bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Risk Factors for Early Adjacent Segment Disease Underwent Revision Surgery within 5 Years after Lumbar Spinal Fusion
Authors: Soh Jaewan , Hong Chang-Hwa
Published: April 2016

Introduction

There are many concerns about adjacent segment disease after lumbar spinal fusion using pedicle screws. Of them, we have a question which occurs early adjacent segment disease(EASD) within 5 years. We analyze the risk factors about EASD in patients who underwent revision surgery within 5 years from first operation.

Materials and Methods

From August 1988 to December 2007, 657 patients underwent lumbar spinal fusion of 3 and less segment to treat degenerative lumbar disease. Among them, 137 patients underwent revision surgery within 5 years due to adjacent segment disease or previously followed more than 5 years were included in this study. Gender, age, fusion method, preoperative diagnosis, number of fusion segments and radiological measurements were analyzed. In radiological measurement, pre-& post-operative lumbar lordotic angle(LLA), pre-& post-operative fusion segment lordotic angle(FSLA), pre-& post-operative FSLA per level, correction of LLA, correction of FSLA, and correction of FSLA per level were estimated. Statistical univariate analysis was performed with the Chi-square test and multivariate logistic regression analysis was done by using SPSS 14.0.

Results

There were 13 patients with revision surgery due to EASD. 6 patients were operated by decompression or discectomy and 7 patients needed additional fusion. In univatiate analysis, there was little relationship between EASD and gender, age, preoperative diagnosis, number of fusion segments, pre-& post-operative LLA, pre-& post-operative FSLA, pre-& post-operative FSLA per level, correction of FSLA and correction of FSLA per level. However, the frequency of EASD was significantly high in cases where PLIF was more than PLF( p = 0.023), correction of LLA was > 15°( p = 0.021) and correction of FSLA per level was > 5°( p = 0.049). In multivariate logistic regression analysis, the frequency of ESAD was significantly high in case where PLIF was more than PLF(odd ratio = 17.866) and correction of LLA was > 15°(odd ratio = 19.282).

Conclusions

There was no statistical significance between EASD and gender, age, preoperative diagnosis, number of fusion segments, pre-& post-operative LLA, pre-& post-operative FSLA, pre-& post-operative FSLA per level, correction of FSLA and correction of FSLA per level. However, PLIF and correction of LLA more than 15 degree increased risk of EASD.
Comparison of Three Doses of Epidural Steroid Injection with Single Dose of Epidural Steroid Injection for Lumbar Radicular pain in Spinal Stenosis Patients
Authors: Ahmad Saeed , Aziz Amer , Ahmed Ijaz , Javed Shahzad , Ahmed Naeem , Uz-Zaman Atiq , Akram Rizwan
Published: April 2016

Introduction

Low Back pain and lumbar radicular pain due to Lumbar spine stenosis is one of the most common complaint in the Spine outpatient department or hospital admissions. Epidural steroid injection have well established role in the treatment of lumbar radicular pain, but the exact dose of Epidural Steroid injection has yet to be decided. The aim of this study is “To Compare three doses of epidural steroid injection with single dose of epidural steroid injection for Lumbar Radicular pain in spinal stenosis patients.”

Materials and Methods

95 patients with lumbar radicular pain due to spinal stenosis were randomly allocated into 2 groups. In group A 42 patients were given 120 mg of Depo-medrol (40 mg per day for 3 days) and in group B, 43 patients were given 40 mg of Depo-medrol as a single dose. Both group A and Group B were matched in terms of age and gender. On visual analogue score pain was assessed after 2 weeks, 3 months and 6 months.

Results

In group A (3 doses of depomedrol) VAS improvement at 2 weeks, 3 months and 6 months were more than group B(single dose of depomedrol) which was statistically significant ( p < 0.05). There were no major complications like epidural hematoma or abscess formation in both groups. The overall minor complications like flushing, transient hyperglycemia and headache due to CSF hypotension were more in Group A than Group B but statistics shows no significant difference. All the complications resolved without any morbidity and no patient required further hospitalization.

Conclusion

In the case of lumbar radicular pain, Epidural Steriod Injection with 3 doses of Depo-medrol is more effective than a single dose of epidural steroid without significant increase risk of complications.
Thoracic Disc Herniation: 20 Years Experience in 82 Cases
Authors: Rahimizadeh Abolfazl
Published: April 2016

Objective

Thoracic disc herniation in uncommon though its surgical management remains challenging topic. Surgery of such disc herniation represents less than 1%to 2% of operation for all disc disease. However, there is no consensus on the best approach and reports are based on small series. Method:This study includes 82 patients with thoracic disc herniation operated in the past 20 years. 71 cases were operated via transthoracic or retopeitonral subdiphargmatic approach and nine through transfacet pedicle sparing route and Two with T1-T2 through low suprasternal notch corridor. In 12 instances two level discs were approached and in one three level, corpectomy was done in 3 cases. Autogenous graft was used in 18 cases, simple cages in 36, expandable cage in three and allograft in the remaining cases.

Result

Clinical outcome according to the thoracic JOA Score showed significant postoperative improvement. All transfacet pedicle sparing cases and two cases with isolated T1-T2 showed excellent result. six of the anterior group cases were complicated with unilateral paralysis of abdominal wall muscles. Intraoperative dural tear occurred in 4 cases which were sutured. All the patients in this group showed marked recovery except one who was temporarily deteriorated but gradually became better but not fully yet. In two other patients who were wrongly operated with laminectomy and screw fixation no recovery was seen in one but the other one has shown some recovery. In one case where the dura was covered with a thin layer of free fat graft for control of bleeding, overgrowth of fat was observed without any neurology till now.

Conclusion

Surgery of thoracic disc pose a challenge to the surgeon. The type of the surgery depends on the location of the disc. Centrally located ones and calcified hard ones are best achieved anteriorly But does located laterally via transfacet pedicle spring. Clinical outcome after surgery of a herniated thoracic disc proved successful, especially when the disc consistency, is evaluated before surgery and the affected level intraoperatively. Microscope, patience and the learning curve are important in achieving good result.
How Lumbar Disc Geometrics Affect the Risk for Rod Fracture in Patients Undergoing Adult Spinal Deformity Surgery: An Initial Report
Authors: Briski David , Zavatsky Joseph , Cook Brandon
Published: April 2016

Introduction

Rod fracture (RF) may have significant consequences for patients, including pain, loss of deformity correction, and the need for revision surgery. Risk factors associated with RF includes age, previous spine surgery, insufficient sagittal plane correction, rod material and bending, and pedicle subtraction osteotomy (PSO). Lumbar disc geometrics, regardless of PSO, may be a risk factor affecting RF rates. Out Objective is to evaluate disc geometrics as a risk factor for RF in patients undergoing surgical correction for adult spinal deformity (ASD). Materials/Methods: A retrospective review of a single surgeon's practice from 2010 to 2014 was performed. All patients who underwent long fusion constructs for adult deformity with a minimum of 2-year follow-up with radiographs were included. Patients were divided into 2 Groups: Group 1 (RF) - patients who sustained a rod fracture, Group 2 - patients without RF.

Results

Thirty-seven of 41 patients met inclusion criteria. Group 1 - included 11 patients (30%) with RF, all requiring revision surgery. Group 2 - included 26 patients (70%) who did not have evidence of RF at 2-year follow-up. There was no significant difference between the 2 Groups regarding age, weight, construct length (12 versus 11 levels), apical lordosis level (L3), pre or post-operative lumbar lordosis, or mean number of non-fused lumbar discs (3). Twenty-one of the 37 patients (54%) had a PSO performed. There was no difference in the prevalence of PSO between the 2 Groups: 5/11 patients (45%) in Group 1 (RF) versus 17/26 patients (65%) in Group 2. Nineteen of the 37 patients (51%) had previous lumbar spinal surgery. Measurements comparing intervertebral disc geometry 2 levels immediately cranial and caudal to the PSO or the apical lumbar vertebra were noted to have a significant difference in the mean cranial disc height (9.5mm versus 6.5mm, p < 0.01), mean cranial diameter (40mm versus 34mm, p < 0.01), mean cranial volume (13284mm3 versus 8145mm3, p < 0.01), and mean caudal volume (10635mm3 versus 7771mm3, p = 0.02). Caudal disc heights and diameters were larger in the RF group, but did not reach statistical significance.

Conclusions

The overall prevalence of RF was 27% with no difference in PSO rate between the 2 Groups. Patients with RF had significantly larger non-fused disc heights, diameters and volumes. The increased disc geometrics may allow for increased micro-motion in the anterior column resulting in increased failure rates. Lumbar interbody support in those discs at risk may improve stability and decrease RF rates. Further data analysis and clinical correlation is required.
Preoperative Prone Position Exercises: A Simple and Novel Method to Improve Tolerance in Kyphoplasty for Treatment of Single Level Osteoporotic Vertebral Compression Fractures
Authors: Lee Guangzhou , Wang Qing
Published: April 2016

Introduction

To evaluate the effect of preoperative prone position exercises(PPPE) on patient tolerance to percutaneous kyphoplasty(KP) and to determine if such exercises will improve postoperative clinical outcome.

Material and Methods

Eighty-three patients with single level osteoporotic vertebral compression fractures (OVCFs) were nonrandomly assigned to undergo KP under local anesthesia with PPPE or without. The number of procedure with or without a pause, need for intravenous sedation, and patient satisfactory were recorded and analyzed. Clinical outcomes were assessed using the visual analog scale and the Oswestry Disability Index. The follow-up time was 6 months.

Results

The baseline characteristics of both groups were comparable. The number of procedure without a pause in the exercises group was more than the control group (30/42 patients vs 10/41 patients, respectively, P < 0.001),and fewer patients required intravenous sedation in the exercises group (7/42 vs 28/41, respectively, P < 0.001). Patients in the exercises group were more satisfied compared with the control group (41/42 vs 32/41, respectively, P < 0.01). There were no significant differences between the two groups with regard to improvement in pain and functional scores at all postoperative intervals.

Conclusion

PPPE improves patient tolerance and satisfaction and decreases the need for intravenous sedation for patients with single level OVCFs undergoing KP under local anesthesia. To confirm and validate the results of our study,a large multi-center randomized controlled trial (RCT) study should be conducted.
Facet Joint Manipulation for Craniovertebral Junction Arthrodesis. Worth the Extra Effort?
Authors: Duff John , Henchoz Yves , Bobinski Lukas
Published: April 2016

Introduction

The goal of arthrodesis is bone fusion, effected at the craniovertebral junction through onlay of either morselized iliac crest autograft (ICAG), or posterior structural unicortical ICAGbetween posterior elements. As an alternative, facet manipulation (FM) with C1-C2 or C0-C1 facet decortication and “jamming” of bone spacers into the articular space (C1-C2) has been described. We describe a series of 79 cases of surgical fusion of at least 1 component of the CVJ. FM was used in 65 cases requiring arthrodesis. Among these, we describe 14 cases using cages placed in the atlanto-axial joints (Cage assisted facet arthrodesis CAFA). To examine the efficacy of FM, we look specifically at CT documented fusion, and time to fusion using this technique.

Material and Methods

Retrospective review of medical records of 88 patients undergoing posterior arthrodesis of the craniovertebral junction (CVJ) at our unit from May 2004 to December 2013 was performed. 4 patients were excluded in case of early postoperative death (up to 30 days after the surgery). 5 patients had insufficient radiological follow-up data (follow-up < 6 months). Construct length is detailed in Table 1 . Fusion – pseudarthrosis. Fusion was considered successful on CT if there was visible bridging trabeculations with or without bony remodeling and callus formation, across at least one of C1/C2 facets, and absence of pseudoarthrosis. Criteria for pseudoarthrosis were construct failure, or bone lucency around the screws. Time to fusion was defined as months between surgery and the earliest radiological assessment confirming solid fusion.

Results

Fusion rate and time to fusion. Sixteen patients were not considered for fusion analysis ( N = 6 not grafted), or insufficient follow-up ( N = 10). A solid fusion was achieved in 55 (87.3%) patients. Fusion rate was strongly associated with age. [Table: see text][Figure: see text]

Conclusion

Many techniques are used to achieve solid bony fusion in the upper cervical spine. Facet manipulation, first described by Goel should be the ideal fusion bed but has not been widely used. We report our experience using FM as a fusion technique to highlight its usefulness as a primary means of achieving fusion. It exploits the weight bearing part of the spine, the volume of bone graft materiel is very small compared with other techniques, it can be used when there are no posterior elements. Cage assisted facet arthrodesis (CAFA) may accelerate time to fusion, and may enhance fusion rates.
Two Level Anterior Cervical Arthrodesis with Integrated Spacer and Plate versus Traditional Anterior Spacer and Plate System
Authors: Panchal Ripul , Beliveau Angela , Lee Paul , Shen Peter , Li Chin-Shang , Klineberg Eric , Kim Kee
Published: April 2016

Introduction

Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed by spine surgeons to treat cervical degenerative disc disease. Use of anterior spacer and plate system (ASPS) results in increased disc height, a higher fusion rate, a lower subsidence rate, and a lower complication rates than a spacer alone.1,2 However, anterior cervical plating (ACP) is associated with significant complications, such as dysphagia, plate screw dislodgement, soft tissue injury, esophagus perforation, and neural injury.3–9 Integrated spacer and plate (ISP) or zero-profile cage systems have recently gained popularity among spine surgeon to reduce the drawbacks of the ASPS technique. The objective of this study is to retrospectively evaluate and compare clinical and radiographical outcome of patients after two-level ACDF with IPS and traditional two-level ASPS.

Materials and Methods

From January 2007 to October 2014, a total of 84 consecutive patients with cervical degenerative disc disease who underwent two-level ACDF using the ISP or the ASPS were reviewed for clinical and radiographical outcomes. Patient reported VAS and NDI scores, fusion rates, hardware failure were recorded at 1, 3, 6, 12, and 24 months after surgery.

Results

Forty-three patients received ISP and forty-one patients received ASPS. There were no statistical differences in patient demographics between the two groups. In regards to operative details, there was no statistical differences except ISP were done almost exclusively with autograft and ASPS with allograft. Overall, there were no statistical differences in VAS scores, NDI scores and fusion status between the two groups (p > 0.05). At the proximal surgical level, there was a trend toward an earlier observed radiographic fusion rate in the ASPS group, 6.8 ± 5.4 months compared with ISP group, 8.3 ± 5.5 months ( p = 0.09). Similarly, the observed radiographic fusion rate at the distal surgical level in the ASPS group was 7.0 ± 6.2 months and in the ISP group was 8.1 ± 5.5 months ( p = 0.12). One case of long-term dysphagia (> 3 months) was reported in each group. Both groups had no reports of implant failures.

Conclusion

The integrated spacers and plate for two-level ACDF compared with traditional anterior spacer and plate system may provide comparable clinical and radiographical outcome at two years. However, there may be an earlier observed radiographical fusion in the ASPS group and no difference in long-term reported dysphagia rate.
Is it Necessary to Fuse to S1 for the Tilted L5 in the Treatment of Adult Degenerative Scoliosis?
Authors: Wang Dechun
Published: April 2016

Introduction

The extension of fusion to S1 compared with L5 and lower thoracic levels compared with L1 remains a highly controversial topic in the surgical treatment for adult degenerative scoliosis (ADS). As one of the criterion, if the tilted L5 were over 15°, the distal fusion level should extend to the sacrum. Could the tilted L5 be neutralized and the L5S1 be saved in the ADS correction?

Material and Methods

Posterior one stage of facetectomy and interbody release combined with key segment anterior structural column support were used to treat 32 ADS cases. The thoroughly interbody release and fusion were done with both side in all involved segment, a little bigger inserter were inserted into L3,4 and L4,5 cave side to neutralize the tilted L5 maximally. The operating time and the blood loss were recorded. Mean follow-up was at least two years. All the subjects were analyzed by visual analog scale, Oswestry Disability Index (ODI), and SF-36 scores, SRS 22 before and after surgery and at follow-up. The scoliotic curve, thoracic kyphosis, lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT), sacral slope, and C7 plumb line were measured. For the statistical analysis, multivariate multiple regression models were formulated, considering as significant ( p < 0.05).

Results

The average operating time were 150min and the mean blood loss were 520ml. A statistically significant clinical and radiological amelioration was noted after surgery and at final follow-up. The ODI, and SF-36 scores, SRS 22 improved. The Cobb angle of lumbar lordosis (7 plumb line) and spino-pelvic parameters (PI, PT, sacral slope) returned to the normal range after surgery. L5S1 radiological adjacent segment pathology (RASP) happened in two cases at the follow-up, one was extended to the S1,there is no symptom in another case.

Conclusion

The tilted L5 can be neutralized and the L5S1 can be saved in the ADS correction. Even with a little movement, the saved L5S1 is important for a whole body to balance.
Lateral Approach for Anterior and Anterolateral Placed Cervical Meningioma or Schwannoma
Authors: Abou-Madawi Ali
Published: April 2016

Introduction

Cervical meningioma and schwannoma are benign tumors that may present with a wide variety of clinical features. Surgical treatment of those tumors carries a risk of neurological complications and spinal deformities. Surgical approaches include posterior, anterior, or anterolateral options. This is a Descriptive retrospective clinical case series to evaluate the lateral surgical approach in these tumors.

Patients and Methods

We reviewed patients who underwent lateral surgery for anterior and anterolateral placed cervical meningioma or schwannoma through the past 7 years. A total of 23 patients including 15 females and 8 males were reported. Mean age was 46 years. The average duration of history was 14.9 months. Fourteen patients had meningioma and 9 had schwannoma. According to the JOA-score 15 were normal, 5 were grade-1 and 3 was grade-2. The following factors were evaluated; age, sex, duration, pathology, levels, topographical locations, neurological status, operative time, blood loss, hospital stay, morbidity, and clinical outcome.

Results

All patients were operated through the lateral cervical approach. All patients but three had total tumor removal where small fragment were lift due to technical reasons. According to the JOA-score the 15 normal patients remain the same, the 5 grade-1 improved to normal, and the 3 grade-2 patients improved to normal in one and to grade-1 in another. There was no reported major morbidity or mortality. CSF leak into the closed drainage system was reported in 5 patients without serious effects.

Conclusions

The lateral approach allows for safe and effective removal of anterior and anterolateral placed cervical meningioma or schwannoma. It gives a direct access to tumor without risk of cord manipulation or destabilizing the spine. In addition it gives the same clinical results.as the standard posterior approach.
Trends in Hospital Admissions and Surgical Procedures for Degenerative Lumbar Spine Disease in England: a 15 Year Time-series
Authors: Siva Vino , Papadopoulos Marios , Ozedemir Baris , Patel Hitesh
Published: April 2016

Introduction

Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources.

Material and Methods

Retrospective cohort study using Hospital Episode Statistics (HES) data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyze trends. Outcome measures include trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay.

Results

Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100,000, respectively( p < 0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33 fold increase in admissions for patients aged 60–74 and ≥75 years respectively, and a 2.8 fold increase in procedures for those aged ≥60 years. Trends in hospital admissions were characterized by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay ( p < 0.001). Trends in procedures were characterized by a narrowing gender gap, increasing mean patient age ( p = 0.014) and decreasing mean hospital stay ( p < 0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100,000 (95%CI 0.25–0.30, r 0.99,p < 0.001). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient: 7.63 versus 2.18 per 100,000/year).

Conclusions

LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non-surgical management of this disease, and highlight the need for services capable of dealing with the increased co-morbidity burden associated with an aging patient group.
Socio-Economic Impact of Cervical Spinal Cord Injury Operated in Patients with Lower Income Group
Authors: Goel Shakti Amar , Modi Hitesh N. , Dave Bharat R. , Patel Pankaj R.
Published: April 2016

Introduction

None of study reviewed on socio-economic impact after cervical spine surgery in patients with cervical spine injury or myelopathy. Aim was to study clinico-radiological results and socio-economic impact even after radiologically successful surgery.

Methods

After board approval, 104 participants (56 traumatic, 48 myelopathy) were included. All patients were operated at a single institute between 2007 and 2014 with anterior cervical approach. Patients who were expired after surgery and other pathology were excluded, as aim was to study socio-economic aspect. Nurick scale was used to assess the degree of loss of function in individuals and roentograms for fixation assessment.

Results

The average age of study group was 46.65 years with 58% comprising of males( n = 63). About 46.7% of the study group were laborers or farmers, majority of whom lost their jobs (47%) post injury. None of the patient had medical or life insurance. Average expenditure per family of < 40USD per month. About 19% of the monthly expenditure was spent on their illness; still majority (56%) had aspirations to get the government support in form of financial help or rehabilitation. The Nurick scale did not show any significant change in pre and post operative periods (3.06 v/s 2.83, p > 0.05). Despite good radiological results; the socioeconomic burdens in study group had little impact.

Conclusion

Study shadowed socioeconomic impact after cervical spine injury and are first of its kind in lower income group. Such studies may further throw light in future management of cervical spine injuries in developing versus developed world.
Epidemiology of Traumatic Spinal Cord Injury in Tehran, Iran: A Hospital-based Study
Authors: Sharif-Alhoseini Mahdi , Rahimi-Movaghar Vafa
Published: April 2016

Introduction

Spinal cord injury (SCI) is a devastating condition with enormous personal and social costs. To develop preventive strategies, the determination of epidemiological features and causes is required. The aim of this study was to describe the hospital-based incidence of traumatic spinal cord injury in Tehran, Iran.

Material and Methods

In a retrospective study in Tehran hospitals, the records of traumatic SCI patients, admitted between March 2010 and July 2011 were surveyed.

Results

138 cases of traumatic spinal cord injury were identified. The majority of patients were male (84.8%). The mean age was 33.2 ± 14.3 years. 54.3% patients were residing in Tehran and the others were referred from other cities. The mean annual incidence of hospitalized traumatic spinal cord injury patients of Tehran was 10.5/1,000,000/year (95% confidence interval: 9–12). Fall was the leading cause of injury (45.7%), followed by road traffic crash (40.6%). The most common cause of tetraplegia (cervical traumatic spinal cord injury) was road traffic crash. The duration of hospital stay for tetraplegia and paraplegia (thoracic and lumbar traumatic spinal cord injury) was 22.7 ± 23.7 and 12.5 ± 7.5, respectively ( p < 0.001). Early surgery (surgical decompression within 24 hour) was done for 19% of the patients. The median day of hospitalization for early and late surgery was 7.5 and 12, respectively ( p = 0.044).

Conclusion

Preventing traumatic spinal cord injury should focus on males, age group of 21–30 years, falls and road traffic crash. More studies are suggested to evaluate the incidence of non-hospitalized traumatic spinal cord injury patients.
A Novel Approach to Navigated Implantation of Thoracic and Lumbosacral Pedicle Screws Using Inertial Measurement Units
Authors: Jost Gregory F. , Walti Jonas , Mariani Luigi , Schären Stefan , Cattin Philippe
Published: April 2016

Introduction

A novel method of intraoperative navigation with inertial measurement units was developed to implant pedicle screws in the thoracic and lumbosacral human spine. This was compared with a freehand technique. IMUs house accelerometers and gyroscopes to measure acceleration and angular rotation. Among the many applications, IMUs control and detect motion and orientation of tablet computers and smartphones.

Material and Methods

The study was done on 9 human cadavers. A preoperative CT was performed to measure the axial and sagittal tilt angles of the pedicle screw trajectories from T1 to S1. After defining the entry points on the exposed spine, the IMU-equipped pedicle finder and screwdriver were used to reproduce these tilt angles and implant one half of the screws. The other half was implanted with a freehand technique. Fluoroscopy was not used in any of the procedures. In addition to adhering to anatomic landmarks, the entry points of the last 216 screws of the study were found by intraoperatively reproducing the distance between the left and right pedicle with a divider. The screw trajectories were analyzed and compared on postoperative CTs.

Results

162 screws were implanted with use of the IMUs and 162 screws were implanted with a freehand technique. In relation to the preoperatively planned trajectories, the IMU-guided technique performed significantly better than the freehand technique (axial tilt p = 0.000001, sagittal tilt p = 0.0000000003): With the IMU-guided technique, the mean offsets between the planned and postoperatively measured tilt angles of the screws were for the axial plane 3.3 ° ±3.5° (median 2°, range 0° - 23°) and for the sagittal plane 3.4 ° ±3° (median 3°, range 0° - 13°). For the freehand techniques the mean offsets between the planned and postoperatively measured tilt angles of the screws were for the axial plane 5.6° ±4.5° (median 5°, range 0° - 31°) and for the sagittal plane 6.7° ±5.4° (median 6°, range 0° - 33°). Evaluation of the overall screw position showed that the IMU-guided technique in combination with the divider scored significantly better than the freehand technique plus divider ( p = 0.006).

Conclusion

Inertial measurement unit–based intraoperative navigation may provide a more reliable implantation of pedicle screws in the thoracic and lumbosacral spine than a freehand technique. Furthermore, adding a divider to intraoperatively reproduce the interpedicular distance of a given level may further improve this novel technique. Translating this rather low-cost technology from consumer electronics to a clinical spine scenario may assist implanting thoracic and lumbar pedicle screws with minimal to no fluoroscopic guidance, yet at no loss of precision.
The Establishment of a Predictive Model for Major Postoperative Complications in Spine Deformity Surgery and Evaluation of Its Clinical Application
Authors: Hai Yong , Zhao Hui
Published: April 2016

Introduction

Spinal orthopedic surgery is a risky method for the treatment of spinal deformity. Over the past years, despite of the remarkable progress in the field of spinal surgery, the major complications from spinal surgery still occur. The aim of this study was to establish a predictive model (The Chaoyang risk score) for major complications after surgery to treat spine deformity disease and evaluate its effect for clinical application.

Methods

Data were collected retrospectively from 245 consecutive patients who underwent surgery for spine deformity disease. We defined the major postoperative complications as the occurrence of infection, nerve injury, organ dysfunction, or death after surgery. The logistic coefficient, and the additive score by odds ratio was used to calculate logistic score. The Chaoyang risk score were applied to predict Postoperative Complications. A C statistic (receiver operating characteristic curve) was used to test discrimination of the model. Calibration was assessed by Hosmer-Lemeshow goodness-of-fit statistic.

Results

The result of logistic regression showed that preoperative nerve injury, medical history of spine deformity( > 10years), time of surgery(>5 hours), Maximal voluntary ventilation observed/predicted < 50%, intraoperative osteotomy were independent factors for the complications. The simple logistic model of the Postoperative Complications risk score showed very good discriminatory ability (C statistic = 0.866 > 0.75) and calibration (Hosmer-Lemeshow, p = 0.978 > 0.05) in predicting Postoperative Complications.

Conclusion

The logistic algorithm of the Postoperative Complications risk score is a simple, objective, convenient and accurate scoring system which may be used to predict Complications after surgery to treat scoliosis disease.
Transforaminal Lumbar Interbody Fusion or Posterior Lumbar Interbody Fusion: Which is Better? A Single-Centre Study
Authors: Ashouri Feras , Khan Shoaib , Bahtia Chandra , Aneiba Khaled
Published: April 2016

Introduction

The first lumbar spinal fusion was introduced over 70 years ago and techniques have been evolving since then. Two popular techniques are Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Lumbar Interbody Fusion (PLIF). However, it is still controversial which is better. The aim of this study was to compare the clinical and radiological outcomes of those techniques.

Material and Methods

We retrospectively reviewed our spinal unit database to identify the patients who underwent TLIF and PLIF over the last 1 year. A hundred and ten patients were identified (54 TLIF, 56 PLIF). Demographics, Visual analogue score for leg and back pain and SF36 scores were analyzed preoperatively, at six weeks, six months and twelve months postopertively. Two independent reviewers assessed the X-rays for fusion at twelve months postoperatively using the Brantigan-Steffee classification.

Results

With regards to the clinical outcomes, TLIF patients had significantly better outcomes at six weeks with lower visual analogue scores (VAS) and better SF36 scores. The difference between the two groups has significantly reduced after one year. Both TLIF and PLIF patients had excellent lumbar spine fusion on X-rays at one year with good interobserver reliability (Kappa = 0.95)

Conclusion

Both TLIF and PLIF are excellent techniques for lumbar spinal fusion. There are no significant differences in the clinical and radiological outcomes between the two techniques at one year.
The Outcome of Using Closed Suction Wound Drains in Patients Undergoing Lumbar Spine Surgery: a Systematic Review
Authors: Waly Feras , Alzahrani Mohammad , Abduljabbar Fahad H. , Landry Tara , Ouellet Jean , Moran Kathryn , Dettori Joseph R.
Published: April 2016

Introduction

Wound suction drains have been used to decrease the rate of post-operative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. In spine surgery, controversy is profound as on one side it decreases the rare but devastating complication of post-operative epidural hematoma, while it may have a hypothetical increase in the risk of infection. In the spine literature the incidence of epidural hematoma in the post-procedural period ranges from 0.2–2.9%, while post-operative wound infection is in the 0.7–16%, thus identifying a method that can decrease the incidence of these complications would be of uttermost benefit. To help address this debate, we conducted a systematic review discussing the use of these drains and to extensively explore the efficacy and safety of closed suction wound drainage in spine surgery in the post-operative period.

Materials and Methods

Electronic databases and reference lists of key articles were searched up through January 22nd 2015 to identify studies comparing the use of closed suction wound drains with no drains in spine surgery for lumbar degenerative conditions. Outcomes assessed included the cumulative incidence of epidural hematoma, superficial and deep wound infection and postoperative blood transfusion. The overall strength of evidence across studies was based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group.

Results

Five heterogeneous studies, three randomized controlled trials (RCT) and two cohort studies, form the evidence basis for this report. There was no difference in the incidence of hematoma, superficial wound infection, or deep infection in patients with or without closed suction wound drains after lumbar surgery. The upper bounds of the 95% confidence interval for hematoma ranged from 1.1 to 16.7%; for superficial infection, 1.0 to 7.3%; and for deep infection, 1.0 to 7.1%. One observational study reported a 3.5-fold increase in the risk of blood transfusion in patients with a drain. The overall strength of evidence for these findings is considered LOW or INSUFFICIENT.

Conclusions

Conclusions from this systematic review are limited by the quality of included studies that assessed the use of closed suction wound drains in lumbar spine surgeries for degenerative conditions. We believe that spine surgeons should not routinely rely on use of closed suction wound drains in lumbar spine surgery until higher level of evidence becomes available to support its use.
Assessment of Postoperative Epidural Hematoma after Lumbar Microendoscopic Surgery
Authors: Manabe Hiroaki , Mishiro Takuya
Published: April 2016

Introduction

Symptomatic postoperative spinal epidural hematoma (SEH) is observed occasionally but rarely gets into serious complication after lumbar spinal surgery. It is also known that SEH occurs even in the endoscopic surgery. The purpose of this study is to assess characteristics and outcome of those cases which had SEH treated surgically after the initial microendoscopic surgery in the lumbar spine.

Method

From 2003 to 2015, total of 1249 patients with lumbar disc herniation or canal stenosis underwent microendoscopic discectomy or laminectomy in our institution. Traditional open spinal surgeries were compared with those microendoscopic surgeries. Six patients after microendoscopic surgery in the series required evacuation of SEH after the initial surgery were included in this study. Preoperative characteristics of the patients, clinical outcome and postoperative course were assessed.

Result

The incidence of SEH after microendoscopic surgeries required additional treatment was 0.48% (6 of 1249). The incidence of SHE after open spinal surgeries were 0.77% (11 of 1421). The initial procedure was microendscopic discectomy in three cases and microendoscopic laminotomy in three cases. One patient had hypertension, two patients had prediabetes and one patient had thrombocytopenia (12.110*3/μl) by hepatitis. Three cases were treated in the acute stage (within 24 hours after the surgery) and three cases were treated in the subacute stage (between 3 and 7 days after the surgery). In all cases, severe leg pain was appeared in short time. Two patients got muscle weakness. After the surgical evacuation of hematoma, all cases recovered from neurological symptoms and leg pain immediately. But one patient had repetitive leg pain after the evacuation with local anesthesia or general anesthesia. Finally Blood transfusion and factor VIII were required to stop SEH. Factor VIII activity of the patient was 58% at two days after the initial surgery. The patient fully recovered at six months after the initial surgery.

Conclusion

The incidence of SEH was not significant in comparison with a conventional method. It was considered that narrow epidural space by microendoscopic surgery affected dural compression by even a little bleeding. Basically, in preventing SEH, preoperative bleeding tendency, intraoperative bleeding, postoperative blood pressure and drainage should be confirmed. Even though, it was very difficult to detect the crucial factor of the symptomatic SHE, patient factor like bleeding and cerebrospinal pressure or iatrogenic factor like redundant invasion may lead to symptomatic SHE. Prompt treatment for symptomatic SEH was necessary.
Prospective Multicenter Assessment of Intraoperative and Perioperative Complication Rates Associated with Adult Spinal Deformity (ASD) Surgery in 558 Patients
Authors: Klineberg Eric , Smith Justin , Lafage Virginie , Shaffrey Christopher , Bess R. Shay , Schwab Frank , Gupta Munish Chandra , Hart Robert , Protopsaltis Themistocles , Mundis Gregory , Kim Han Jo , Burton Douglas , Scheer Justin , Ames Christopher ,   International Spine Study Group
Published: April 2016

Introduction

Few previous studies have focused on early (intraoperative and perioperative) complication rates for ASD surgery, with reported overall rates ranging from ~10% to 75%. However, most available studies are relatively small single- center series and likely underestimate complication rates due to retrospective design and lack of rigorous collection of complications. Accurately defining the early complication rates is particularly important for patient counseling with regard to the risks and benefits of surgical treatment.

Material and Methods

As part of a prospective ASD database, standardized collection forms, on-site coordinators and auditing helped ensure complete capture of complications. Intraop and periop (<6 wks) complications were collected for all patients with these available data, regardless of subsequent length of available follow-up.

Results

558 patients underwent surgical treatment for ASD and had a mean age of 57 years, mean Charlson Comorbidity Index of 1.5 and previous surgery in 48%. The majority (98%) of patients had treatment including a posterior instrumented approach and included a 3-column osteotomy in 22% of patients. A total of 171 intraoperative complications (69 major, 102 minor) affected 127 (22.8%) patients, and a total of 272 perioperative complications (133 major, 139 minor) affected 185 (33.2%) patients. Collectively, 443 early complications (202 major, 241 minor) were reported, with 264 (47.3%) patients experiencing one or more complication. The overall mean numbers of intraoperative, perioperative and total complications per patient were 0.31, 0.49 and 0.79, respectively.

Conclusion

ASD surgery is associated with high rates of early complications, with 47.3% of patients having at least one complication. These rates are substantially higher than previously reported. These finding may prove useful in treatment planning and patient counseling.
Management of Cervical Lateral Mass Fractures
Authors: Razzaq Ashfaq
Published: April 2016

Introduction

Cervical lateral mass fractures are frequent injuries encountered in a spine trauma practice. The aim of this study was to define outcomes for operative versus non-operative management by reviewing our experience with these injuries.

Material and Methods

The design of this study was retrospective. It was conducted at University of Alabama Hospitals, USA. Institutional Review Board approval was duly obtained. We used electronic records and ICD codes to identify 34 consecutive cases, presenting to this hospital in the year 2011.

Results

The age range was 22–88 years (mean=45). Most injuries were due to motor vehicle accidents. C7 facets were the most frequently injured ( n = 22). The injuries were grouped by fracture orientation into: Coronal split fracture n = 19, sagittal split n = 8, comminuted n = 4, floating (fractured pedicle and lamina) n = 3. Surgical intervention was performed in 16 patients (47%) and non-surgical (rigid collar/halo) in 18 patients (53%). Of surgical cases, 14 received ACDF and 2 received posterior constructs. The follow-up duration was 2 weeks to 12 months (mean 3.2 months). In the surgical group 8 patients were asymptomatic at follow-up, and 8 patients had neck pain. In the non- surgical group 11 patients were asymptomatic and 2 patients had neck pain. In the surgical group definite evidence of fusion was seen on follow-up radiographs in 7 patients and a further 6 patients did not have any movement on flexion extension views. One patient in the surgical group had post-op movement on dynamic X-Ray. In the non-surgical group, 10 patients had no movement on flexion extension views, one patient had minor movement, and no X-Rays were available in the remaining cases.

Conclusion

Clinical outcomes were similar in both surgical and non-surgical groups of facet fractures, with about half in each group being pain free at follow-up. Similarly radiological studies demonstrated good spinal stability in the majority of both surgical and non- surgical groups. There is no clear consensus in the literature regarding the treatment paradigms for cervical facet fractures. Our retrospective data suggests equivalent outcome with both surgical and non-surgical treatment modalities. Further randomized prospective studies are warranted.
Anterior Cervical Decompression, Fusion, and Stabilization by Cervical Plate and Screw for Traumatic Lower Cervical Spinal Injury: A Series of 62 Patients
Authors: Jonayed Sharif Ahmed , Alam Shah , Karim Rezaul , Chakraborty Shubhendu , Alam Tashfique
Published: April 2016

Introduction

Acute cervical spinal injury is one of the most common causes of severe disability and death following trauma. Though treatment of cervical spine injury is controversial but anterior cervical surgery has still a better outcome then any other method.

Material and Methods

A prospective study was done in NITOR and other private clinics at Dhaka from July 2009 - September 2014. Discectomy or corpectomy was done for decompression, tricortical bone graft or cage with bone graft was used for fusion. Cervical plate was used in all. Total case was 62 (M-46, F-16). Age ranging from 14 – 52 years. Total follow up time was 3 Months to 48 Months. Quantification of deficit and neurological outcome was rated by ASIA impairment scale.

Results

The results shows that peak incidence was in 3rd decade. Falling due to slip while carrying heavy load on head was the most common cause. The commonest skeletal level was C5/C6. Among 62, during the pre operative period, 6 patients had ASIA impairment scale A, 25 patients had ASIA impairment scale B, 28 had ASIA impairment scale C & 3 had ASIA impairment scale D. At follow up, 22 of ASIA B changed to ASIA D, 3 of ASIA B changed to ASIA E, 18 of ASIA C changed to ASIA D, 10 of ASIA C changed to ASIA E, 3 of ASIA D changed to ASIA E & 6 of ASIA A remain unchanged. None had worsening of neurodeficit due to surgery.

Conclusion

For better outcome, proper selection of case is very important. As no neurological recovery occurs in complete lesion but for early mobilization and prevention of further complication- surgery may be considered.
Posterior Transpedicular Approach for Circumferential Decompression and Anterior Reconstruction Using Trabecular Metal Mesh Cage in Patients with Metastatic Spinal Tumor
Authors: Yang Shih-Chieh
Published: April 2016

Introduction

The goal of surgical management for metastatic spinal tumors is to remove the tumor mass, restore the spinal stability and alignment, and provided better quality of life. Posterior transpedicular approach for circumferential decompression and reconstruction was proposed in concern of the morbidity related to anterior approach. We used this unique technique with trabecular metal (TM) mesh cage for anterior reconstruction to treat the patients with metastatic spinal tumor. Our purpose is to evaluate the feasibility and efficacy of this method as an alternative procedure for managing metastatic spinal tumors.

Methods

From January 2009 to December 2012, we performed single stage circumferential debridement and reconstruction with TM mesh cage through single posterior approach to treat 20 patients with metastatic spinal tumors. The visual analog score (VAS), neurologic status, vertebral body reconstruction, operation time, blood loss, and complications were recorded. The patient's conditions were evaluated on the basis of modified Brodsky's criteria which categorized them as excellent, good, fair, or poor.

Results

The average VAS score was 8.2 (range, 7 to 9) before surgery, which was significant decreased to 3.2 (range, 2 to 4) after surgery ( p < 0.001). The average cobb's angle correction was 12 degree (range, 3 to 29). The neurologic status which classified by Frankel's scale was significant improved after surgery ( p < 0.001). No one experienced severe complication such as deep infection or neurologic deterioration. Three patients experienced long-term paresthesia around nerve roots territory. Eighteen patients could achieve good or excellent outcome based on modified Brodsky's criteria and the improvement showed significant difference after surgery ( p < 0.001). The blood loss and operative time in the last 10 cases was significantly decreased while comparing to the initial 10 cases ( p = 0.007 for blood loss and p = 0.005 for operative time). No significant difference in clinical outcome which classified by Macnab criteria between the initial and last 10 patients ( p = 0.654).

Conclusions

In our case series, good functional outcome and low complication rate could be achieved by single-stage posterior transpedicular approach. It could be an alternative method to manage the patients with metastatic spinal tumors.