upright and side bending radiographs in thoracic AIS.

Patients and Methods

This study included a total of 116 consecutive patients with AIS with main thoracic curve. According to thoracic curve flexibility index (TCFI), 56 patients with TCFI < 50% were assigned to group A (Stiff), and the other 60 patients with TCFI ≥ 50% were assigned to group B (Flexible). Age, curve magnitude, disc wedging, and disc wedging percentage were compared between the two groups. Segmental flexibility indices ([upright disc angle-bending disc angle]/[upright disc angle]) were computed and compared between periapical and remote levels. Correlations were estimated using Pearson correlation coefficients. After adjustment of covariates, logistic multivariate regression analysis of independent factors for TCFI was performed.

Results

Significant differences with respect to the age and curve magnitude were observed between the two groups (16.33 ± 3.08 vs. 13.50 ± 1.97, p < 0.01 and 56.06 ± 8.34 vs. 48.60 ± 7.87 degrees). The wedging angle and wedging percentage of discs in group B were significantly higher than those in group A (21.86 ± 6.18 vs. 17.52 ± 6.37 degrees, p < 0.01 and 43.55% ± 8.5 vs. 26.56% ± 9.1, p < 0.01). There was a significant correlation between disc wedging percentage and TCFI ( r = 0.766, p = 0.001). Multivariate regression analysis showed that the disc wedging percentage was the single greatest predictor of TCFI. And the disc wedging showed symmetric periapical distribution with significant decrease (all p values < 0.01) for every cephalad (+) and caudad (−) level change. The apical level +1 and −1 wedged at 6.3 and 6.7 degrees (range, 3.5–10.8 degrees), respectively. We noted mean periapical flexibility indices of 41% (+1), 44% (−1), 53% (+2) and 97% (−2), which were significantly less ( p < 0.01) than for the group of remote levels 90% (+3), 160% (−3), 116% (+4), and 208% (−4).

Conclusion

Disc wedging contributes to the spinal flexibility in thoracic AIS. The average flexibility indices of the periapical discs are significantly less than that of the remote discs. These may offer useful information in the evaluation of surgical options and preoperative planning.
The Outcome of Providence Nighttime Bracing in Adolescent Idiopathic Scoliosis
Authors: Simony Ane , Beuschau Inge , Quisth Lena , Andersen Mikkel O.
Published: May 2015

Introduction

Six years ago, the primary conservative treatment of adolescent idiopathic scoliosis (AIS) in the southern part of Denmark, went from full-time bracing to nighttime bracing. The purpose of this study is to evaluate the effectiveness of nighttime bracing in AIS.

Patients and Methods

Patients diagnosed with AIS and skeletal immature. With an apex of the primary curve from TH7 and below and with a Cobb angel between 20 and 45 degrees. The patients were asked to wear the brace at least 7 8 hours per night. No other previous treatments were accepted and a follow-up at least 6 months out of brace. The brace treatment was continued until 2 years post menarche or for male at the expected adult height. Cross-measured X-rays were used to compare the primary Cobb angel, the in-brace correction and the outcome Cobb angel. A decreased outcome Cobb angle as well as the overcorrection of the curve measured in brace was recorded as zero. The brace treatment was considered failed if progression more than 5 degrees occurred and if surgery were performed.

Results

A total of 55 patients, 8 males and 47 females, with the mean age at 14 years (range, 11–16.5 years) and the mean primary Cobb at 31 degrees (range, 20–41 degrees) were included in this study. The mean time of treatment was 18 months (range, 5–59 months). After ended treatment, the mean Cobb angle was 28 degrees (range, 7–50 degrees), and we observed in average no progression of the curves. The end results were 11 failures (range, 6–15 degrees); equal 20% and of these 11 patients, 3 patients had surgery performed (5%).

Conclusion

The results show a good curve control and an acceptable 20% failure rate, which is equal to other studies. The progression of the curves is controlled acceptable, even with the larger curves included in this study. The providence brace is an excellent alternative to standard conservative treatment. Larger studies are needed to establish the relationship between embrace correction and curve progression.
Camptocormia and Dropped Head Syndrome Induced by Chemoradiotherapy for Base Tongue Carcinoma: A Case Report and Review of Literature
Authors: Ono Allan Hiroshi , Zelada Flavio Benites , Narazaki Douglas Kenji , Jacobsen Teixeira William Gemio , Marcon Raphael Martus , Cristante Alexandre Fogaca , Barros Filho Tarcisio Eloy Pessoa
Published: May 2015

Introduction

Camptocormia (bent spine syndrome) is an acquired postural disease characterized by forward flexion of the thoracolumbar spine. Camptocormia leads to lumbar kyphosis and increases during walking or standing. Management of Camptocormia is still a challenge and the literature on this topic is limited. There is no specific pharmacologic treatment for primary axial myopathy.

Patients and Methods

Our patient is a 68-year-old man, diagnosed in 2009 with a base tongue squamous cell carcinoma, surgically removed in September 2010. By May 2011, it was diagnosed with local recurrence, submitted to radiosensitive chemotherapy, and followed by radical radiotherapy 35 fractions of 70 Gy.

Results

After general anesthesia, and neuromonitoring a median incision was made from C3 to the sacrum, former instrumentation C3–T3 were tested, and no loosening or breakage was detected. Pedicle screws were inserted by free hand technic except C7 and T1 because the small space for rod connectors and T6, T10, L2, and L5 were osteotomies were performed total of 28 screws until S2 with sacropelvic fixation. In T6 and T10, Ponte osteotomies were made, and closing wedge pedicle subtraction in L2 and laminectomy of L3. Patient presented good outcome, receiving discharge at 7th postoperatory day, and initiated naturotherapy, fonotherapy, and physiotherapy, and nasoenteral catheter were maintained until 3 weeks and some swallowing improvement reported by the 6th week. In the follow-up, patient maintained satisfied with procedure and returned to work by 3rd month, screening showed no recurrence of the tumor or distant metastasis.

Conclusion

This is the first case described where dropped head syndrome and camptocormia occurred in the same patient because of radiosensibilizing chemotherapy for a nasopharyngeal carcinoma. We only found a single case report of a patient with dropped head syndrome associated with chemoradiotherapy for a nasopharyngeal carcinoma in a 59-year-old Japanese patient, described by Hashimoto (2012), treated without surgery who developed symptoms 2 years after chemoradiotherapy.
Correlation of Myelopathy to Regional Neck Disability: A Surgical Approach-Specific Analysis in 217 Patients
Authors: Ames Christopher , Smith Justin , Liu Shian , Shaffrey Christopher , Kim Han Jo , Arnold Paul , Challier Vincent , Chapman Jens , Protopsaltis Themistocles , Schwab Frank , Scheer Justin , Massicotte Eric , Yoon S. Tim , Lafage Virginie , Fehlings Michael
Published: May 2015

Introduction

Outcomes for cervical spondylotic myelopathy (CSM) have been measured by numerous health-related quality of life (HRQOL) scales such as the disease-specific modified Japanese Orthopaedic Association (mJOA) and the regional-specific neck disability index (NDI). However, there is no literature analyzing the correlation of myelopathy improvement to regional neck disability changes after surgery.

Materials and Methods

Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 217 patients (78%) met the following inclusion criteria: symptomatic CSM, age over 18 years, and 6 months follow-up with mJOA and NDI. The patient population had a mean age of 57 years and 42% were females ( n = 92). NDI and mJOA were analyzed at baseline and 6 months post-op for the entire group. Correlations were also analyzed by the following subgroups: anterior approach group (AAG, n = 141) and posterior approach group (PAG, n = 76).

Results

From baseline to 6 months, there was a statistically significant improvement in both mJOA (BL 12.87–6 M 15.25, p < 0.0001) and NDI (BL 42.25–6M 31.61, p < 0.0001) in the overall group. There was a significant small negative correlation between NDI and mJOA at baseline ( R =  − 0.34, p < 0.0001) and at 6-month follow-up ( R =  − 0.44, p < 0.0001). Within the AAG, there was also a significant negative correlation between NDI and mJOA at baseline ( R =  − 0.31, p < 0.0001) and 6 months ( R =  − 0.53, p < 0.0001). Within the PAG, there was also a significant negative correlation between NDI and mJOA at baseline ( R =  − 0.43, p < 0.0001) and 6 months ( R =  − 0.34, p = 0.003).

Conclusion

Overall, NDI has a significant negative correlation with mJOA at baseline and postoperatively in patients with CSM. This correlation increases postoperatively in the overall group. The PAG showed a decrease in the correlation coefficient after surgery, whereas the AAG showed an increase. This could be because the posterior approach tended to be a more extensive surgery for multilevel disease in older patients, compared with the anterior approach, resulting in more soft tissue disruption and a delay in neck active motion. Regardless of the approach, mJOA still remains significantly correlated with NDI.
Cervical Spondylotic Myelopathy: Does Surgical Approach Influence Postoperative Sagittal Alignment and Outcomes?
Authors: Fehlings Michael , Smith Justin , Challier Vincent , Shaffrey Christopher , Kim Han Jo , Arnold Paul , Chapman Jens , Protopsaltis Themistocles , Lafage Virginie , Liu Shian , Lafage Renaud , Schwab Frank , Massicotte Eric , Yoon S. Tim , Ames Christopher
Published: May 2015

Introduction

The effect of surgical approach on outcomes for cervical spondylotic myelopathy (CSM) is controversial. Fehlings et al showed that patients treated with anterior techniques tend to be younger, less impaired, and had more focal pathology. In this study, we compared outcomes of an anterior approach group (AAG) versus a posterior approach group (PAG) with a focus on the effect of sagittal alignment.

Patients and Methods

Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 117 patients met inclusion criteria, were nonrandomized to an AAG ( n = 51) or PAG ( n = 62), with postoperative static lateral radiographs, Nurick assessment, and health-related quality of life outcomes at 6 months and/or 1 year. The AAG underwent anterior decompression and fusion, PAG either laminoplasty or laminectomy with fusion. Sagittal regional and focal parameters were compared by multivariate regression.

Results

At baseline, the groups showed significant age difference (AAG 51 years, PAG 62 years, p < 0.001), rheumatological comorbidity (AAG 3%, PAG 19%, p = 0.011), and modified Japanese orthopaedic association (mJOA). The PAG had significantly more regional malalignment at baseline, but there were no focal alignment differences between the two. Surgical features were significantly different for greater than three levels treated (AAG 27%, PAG 97%, p < 0.001) and blood loss (AAG 152 mL, PAG 380 mL, p < 0.001). After surgery, both AAG and PAG improved significantly in mJOA and Nurick grade, however, there was no statistically significant difference in mJOA postoperatively. AAG had a significant decrease in SVA whereas the PAG had a significant increase in SVA. There were no relevant postoperative focal alignment differences.

Conclusion

The PAG had older patients with more disability. Even when age, baseline mJOA, and regional parameters were controlled, the PAG cohort still correlated with worse CGH_C7 SVA and TS–CL. It is interesting to note that the PAG had a lower mJOA than the AAG at baseline, they both improved and were not significantly different postoperatively. This suggests that both techniques relieve symptomatic disease, but patients in the posterior group may continue to progress in sagittal misalignment.
Reliability Assessment of a Novel Cervical Deformity Classification System
Authors: Smith Justin , Eastlack Robert , Blaskewitz Donald , Shaffrey Christopher , Schwab Frank , Bess Shay , Kim Han Jo , Klineberg Eric , O'Brien Michael , Albert Todd , Riew K. Daniel , Fehlings Michael , Lafage Virginie , Ames Christopher
Published: May 2015

Introduction

Despite the complexity of cervical deformity and the significant impact on patient quality of life, there exists no comprehensive classification. An initial novel classification system has been recently designed with a deformity descriptor and five modifiers that incorporate sagittal regional and global spino-pelvic alignment and neurological status. Our objective was to characterize the intra- and interobserver reliability of this classification.

Material and Methods

A series of 10 cervical deformity cases, broadly representative of the classification system, were selected and sufficient radiographic and clinical history to enable classification were assembled. A panel of deformity surgeons was queried to classify each case twice, with a minimum of 1 intervening week. Inter- and intrarater reliability measures were based on calculations of Fleiss kappa coefficient values.

Results

A total of 20 spine deformity surgeons participated in this study. Interrater reliability (Fleiss kappa coefficients) for the deformity descriptor rounds 1 and 2 were 0.489 and 0.280, respectively, and mean intrarater reliability was 0.584. For the modifiers, including the SRS–Schwab components, the interrater (round 1/round 2) and intrarater reliabilities (Fleiss kappa coefficients) were as follows: C2-C7 SVA (0.338/0.412, 0.584), horizontal gaze (0.779/0.430, 0.768), TS–CL (0.721/0.567, 0.720), myelopathy (0.602/0.477, 0.746), curve type (0.590/0.433, 0.564), PI–LL (0.554/0.386, 0.826), PT (0.714/0.627, 0.633), and C7–S1 SVA (0.071/0.064, 0.233), respectively. The parameter with the poorest reliability was the C7–S1 SVA, which may have resulted from differences in interpretation of positive and negative measurements.

Conclusion

The proposed classification provides a mechanism to assess cervical deformity within the framework of global spino-pelvic malalignment and clinically relevant parameters. The intra- and interobserver reliabilities suggest moderate agreement and serve as the basis for subsequent improvement and study of the proposed classification.
Rationale, Design, and Early Trial Performance of AOSpine North America Multicenter Double Blind Randomized Controlled Trial of Safety and Efficacy of Riluzole in CSM (CSM—Protect Trial)
Authors: Fehlings Michael , Kopjar Branko
Published: May 2015

Introduction

Although surgical decompression is an effective treatment for cervical spondylotic myelopathy (CSM), many patients have substantial residual neurological and functional impairment. Compelling evidence from preclinical models suggest a benefit of adding a neuroprotective drug which targets sodium/glutamate excitotoxicity to the treatment of patients with CSM. The purpose of this study is to evaluate efficacy and safety of sodium-glutamate antagonist riluzole in improving neurological outcomes in patients with CSM undergoing surgical treatment.

Patients and Methods

Prospective multicenter double-blind randomized controlled trial in which a total of 300 patients undergoing surgical decompression for CSM will be randomized 1:1 to riluzole 2 × 50 mg daily for 14 days before the surgery and 28 days after the surgery or to the placebo. Primary outcome measure is change in mJOA between baseline and 6 months. Secondary outcomes include ASIA, SF36v2, NDI, Eq. 5D, Pain VAS, and complications. Sample size was estimated based on data from recently completed prospective cohort study. The sample size of 270 completed subjects will have 80% power to detect absolute difference of 0.9 in mJOA score between the investigational and the control group. The statistical analysis is organized as a sequential adaptive trial with one interim analysis at 65% of the accrued sample for early futility and efficacy. Adaptive statistical design allows for sample size adjustment at the time of interim analysis.

Results

To date, 153 subjects have been enrolled. Average age of the enrolled subjects is 58.4 years (SD, 10.13). The baseline mJOA is 11.9 (SD, 1.5). Baseline NDI is 42.4 (SD, 20.1) and the baseline SF36v2 Physical Component Score (PCS) is 33.5 (SD, 9.3).

Conclusion

In spite of the benefits of the surgical intervention, patients with CSM experience significant residual impairment and neurological compromise. Adding neuroprotective treatment with riluzole may improve outcomes of surgery. This discussion will emphasize the unique study design and the biological rationale for considering riluzole as a potential neuroprotective adjunct for patients undergoing surgery for CSM.
Preoperative Patients' Perception of Motor Deficit caused by Lumbar Disc Herniation and its influence on Health-Related Quality of Life
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Bossardi Julia Bertholdo , Conzatti Lucas Piccoli
Published: May 2015

Introduction

The incidence of motor deficits (MD) varies from 15 to 69% during the investigative or preoperative period. There seems to be no consensus regarding the precise importance of neurological impairment in determining the need for surgery and its impact on the patient's self-reported health-related quality of life (HRQoL). The objective of this study was to evaluate the impact of MD on the HRQoL of patients with lumbar disc herniation (LDH) before a specific treatment.

Patients and Methods

A prospective cohort of 254 consecutively enrolled patients with LDH associated to neurological impairment and sciatica without a response to conservative treatment was evaluated. After exclusion criteria, 168 were included. Validated instruments in the preoperative period were used to evaluate QoL: pain, disability, QoL, anxiety, and depression.

Results

A normal motor strength was observed in 57 (33.9%) patients and MD was observed in 111 (66.1%) cases. No statistically significant differences were observed between patients with and without MD regarding gender, age, level of herniation, lateralization, and work compensation. Regarding QoL, no difference was detected in the eight domains of SF-36 and between the PCS and MCS groups. The only difference observed was a higher disability rate in the MD group, with the mean ODI difference being 7.84 (CI 95%, 1.82–13.87; p = 0.011) Motor weakness was observed by 35.1% ( n = 39/111) of patients with an abnormal motor examination and it was related to severity ( X2: 46.058; p < 0.0001).

Conclusion

In patients with LDH without a specific treatment, the presence of MD does not impair the pain, disability, depression, and self-reported QoL measures. The MD has no discriminative power for QoL measures in patients with LDH.
Outcome Assessment in Spine Surgery
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , Dal Castel Mateus , Coberlini Louise , Cardoso Scheila
Published: May 2015

Introduction

The use of clinical and functional evaluation instruments for vertebral pathologies, besides determining how the situation evolves after treatment, can predict the postoperative outcome. The objective of this study is to describe the methodology to evaluate outcome in the spinal surgery.

Patients and Methods

After surgical treatment is indicated, the patients are invited to participate in the study by signing a letter of free and informed consent. The patients complete the questionnaires at the doctor's office, and are helped regarding doubts in filling them out by a person who is not involved in the surgery. All the evaluation instruments used are self-applied. The following are used: numerical rating scale of pain (NRS), SF-36 questionnaire, Fear-Avoidance Beliefs questionnaire (FABq), Beck Depression Inventory (BDI), hospital anxiety and depression scale (HAD), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). The patient himself/herself answered the questionnaire, not the secretary or the surgeons. The patient fill out the questionnaire using a regular paper (paper-and-pen questionnaire) or computer software directly using the internet from their home. The surgeons give the patients feedback on the results.

Results

A total of 220 patients with lumbar spine pathologies and 32 with cervical pathologies were evaluated. Typically, when completing paper forms the data are collected, recorded, and computerized manually. The pros was that you got something answered by the patient and the cons were missing values—the patient does not answer some questions (3%), the secretary skips some questions (1%), misrecordings with the chance of error when inserting the data into the computer (range, 2–5%); and secretary's work were laborious and time consuming. When the patient answered the questionnaire directly to the computer software, the data were self-recorded by the patient using a touch-screen system at the clinic or by accessing the webpage using their own username and password. In those cases, the cons were that some patients do not know how to deal with a computer and the pros were that the data are already in the computer and in the Excel workbook and when the patient enters the office the surgeons already have the questionnaire results. The prevalence of depression according to the BDI was 28.0 and 31.2% in patients with lumbar and cervical surgical disease, and the prevalence of anxiety according to HAD-A is 40.1 and 46.9%, respectively. The mean of ODI was 46.5 and of NDI 25.4. Most of the patients, when they have been instructed about completing them, do not have any difficulty in finishing them. The mean time for the completion of all instruments is 25 to 35 minutes.

Conclusion

The use of instruments validated to evaluate patients with degenerative spinal diseases is feasible and should be encouraged among the spinal surgeons. Following the right steps, the patient is convinced of the importance of answering correctly.
Effective Protocol to Treat Patients with Deep Wound Infection after Spinal Lumbar Fusion
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Bassanesi Francisco
Published: May 2015

Introduction

Deep wound infection (DWI) is a complication associated with poorer outcome and increased costs. The DWI rates increased in the last decade especially because of the use of spinal instrumentation. Although this condition is important for the surgical outcome, there is still no agreement about the about the need to remove the instrumentation. The objective is to describe the authors' experience in managing DWI without the removal of instrumentation after performing a procedure on the lumbar spine and the clinical and functional long-term course of these patients.

Patients and Methods

A prospective cohort study with the patients who presented deep infection of the surgical wound. All the patients with a clinical suspicion of this complication were submitted to an aggressive protocol of wound opening, collection of material for a microbiological examination, exhaustive washing, debridement, implementation of a continuous washing system, primary suturing of the wound, and treatment with antibiotics IV and then orally. The instrumentation was not removed from any patient. The patients were evaluated radiologically, clinically, functionally, and by blood test examination, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein, during the follow-up. Paired analyses were performed using the Wilcoxon test to evaluate changes in the instrument scores.

Results

The mean age was 59.31 ( ± 13.17) and most of the patients were female (94.7%; 18/19). At least one comorbidity was observed in 68.4% of the patients, the most frequent being obesity, present in 26.3% of the patients. The mean period for the identification of DWI was 2 weeks and 57.9% underwent only one wound exploration. Staphylococcus aureus was the most common microorganisms ( n = 13 cases, 68.4%). Blood tests showed a significant decrease of the WBC, ESR, and CRP 6 weeks' posttreatment when compared with pretreatment values. Comparing the 6 weeks' posttreatment evaluation and the final evaluation, a significant reduction of ESR and CRP was also observed.

Conclusion

Patients with DWI after posterior lumbar spinal instrumentation fusion can be treated without removal of the instrumentation through an aggressive protocol of wound exploration, extensive washing, debridement of necrotic tissue, closed irrigation system during 5 days, and proper antibiotic therapy. The WBC, ESR, and CRP blood tests were not useful to predict the need for surgical reinterventions. Despite the complication, the patients presented improvement with respect to pain, functional capacity, and preoperative quality of life.
Minimally Invasive Scoliosis Surgery in Lenke 5 Adolescent Idiopathic Scoliosis: A Preliminary Result
Authors: Zhu Zezhang , Liu Zhen , Zhu Wei-Guo , Qian Bang-Ping , Wang Bin , Sun Xu , Yu Yang , Zhu Feng , Qiu Yong
Published: May 2015

Introduction

Minimally invasive spine surgery has been introduced in the treatment of multilevel pathology, such as adult lumbar degenerative disorders. Recently, the concept of minimally invasive scoliosis surgery (MISS) was put forward and applied to the correction of scoliosis. However, few studies have reported the utilization of MISS technique in adolescent idiopathic scoliosis (AIS). The objective of this study is to assess the outcomes of posterior MISS in Lenke 5 AIS.

Patients and Methods

A total of seven patients were included who underwent posterior MISS from November 2012 to July 2014. There were six females and one male, with an average age of 17 years (range, 15–18 years). The operation time and intraoperative blood loss were recorded. The following radiographic parameters were evaluated before surgery, immediately after surgery, and at the last follow-up: curve magnitude, apical vertebral translation (AVT), apical vertebral rotation (AVR), trunk shift, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The accuracy of pedicle screw placement was assessed according to postoperative CT scans. Screw perforation > 2 mm of either pedicular or vertebral cortex was considered at potential risk, and medial pedicle perforation > 4 mm or contour of aorta was considered at high risk.

Results

The average operation time was 4.4 hours (range, 2.0–6.5 hours) and intraoperative blood loss was 225 mL on average (range, 100–400 mL). A total of 66 screws were inserted in the seven patients. The Cobb angle of thoracolumbar/lumbar curve was 40 to 65 degrees (mean, 46.3 degrees) before surgery. Immediately after surgery, the correction rate of main curve was 76.4% on average (range, 70.0–87.8%), and an obvious improvement was noted in terms of AVT, AVR, trunk shift, TK, and TLK. All the patients were followed up for 8.4 months (range, 3–21 months) on average. At the last follow-up, the average loss of correction of the main curve was 1.9% (range, 0–6.0%). Except the increase of SVA (from −31.1 to −7.3 mm), no obvious changes of AVT, AVR, trunk shift, TK, TLK, and LL were observed during the follow-up. According to CT evaluation, 56 screws (84.9%) were fully contained within the cortical boundaries of the pedicle, 10 screws (15.1%) breached pedicle walls whereas 5 screws (7.5%) were at potential risk. No wound infection, implant failure, and neurologic complications were found after surgery.

Conclusion

A minimally invasive posterior approach, although technically challenging, is a feasible and safe option for patients with Lenke 5 AIS. However, long-term data are needed before routine use.
Nucleoplasty for the Treatment of Low Back Pain Caused by Degenerative Disc Disease
Authors: Manukovsky Vadim , Tiulikov Konstantin , Litvinenko Igor , Korostelev Konstantin , Badalov Vadim
Published: May 2015

Introduction

Puncture methods—Nucleoplasty by coblation and radio frequency denervation—have recently been widely used for the treatment of pain syndrome caused by intervertebral disc protrusion. The purpose of this study was to assess the effectiveness of nucleoplasty and radio frequency denervation of intervertebral joints as advanced minimally invasive surgical techniques for alleviating pain in the case of intervertebral disc disease, spondylarthrosis, and other vertebroneurologic diseases accompanying degenerative disc disease.

Methods

Since 2010, 70 patients with lumbar disc protrusion and signs disc-radicular conflict underwent nucleoplasty by cold plasma. All patients had a history of back pain or/and leg pain for not less than 3 months and were followed up after undergoing minimally invasive procedures for a year. Visual Analog Scale, Oswestry Disability Index (ODI), and Treatment Satisfaction Scale were used for evaluation. A total of 50 patients of control group also with protrusion of intervertebral disc were treated therapeutically.

Results

No complications were noted. At 12-month follow-up, all the operated patients showed the decrease of pain syndrome intensity according to the Visual Analogue Scale ( p < 0.0001), and decrease ODI compared with patients treated therapeutically ( p < 0.001). Treatment Satisfaction scores were higher as compared with the patients of the control group.

Conclusions

Nucleoplasty allowed us to successfully treat patients affected by lumbar disc protrusion who treated therapeutically not less than 6 weeks without effect. Minimally invasive electrosurgical techniques appeared to be safe and effective in the treatment of carefully selected patients suffering from low back and leg pains caused by a degenerative-dystrophic process. Nucleoplasty technique is more effective in younger patients. Procedures performed at several levels also result in marked clinical improvement. the primary advantages of these techniques were their safety and efficacy, minimal invasiveness, and the absence of a peridural scar. They do not complicate further microsurgical intervention.
Lumbar XLIF and Bilateral Percutaneous Pedicle Screw Fixation Performed all in Lateral Position
Authors: Buric Josip
Published: May 2015

Introduction

Evaluation of the feasibility, technical difficulty, and clinical results in performing combined lumbar XLIF and bilateral percutaneous pedicle screw fixation done all in lateral position. Lumbar XLIF and bilateral percutaneous pedicle fixation is a valuable minimally invasive approach for achieving a useful and solid lumbar circumferential fusion in selected cases. Nonetheless, until today a change of the position of the patient on the operating table from lateral to prone was used. Theoretically, performing both approaches in the same position would significantly reduce the time of surgery.

Patients and Methods

A total of 10 consecutive patients were submitted to a circumferential fusion done in the same, lateral, and position. There were six female and four male patients, mean age 52 years. Low back pain and degenerative disc disease were the main patient's complaint and pathology, respectively. Patients were followed up for surgery length and walk out of bed timing and compared with the patients done previously with change of position. Clinical outcome was evaluated with VAS and ODI scores.

Results

Four patients performed a two-level circumferential fusion (L3–L5) whereas six patients performed the procedure on a single level (four on L4–L5 and two on L3–L4). Mean surgical time was 79 ( ± 14) minutes (29 for XLIF and 50 for pedicle fixation) and 114 ( ± 21) minutes (54 for XLIF and 60 for pedicle fixation) for 1 and 2 level circumferential fusion, respectively. Average time lap between the XLIF part and pedicle screw part of the procedure was 4 minutes. As compared with the usual approach with the change of position, approximately 20 minutes were saved. There was no significant difference in walk out of bed timing as well as no difference was found for clinical outcome scores (VAS and ODI). No additional complications were noted in this group of patients as compared with the patients operated previously with the change of position.

Conclusion

Lumbar circumferential fusion with XLIF and bilateral percutaneous pedicle screw fixation performed in lateral position seems a useful modification of the classical method done in two different positions. The main advantage is time saving. Technical challenge in performing the procedure in lateral position is slightly more demanding because of the different patient orientation; however, the learning curve is short and after a few cases, the timing of the approaches between prone and lateral position equals. No differences on clinical outcomes and complication rates were noted.
Magnetic Resonance Imaging association with the preoperative Neurological Status and its Predictive Value of the Postoperative Recovery in Patients with Cervical Spondylotic Myelopathy
Authors: Zaater Ahmed , Mashhour Shady
Published: May 2015

Introduction

This is a prospective observational study of consecutive patients undergoing surgery with cervical spondylotic myelopathy (CSM), to assess the association of the quantitative assessment of preoperative magnetic resonance imaging (MRI) with the preoperative neurological status and postoperative neurological recovery. The factors of predictive value to the neurological recovery in patients with CSM postoperatively are of great interest. Currently, the significance of MRI signal changes in relation to prognosis in the literature is conflicting and inconsistent.

Patients and Methods

A 50 consecutive patients with CSM were studied preoperatively and postoperatively after 1 year. Modified Japanese Orthopedic Association (mJOA) was recorded preoperatively and 1 year after surgery. Using univariate and multivariate analysis, the relation of the preoperative status and postoperative recovery to quantitative MRI measurements preoperatively were assessed.

Results

Low T1 signal change preoperatively was associated with a lower preoperative mJOA ( p = 0.021). Focal high T2 signal was associated with lower preoperative mJOA scores ( p = 0.62). Preoperative focal T2 signal had a significant association with poorer postoperative recovery rate ( p = 0.032).

Conclusion

MRI signal changes can predict preoperative neurological status and postoperative recovery. The presence of hypointense T1 signal and focal hyperintense T2 signal on MRI are indicators of poorer outcome.
A Field Survey of Spinal Cord Injury in Bodyboarders
Authors: Yanagawa Youichi , Ishikawa Kouhei , Omori Kazuhiko , Obinata Mariko , Osaka Hiromichi , Oode Yasumasa , Kubota Atsushi , Sakuraba Keishoku
Published: May 2015

Introduction

During the summer, a large number of tourists visit Izu Peninsula, and our hospital is the only hospital capable of treating patients with acute-phase spinal cord injuries on Izu Peninsula. Among the various marine sports, bodyboarding was the leading cause of spinal cord injury in subjects transported by the physician-staffed emergency helicopters in Izu peninsula.1 Hence, we investigated the number of players of surfing, bodyboarding, and obtained information using a questionnaire in a field.

Material and Methods

From July 26, 2014 to August 5, 2014, we asked bodyboarders at the beaches and our hospital on Izu Peninsula to complete a questionnaire. The items on the questionnaire were as follows: sex, age, hometown, years of experience, owner of the bodyboard, history of head injury, history of dysesthesia of the extremities, background of the event if the answer was yes for a history of head injury or dysesthesia, and whether the bodyboarder was aware of the possibility of spinal cord injury while bodyboarding. The subjects were divided into two groups based on whether they did or did not experience dysesthesia during bodyboarding. And, we also counted the number of bodyboarders and surfers at several beaches on Izu Peninsula by eyesight, during the top season of summer from August 17, 2014 to August 23, 2014.

Results

We obtained answers from 24 bodyboarders. During this period, the number of bodyboarders was clearly fewer than that of surfers. There were no significant differences in terms of sex, hometown, years of experience, owner of the bodyboard, and knowledge of the possibility of spinal cord injury while bodyboarding. Meanwhile, the age of the subjects in the Dysesthesia group ( n = 4) was older than that of the Control group ( n = 20, p < 0.05). All of the subjects in the Dysesthesia group felt dysesthesia of the upper extremities when their head hit the sea bottom while being buffeted by waves. During this summer season, there was the only case of spinal cord injury induced by bodyboarding, and there were no cases of spinal cord injury induced by surfing. Concerning the results of number for each sport, there were 498 surfers and 643 bodyboarders during the top season of summer. The ratio of players of the two sports was 1 to 1.3, whereas the ratio of patients with spinal cord injury was 1 to 14 over a 5-year period.1 Most of them had cervical spinal stenosis.

Conclusion

Bodyboarders are more likely to experience spinal cord injury than surfers. A middle-aged or older people, who may have signs of cervical spinal canal stenosis, such as neck pain or dysesthesia of the extremities, should avoid bodyboarding to avoid spinal cord injury. Reference Omori K, Kondo A, Oode Y, Itoi A, Sakuraba K, Yanagawa Y. Factors related to trauma secondary to bodyboarding water sport. J Emerg Trauma Shock
Flowcytometric Evaluation of the Safety of Intraoperative Salvaged Blood Filtered with Leucocyte Depletion Filter in Spine Tumor Surgery
Authors: Kumar Naresh
Published: May 2015

Background

Intraoperative cell salvage (IOCS) has not been widely adopted in oncological surgery because of hypothetical concern of reinfusion of malignant cells. We conducted the study to evaluate the feasibility of IOCS in combination with leukocyte depletion filter (LDF) in metastatic spine tumor surgery (MSTS) using quantitative flow cytometry tumor detection technique.

Methods

Patients with known primary epithelial tumor, operated for metastatic spinal disease, were recruited. Blood samples were collected at five different stages during surgery: two stages from patient vein during induction and at the time of maximum tumor manipulation, three stages from the operative blood before IOCS processing, after IOCS processing, and after IOCS–LDF processing. Of the samples taken at each stage, 5 mL were analyzed for tumor cells using flow cytometry.

Results

Of the 12 patients recruited, only 11 could be finally analyzed. Flow cytometry analysis of their samples showed that 8 of 11 patients had tumor cells in the unfiltered salvaged blood. In filtered salvaged blood, the tumor cell count was zero in the majority of samples (8/11 patients) whereas three patients' samples had a few tumor cells. The difference between the mean tumor cell quantity in the samples taken from stages A and E was significant ( p = 0.04). Similarly, the difference between the mean quantities of tumor cells in the samples in stages B and E was significant ( p = 0.01). However, there were no significant differences between the mean quantities of tumor cells when comparing the samples from either stages A and B, stages D and E, or stages C and E.

Conclusion

IOCS–LDF was shown to be effective in removing tumor cells from blood salvaged during MSTS. If there were any tumor cells found, the quantity was significantly less than that in patient's circulation. The results of this study supported that fact that IOCS–LDF treated blood in MSTS is safe for transfusion.