bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Risk Factors of Proximal Junctional Kyphosis in Surgically Treated Young Children with Scoliosis
Authors: Sun Xu , Chen Xi , Zhu Zezhang , Wang Bin , Qian Bang-Ping , Yu Yang , Zhu Feng , Liu Zhen , Qiu Yong
Published: May 2015

Introduction

Proximal junctional kyphosis (PJK) is a well-recognized postoperative phenomenon in adults and adolescents after scoliosis surgery; however, no reports have addressed the incidence, risk factors, and behavior of PJK in young children following spinal correction surgery. The objective of this study is to determine the incidence, risk factors, and behavior of PJK in young children undergoing posterior instrumented spinal fusion.

Materials and Methods

This study reviewed 61 consecutive young children with congenital scoliosis treated with posterior instrumented spinal fusion (≥ 4 levels) from 2009 to 2011 in our center. They were younger than 10 years at surgery and had a UIV located between TI and T11. They were followed-up for at least 2 years. PJK was defined by a proximal junctional angle greater than 10 degrees and at least 10 degrees greater than the corresponding preoperative measurement. Radiographic measurements were performed preoperatively, immediately after surgery, and at latest follow-up, including proximal junctional angle (PJA), thoracic kyphosis, lumbar lordosis, kyphosis angles at T1–UIV, and UIV–T12, as well as the matching of rod contour. Matched rod contour referred to the difference between the proximal instrumented region angle and the proximal rod curvature less than 5 degrees. Comparison was performed between patients with and without PJK.

Results

The average age at surgery was 5.4 years (2–10 years) and the average follow-up was 2.7 years (2–4 years). PJK developed in 11 of the 61 patients (incidence, 18%). PJK group had larger preoperative thoracic kyphosis (48.7 vs. 36.3 degrees), longer fusion levels (9.2 vs. 6.8 levels), and larger amount of kyphosis correction (20.8 vs. 11.7 degrees). In addition, proximal instrumentation failure and unmatching of rod contour were identified as risk factors significantly associated with the occurrence of PJK. In the PJK group, average PJA increased by 14.4 degrees after 3 to 6 months postoperatively and then by 2.5 degrees until final follow-up. Six patients had screw pullout at the upmost instrumented vertebra but none complained of pain or appearance problems. They received brace treatment and their PJK was resolved.

Conclusion

This study demonstrated that 18% of young children were observed with PJK after correction surgery for congenital scoliosis. PJK mainly occurred within 6 months postoperatively, and its risk factors included preoperative hyperkyphosis and over correction of kyphosis, proximal instrumentation failure, and unmatching of rod contour. Brace treatment served as a salvage option for PJK in young children.
Radiological Outcome in Adolescent Idiopathic Scoliosis Patients 20 Years after Treatment
Authors: Simony Ane , Christensen Steen Bach , Andersen Mikkel O.
Published: May 2015

Introduction

The purpose of this study was to evaluate the long-term radiological outcome, curve progression, and adjacent level degeneration 20 years after idiopathic scoliosis treatment with Boston brace or Harrington rods.

Materials and Methods

A total of 219 patients treated with Boston brace or posterior spinal fusion a.m. Harrington were invited to participate in a long-term evaluation with clinical examination and X-ray evaluation. The old medical charts and X-ray descriptions were available. Standing X-ray was examined, the Cobb angle measured and compared with the patient's previous X-ray and the adjacent levels were evaluated for any signs of adjacent level disease or local kyphosis.

Results

A total of 159 patients (78%) participated. Of them, 66 patients were treated with Boston brace and 92 patients were treated with posterior spinal fusion a.m. Harrington. In the brace group, the Cobb angle before treatment was 37.5 degrees (35.1–40.0 degrees) and after treatment was 34.7 degrees (31.9–37.5 degrees). Cobb angle after 20 years was 40.2 degrees (36.7–43.6 degrees). In the surgical group, the Cobb angle before treatment was 54.5 degrees (50.4–58.8 degrees), 1-year postoperatively was 29.5 degrees (25.7–33.9 degrees). Cobb angle after 20 years was 32.35 degrees (27.9–39.5 degrees). A total of 26 patients had distal segment degeneration in X-ray (16.5%), 4 patients were treated with brace and 22 patients with posterior spinal fusion. A total of 8 patients had proximal segment degeneration (5%), 2 patients were treated with brace and 6 patients with posterior spinal fusion. A total of 4 patients were treated with posterior fusion of the distal adjacent segment (2.6%), 1 was treated with brace and 3 were treated with posterior spinal fusion.

Conclusion

The average follow-up was 24.5 years (range, 15–35 years). The brace group had a small reduction in the spinal deformity during the treatment period, and X-rays show a small progression of the deformity, with the Cobb angle increasing by 5.5 degrees within 20 years. The surgically treated patients had a large correction during surgery and there is no statistical significant progression or loss of correction over a 20-year period. Only 4 patients in the brace group have distal segment degeneration and only 1 patient was treated with a one-level spinal fusion. The surgically treated groups had a significant deformity correction during surgery and have maintained the correction after 20 years. A total of 22 patients have distal degeneration and 3 patients were treated with distal adding on surgery.
The Fate of L5–S1 with Low Dose BMP-2 and Pelvic Fixation in Adult Deformity Surgery
Authors: Annis Prokopis , Spiker Ryan , Lawrence Brandon D. , Daubs Michael D. , Brodke Darrel S.
Published: May 2015

Introduction

Pseudarthrosis at L5–S1 is one of the most common complications of long fusions to the sacrum in adult deformity surgery. Strategies for decreasing pseudarthrosis include interbody fusion, use of BMP-2 at the lumbosacral junction, and the use of sacropelvic fixation, individually or in combination. High-dose BMP-2 (20–40 mg) placed posterolaterally has shown comparable fusion rates to interbody fusion. The purpose of this study was to evaluate L5–S1 fusion rates when lower dose BMP-2 (average 3.2 mg) and pelvic fixation were used, with or without interbody fusion.

Materials and Methods

This is a retrospective review of 61 consecutive patients with a minimum follow-up of 2 years at a single institution. All patients had an isolated posterior approach, ≥ 5 levels fused including L5–S1, use of pelvic fixation, and no previous L5–S1 procedures. The patients were divided into two groups for comparison based on the use of an interbody cage/fusion at the L5–S1 level. Radiographic union was assessed by three independent reviewers using Bridwell criteria. Revision rates and implant-related complications were also reported.

Results

The fusion rate at L5–S1 was 97% (59/61) with no difference between the interbody and no interbody fusion groups (97 vs. 96%, p = 1.0). The overall revision rate for L5–S1 nonunion was 1.6%. The mean amount of BMP-2 used in the interbody group was 4.1 mg (2–10), 2.5 mg (0–8) in the disc space, and 1.6 mg (0–4) in the interbody cage, while there was no difference in the amount of rhBMP-2 placed posterolaterally between the two groups (IF = 1.6 vs. NIF = 2.0 mg, p = 0.08) along with autograft and allograft. There were no significant differences in the radiographic parameters or deformity correction between the groups.

Conclusion

The use of low dose of BMP-2 at the L5–S1 level in combination with sacropelvic fixation achieved satisfactory outcomes in adult deformity surgery. No additional radiologic or clinical benefit was realized with the addition of an interbody fusion at the L5–S1 level.
Assessment of Impact of Long-Cassette Standing X-rays on Surgical Planning for Lumbar Pathology: An International Survey of Spine Surgeons
Authors: Smith Justin , Shaffrey Christopher , Lafage Virginie , Schwab Frank , Protopsaltis Themistocles , Klineberg Eric , Scheer Justin , Deviren Vedat , Hart Robert , Bess Shay , Arnold Paul , Chapman Jens , Fehlings Michael , Ames Christopher
Published: May 2015

Introduction

Surgical planning to address significant lumbar spine pathology, performed without appreciation of global spinal alignment, may have negative consequences. Our objective was to assess whether the extent of recommended surgery for lumbar pathology would significantly change with the addition of long-cassette standing X-rays.

Materials and Methods

This was an international online survey of spine surgeons. A series of 15 cases of lumbar spine pathology was presented with a brief clinical vignette and lumbar imaging (X-rays and MRI/CT). Surgeons were asked to select the most appropriate surgical plan, with five choices, ranging from least aggressive (decompression alone; 1 point) to the most aggressive (upper thoracic to sacrum/ilium fusion ± osteotomies/decompression/interbodies; 5 points). Cases were then reordered and presented with long-cassette standing X-rays and the same surgical planning question. Results were compared based on lumbar imaging only versus addition of long-cassette X-rays. Five cases (control group) had normal global alignment and 10 cases (study group) had global malalignment.

Results

A total of 316 surgeons completed the survey, predominantly (63%) from North America and Europe. Specialties included orthopedic surgery (65%) and neurosurgery (34%), 68% completed spine fellowship, and responders had a mean 13.4 years in practice that was a mean of 76% spine and included a mean of 123 fusions per year. For study cases, extent of recommended surgery increased significantly with the addition of long-cassette X-rays versus lumbar imaging only ( p = 0.002). For control cases with normal global alignment, no significant changes in surgery plans were identified with the addition of long-cassette X-rays ( p = 0.280).

Conclusion

Long-cassette standing X-rays can have a significant impact on surgical planning for lumbar pathology. Surgeons should maintain a relatively low threshold for obtaining long-cassette standing X-rays when contemplating surgical treatment for significant lumbar spine pathology.
Skeletal Muscle Mass is a Prognostic Marker at Diagnosis in Patients with Metastatic Spinal Cord Compression
Authors: Gakhar Harinder , Dhillon Amritpaul , Blackwell James , Hussain Kesar , Bommireddy Rajendra , Klezl Zdenek , Williams John
Published: May 2015

Introduction

Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity, and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision-making, in these individuals, by investigating the association between muscle mass and 1-year survival.

Materials and Methods

Muscle mass was calculated as total psoas area (TPA)/vertebral body area (VBA), by two independent blinded doctors from CT images, acquired within 7 days of spinal metastases diagnosis, at the L3 level. Outcome at 1 year following surgery was recorded from a prospectively updated metastatic spinal cord compression database.

Results

A total of 86 patients were followed for 1 year, with overall mortality at 39.5%. There was no gender difference although those alive at 1 year were of a significantly younger age. Alive at 1 year mean age was 62 years (IQR 53–71.75) versus dead at 1 year mean age was 68 years (IQR 61.75–76.25); ( p = 0.04). Significantly more patients in the lowest quartile of muscle mass died within 1 year, compared with the highest quartile (57.1 vs. 23.8%, p = 0.02). Individuals who died within a year had significantly lower lean muscle mass on initial CT compared with those alive at the end of 1 year ( p = 0.05). Patients with lung and gastrointestinal primary malignancies were more likely to die at 1 year, with both groups having 1-year survival rates less than 50%. Of the malignancies recorded, lung primary patients had a significantly lower muscle mass on CT than breast and lymphoma patients ( p < 0.01).

Conclusion

Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may influence decision to operate patients with spinal metastases.
Intradural Extramedullary Spinal Cord Tumors: A Series of 72 Cases
Authors: Pothiraj Raju Rajkumar
Published: May 2015

Introduction

To analyze and present intradural extramedullary spinal cord tumors and the prognostic factors affecting their neurological outcome.

Materials and Methods

From June 2002 to June 2014, we had 72 cases of such tumors. Among them, 14 at cervical, 6 at cervicodorsal junction, and 52 at dorsal and dorsolumbar region. All of them presented with neurological symptoms and deficits. Microsurgical excision of the tumor was done in all cases. Histopathology showed schwannoma in 42 cases, meningioma in 28 cases, malignant schwannoma in 1 case, and dermoid cyst in 1 case.

Results

Except for the malignant schwannoma case, all patients had improvement in the neurological deficits. Follow-up period ranged from 2 months to 12 years. Postoperative CSF leak occurred in three patients, one at cervical region and two at dorsal region. CSF leak stopped with duraplasty and revision of the wound.

Conclusion

Size and location of the tumor, severity of neurological deficit at the time of presentation, degree of cord retraction and vascular insult during excision of tumor, and completeness of the removal are the prognostic factors in the postoperative neurological outcome of the patients with these tumors.
Biomodeling in Complex Revision Deformity Spine Surgery: Experience with Two Cases
Authors: Ramos Javier , Dittmar Michael , de Haro Jorge , Cruz Francisco
Published: May 2015

Introduction

The distortion of the anatomy in some spine pathologies such as severe scoliosis and tumors, make the surgery a complex event, and the planning plays an important role. The image study interpretation in this kind of cases is difficult.

Methods

Biomodelism provides a better understanding of the anatomy and the surgical plan. Two models performed before the surgery of a complex spine deformity, we obtain DICOM images with a CT scan with reconstruction of 64 slides, 1 mm of thickness, and an interval of 1 mm and a reconstruction was done, the data were transferred to a stereolithographic format to print the model. The model was used to plan the surgery, check the trajectory of the pedicular screw, the approach, and the education of the family. The model was sterilized before and used as a tactile guide in the surgery.

Results

Before the surgery, the family and the patients understand the surgical procedure, the surgical team could evaluate the anatomy to understand the pathology. During the surgery, the model serves as a guide to realize the approach and the screw placement in a simple and systematized manner according to the surgery plan, and helps to evaluate the event after the surgery.

Discussion

D'Urso et al got a huge experience with biomodelism, we believe that the result in they work like in our work bring satisfactory results before, in the surgery and after the surgery, in the planning and the development of the procedure, as well as the postoperative evaluation with the use on the plastic model.

Conclusion

The use of biomodeling should be a frequent tool in spine complex cases where the anatomy could be affected.
Pathologic Axis Fracture Secondary to Solitary Bone Plasmacytoma: A Case Report and Literature Review
Authors: Yurac Ratko , Delgado Matias , Marré Bartolomé , Ballesteros Vicente
Published: May 2015

Introduction

Solitary bone plasmocytoma (SBP) is an uncommon entity. It represents 5 to 10% of all plasmatic cell neoplasms. Usually, it affects axial skeleton and rarely cervical spine. Patient and Methods: A case report of a 73-year-old woman with 1.5 month of progressive neck pain with limitation of cervical mobility is presented. A nonsystematic literature review about cervical spine SBP was conducted.

Results

Cervical X-ray study showed a lytic lesion in C2 vertebral body with anterolisthesis of the atlas over the axis. Computed tomography scan confirmed complete destruction of C2 vertebral body with partial occupation of the spinal canal seen in the magnetic resonance imaging. The systemic tumor spread was discarded. The patient went for surgery with the diagnosis of a vertebral tumor lesion of C2. Posterior occipitocervical fixation of C0 to C5 with iliac crest autogenous bone graft and complementary fixation of the posterior arc of C1 to the placed rods with titanium cables was performed. Bone tumor biopsy using a posterior approach through the pedicle was done. Histological and immunohistochemical study resulted concordant with an SBP. Immediate postoperative was satisfactory, with disappearance of neck pain and with no neurological deficit. Six weeks after surgery, radiotherapy was conducted completing a total of 25 sessions with complete remission of SBP. Three years' follow-up, the patient presented no neck pain and no recurrence of disease. Seven years postoperative CT scan showed no signs of cervical SBP.

Conclusion

Spine SBP is a rare entity. It has a good prognosis depending on the correct and early diagnostic approach, which will offer the highest probability of therapeutic success. The main pillars of treatment are as follows: (1) spine stabilization surgery, complemented in some cases if necessary with decompression on neural elements and (2) radiotherapy.
Methods of Invasive Surgery Treatment in Patients with Lumbar Failed of Etiology Degenerative
Authors: Dimumbrun González R. , Alvarado E. , Cova Wilmer J. , Coello Miguel
Published: May 2015

Introduction

It is necessary to expose the transcendental forms of invasive treatment for failed back surgery studied in 4 years of follow-up for the benefit of quality of life from patients with chronic spinal pain and functional limitation, and promote replication strategies in community spinal surgeons.

Patients and Methods

A prospective, descriptive, comparative, randomized study of 48 patients with degenerative lumbar disc disease diagnosis of failed back surgery, from any health center in the country with one or more surgical procedures performed in the anatomic area was conducted lumbar region, related to moderate-to-severe low back pain, with or without, radiculopathy tested before and after the invasive modality with the EVA scale of nociceptive pain, neuropathic pain DN4 scale and the scale of oswestry functional disability. Patients with a history of previous surgery were included in this investigation degenerative disease with intractable pain, to alleviate or relieve pain, with less previous evolution of the 6 months in cases of severe pain, and with persistence or increased symptoms before surgery. Some images evidence reflecting the failure or implant surgical techniques. All patients without previous surgery were excluded and also those with percutaneous interventional approaches of chronic spinal pain, as the only tool treatment lumbar radicular pain, failed back surgery patients with traumatic, tumoral, and infectious origin where by all the patients with established diagnosis of failed back surgery degenerative etiology.

Results

The analysis included an interpretation of medical records and surgical event clinical evaluation of 48 patients attending consultations and team column in the University Hospital Dr. “Manuel Nunez Tovar” in the city of Maturin, Monagas State, Venezuela. From January 2010 to June 2014, the majority of patients were males 60.42% and females 39.58%, aged 32 to 68 years. It was fulfilled in the total of 48 patients studied, 66 invasive modalities, discriminated into three groups as follows: revision surgery, 13 patients; approach percutaneous interventional analgesic and anesthetic spine chronic pain as Cosman technique, 19 patients; and mixed mode, 16 patients. Repeat percutaneous interventional total in 18 patients.

Conclusion

The procedures were performed by the same surgical team, using a surgical procedure according to the analysis of symptomatic interpretation of pain, upgrade of the images, affected lumbar level, and characteristic of previous surgery and experience of the team treating surgeons followed by more than 6 months with good and excellent, measurable, and clinically beneficial results.
Diastematomielia Case Report
Authors: Giménez Carlos , Rivas Marcelino , Marin Elio
Published: May 2015

Introduction

The diastematomielia is a form of occult spinal dysraphism, which can be observed between 5 and 10% of the population, and once these 80% of which had lumbar location. The term diastematomyelia is because of Olliver in 1837 and is derived from the Greek “diastema” meaning cleft and “mielia” which refers to the spinal cord. Before 1950, this rare lesion was little known and few reported cases diagnosed postmortem. In the Mayo Clinic, 1935 to 1967, only 10 cases diagnosed during life and treated surgically were presented. After the 1950s, the prognosis of these patients improved significantly with the advent of new diagnostic techniques such as myelography, computed tomography [CT], magnetic resonance imaging (MRI), ultrasound (US), electromyography (EMG), and evoked potentials somatosensory (SSEP), treatment (surgical microscope and bipolar electrocautery), and rehabilitation of motor and sphincter. The diastematomielia is three times more common in women and occurs in any period of life, with peak incidence between 4 and 6 years old. At present, most authors deny the hereditary nature and diagnosis is often performed incidentally. Clinically, the disease presents with the following three pillars: skin disorders, orthopedic deformities, or signs and symptoms of neurological dysfunction. Patient and Methods: This is a case report of a 24-year-old girl with the following diagnosis: diastematomielia, thoracolumbar scoliosis, tethered cord (2 years' post-op). The girl consulted for thoracolumbar scoliosis and low back pain. At the physical examination, we saw thoracolumbar scoliosis, middle line scar (tethered cord post-op), skin stigmatas, and nonmotor deficit. On CT scan, we could observe a bone spur dividing the spinal canal at D9 level. On MRI, we could observe that the spinal cord was divided in two at the same level. In surgery, we found the bone spur at the center of the spinal canal splitting the spinal cord in two. We drilled the bone spur from the top to the base. We had to gently separate the two halves of the spinal cord from the bone spur to reduce the possibilities of damage. The two halves of the spinal cord were covered by dura mater. The surgery concluded with minimal bleeding, no dura mater injuries, and the patient had no deficit after the surgery.

Results

The patient had good postoperative evolution and went home for days after surgery with no deficits.

Conclusion

This is the first case of diastematomielia in 15 years. The diastematomyelia is a rare dysraphism condition. We must think of every child with peripheral stigmata of skin, tiredness when walking, orthopedic deformities, urologic symptoms, and so on. Urodynamic studies should be performed even when there are no symptoms because there may be a subclinical damage. Surgery should be performed early after the diagnosis is made.
A Clinical Prediction Rule to Major Spine Trauma
Authors: Sánchez-Bringas Guadalupe , Cruz-Arenas Esteban , Reyes-Sánchez Alejandro , Obil Chavaria Claudia
Published: May 2015

Introduction

Spinal trauma can be devastating and the ultimate solution is the prevention of delayed or missed diagnosis and treatment. Our purpose was to develop a reliable prediction rule to assess a patient's identify risk factors for spinal injuries that could guide trauma patient's screening for timely spinal fracture diagnosis and treatment.

Patients and Methods

Retrospective study from January 2005 to March 2014 of patients with trauma-associated spinal fractures who were admitted into the spinal surgery service of a referral institute. Two clinical prediction rules based on a set of demographic and clinical variables (injury mechanism, accident site, occupation, toxic substances intake, and presence of other fractures) were developed with a multivariate logistic regression model. AO type A spinal fracture and thoracolumbar spinal segment were the outcomes involved. Model performances were quantified with respect to discrimination area under receiver-operating-characteristics curve (AUROC).

Results

In a total of 209 patients, 78.5% were males, median age 36.7 ± 13.9 years and the most affected age group was that of patients aged 20 to 49 years (43.9%). The fracture distribution for axial compression with intact posterior ligamentous complex type A corresponded to 56.5% of the cases; the thoracolumbar junction was the most affected one (44.5%) at one level and 5.3% at two levels, mainly L1 (19.1%). A combination of fall from 1 to 5 m (OR = 3.9, p = 0.000), domestic occupation (OR = 3.1, p = 0.026), recreational place (OR = 5.02, p = 0.000), and toxic substances intake (OR =1.95, p = 0.035), altogether as a prediction rule, showed excellent discrimination in diagnosing AO type A spinal fracture (AUROC = 0.75) with 59% of sensitivity and 77% specificity. In the second model, a combination of falls from 1 to 5 m (OR = 5.8, p = 0.000) and presence of other fractures (pelvic, head, lower, and upper limb fractures) (OR = 5.1, p = 0.006); showed excellent discrimination in diagnosing a spinal fracture at the thoracolumbar junction (AUROC = 0.72) with sensitivity 70% and specificity 74%.

Conclusion

Our prediction rules, including a set of demographic and clinical variables at hand in the emergency room can guide trauma patient's screening for timely spinal fracture diagnosis and treatment. Our models, although stable and with acceptable discrimination should be validated and put to test in other populations.
Hangman Fracture: Treatment with Fluoroscopically Guided Transcutaneous Pedicle Screws
Authors: Ciancio Alejandro Morales , De Battista Juan Carlos , Sicoli Alfredo D. , Gonzalez Masanés Nicholas
Published: May 2015

Introduction

Hangman fracture is the second most frequent axis fracture, alter odontoid fracture. The most widely used classification is that of Levine and Edwards, based on lateral X-ray. Type I are those fractures with < 3 mm displacement. Type II fractures are those with > 3 mm displacement. Type IIa show little or no displacement, but a severe angle. Type III fractures are those with severe displacement, angle, and unifacet or bifacet dislocation. In several cases, Hangman fracture is associated with other lesions which require priority attention. Patient and Methods: We present the case of a 46-year-old female patient who suffered from polytrauma because of a car accident. She was driving using her seatbelt, but no airbag was available in the car. On entry to the hospital, she presented Glasgow 15/15, Asia E, diabetes antecedents, HTA, and BMI 69.4 kg/m . Also, femur and right ankle fracture plus C2 traumatic spondylolisthesis type IIa. Neurological tests were normal. There was acute cervical and right lower limb pain. Initially, “damage control” was performed: stabilization of extraspinal lesions with external tutor in femur and ankle osteodesis. Since the patient presented morbid obesity, and due to the need of stabilizing her CD fracture, closed reduction and percutaneous osteosynthesis with bilateral fluoroscopically guided pedicle screw. It is absolutely necessary to have a clear front and lateral visualization of the cervical spine to plan the screw trajectory and the incision.

Results

A correct closed reduction of the fracture was attained. We projected each screw trajectory through radioscopy. An incision was done at C6 level and minimally invasive surgery was practiced, using two bilateral cannulated pedicle screws with correct fracture compression. Postoperatory X-ray and TAC showed correct position of both screws and fracture reduction. The patient had a satisfactory global evolution, with total relief of cervical pain, withdrawal of cervical orthosis, and precocious movement. In X-ray controls at 30, 60, and 90 days, correct fracture reduction was observed. TAC performed 6 months after the accident showed fracture consolidation.

Conclusion

We consider that, in certain selected cases, fluoroscopically guided percutaneous surgery is a good alternative when trying to give patients the best solution available. In our case, the patient received its benefits since she continued her orthopedical rehabilitation of other associated lesions without any inconvenience for the cervical surgery, with great pain relief, avoiding deep approach through the body midline; receiving minimal scars and with correct fracture reduction and consolidation. Patient selection is relevant to such an intervention. The learning curve is slow, so one must be used to the conventional technique to then do percutaneous technique.
Minimal Invasive Surgery in Patients with Degenerative Lumbar Pathology. Initial Experience
Authors: Fleiderman José , Lecaros Javier , Munjin Aleksandar , Larraín Cristián
Published: May 2015

Introduction

The transforaminal lumbar interbody fusion (TLIF) is used traditionally as treatment of the degenerative lumbar disease (DLD), obtaining good results. Nowadays, minimal invasive surgery (MIS) TLIF is being used as a treatment to this pathology, with the purpose of reducing damage in soft tissues, as well as, the operative time and patient recovery. The objective of this study is to measure the in-hospital and surgical parameters of a case series, which had lumbar degenerative pathology surgery using the MIS TLIF technique.

Patients and Methods

Data of seven patients were collected, who had surgery by the same surgeon at Hospital del Trabajador (Santiago de Chile) during 2013 under the MIS TLIF technique. The operative time, ambulation start, hospital stay, CT fusion, and complications were measured.

Results

The M/H ratio was 6/1; with an average age of 44.28 ± 10.33 SD. Nine levels (L4–L5: 3 L5–S1: 6) were obtained of the seven patients, who had surgery by DLD under MIS TLIF technique. Two of them were a two-level fusion. The operative time was 169 (range, 145–205) minutes for a one-level fusion and 311 (range, 296–325) minutes for a two-level fusion. The ambulation start was the next day with a hospital stay of 3 (range, 2–3) days. All the surgical levels got a total or partial fusion under CT, with a CT follow-up of 6.91 ± 2.05 SD months. Two cases had a L5 transient paresis.

Conclusions

The MIS TLIF technique obtained good results of fusion under CT with minor complications. It demonstrates short operative time, early ambulation start with short hospital stay in the patients who had EDL surgery.
Analysis of Influences between Pain Marker and Epidural Fibrosis for Multiple Repeated Spinal Surgeries in Sprague Dawley Rat
Authors: Kim Y.
Published: May 2015

Introduction

Epidural fibrosis is one of the source of postoperative pain which is occurred by repeated surgeries. However, it was not known between epidural fibrosis caused by repeated spinal surgery and pain-related protein which is released at the dorsal root ganglion that makes spinal pain syndrome. Using rat spinal surgery epidural fibrosis and adhesion model, we investigate the role of spinal epidural adhesion caused by repeated epidural fibrosis, and we checked the dural thickness of the extent of epidural fibrosis and learn the proportional extent. And, we investigate on rat ganglion expression of MAPK/ERK by direct measurement of the amount of pain-related protein by using of immunohistochemistry and western blot.

Material and Methods

We divided the repeated surgery Sprague Dawley rat in three groups in 3 weeks' interval. Group A was first spinal laminectomy surgery group, and group B was two repeated surgery at the interval of 3 weeks, and finally Group C is three repeated surgery group at an interval of 3, 6, and 9 weeks. We humanely killed rat and checked dural thickness at each group and gathered spinal cord and performed immunohistochemistry p38, ERK, and JNK on each group. Finally, we checked western blot to check the expression of phosphorylated ERK, p38, and JNK. The checked expression levels were compared.

Results

Groups A, B, and C significantly increased the thickness of epidural fibrosis. The immunohistochemistry and western blot results of ERK and p38 expression was increased in serial controls A, B, and C. But, JNK expression increases from group A at a different pattern. By western blot, phosphorylation of ERK, p38 also increased in serial pattern control A, B, and C.

Conclusion

Repeated epidural spinal surgery while increasing the thickness of the ganglion stimulation of pain-related factors causing pain and neurogenic cause was determined to be capable of providing.
Sagittal Balance Before and after Pregnancy. Nature Course and Influence of Performed Spine Surgery Method
Authors: Polis Bartosz , Polis Lech , Nowoslawska Emilia
Published: May 2015

Introduction

The amount of spine surgeries grow each year. Spine diseases usually associated with advanced age start to appear in much younger patients. The matter of sagittal balance plays a crucial role in modern spine surgery. Knowledge of pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and spino-sacral angle (SSA) is mandatory in any modern spine procedure. However, so well understood spine parameters are almost never associated with pregnancy.

Materials and Methods

In our study, we decided to measure all the important spine parameters in a group of young women before pregnancy (healthy and women after spine surgical procedures on L4–S1) and after delivery. One of the most important questions is how to operate a young women properly in the reproductive period (discectomy vs. posterior transpedicular stabilization and PLIF/TLIF fusion). The study includes 90 women (30 in each group). Overall, 30 healthy with no syndromes before and after surgery, 30 who underwent microdiscectomy on L4–S1 level, and 30 who underwent posterior transpedicular and TLIF/PLIF fusion on L4–S1 level. All women had a sagittal balance spine measurements before and after pregnancy (pelvic incidence, pelvic tilt, sacral slope, and spino-sacral angle). The parameters have been comprised and proper conclusions were drawn.

Results

In all operated women before the surgical procedure, sagittal balance was changed. After pregnancy only in fused group, proper sagittal balance was retained. In the other groups (discectomy and healthy), sagittal balance was impaired after delivery.

Conclusions

Sagittal balance changes during natural pregnancy course. Posterior transpedicular stabilization with PLIF/TLIF fusion performed before pregnancy characterized better long-term follow-up than pure discectomy. Also, reoperation proportion was significantly lower in the fused group. In women in reproductive period, surgical procedures based on fusion and sagittal balance correction seems to be a method of choice.
The Effect of Complications and Reoperation on Recovery Kinetics in 149 Adult Spinal Deformity Patients with 2-Year Follow-Up: An Area under the Curve Analysis
Authors: Ames Christopher , Scheer Justin , Mundis Gregory , Klineberg Eric , Hart Robert , Kelly Michael , Deviren Vedat , Burton Douglas , McCarthy Ian , Bess Shay , Schwab Frank , Shaffrey Christopher , Lafage Virginie , Smith Justin
Published: May 2015

Introduction

Complication rates in adult spinal deformity (ASD) surgery are high and the effects on overall recovery are not well understood. Current methods of reporting outcomes are limited to static outcome time points perhaps diminishing the health impact of the entire recovery experience. This study aims to identify the effect of complications on the kinetics of the recovery process (recovery kinetics) by examining the effect of HRQOL over time via an area under the curve analysis (AUC).

Materials and Methods

A retrospective review of a multicenter, prospective ASD database. Inclusion criteria, ≥ 18 years, ASD. Complication number, type, and need for reoperation (reop) were recorded. Patients (pts) were stratified as having no complication (NOCOMP) and any complication (COMP). HRQOL collected included Oswestry Disability Index (ODI), Short Form-36 (SF-36), and Scoliosis Research Society-22 (SRS22) at baseline, 6 weeks, 1 and 2 years post-op. All HRQOL was normalized to each pts' baseline scores as a comparison relative to where the pts started. An AUC was then calculated across the entire 2 years. Standard HRQOL, normalized HRQOL, and AUC means were compared between the groups.

Results

A total of 149 pts were included (COMP: 84 and NOCOMP: 45). There were no significant HRQOL differences at any time point between the groups ( p > 0.05 for all). However, after normalizing the HRQOL, COMP had significantly lower SRS mental scores at 1 year (1.1 ± 0.2 vs.1.2 ± 0.3, p = 0.0002) and 2 years (1.1 ± 0.3 vs. 1.3 ± 0.4, p = 0.0003). COMP had significantly lower SRS Mental AUC than NOCOMP (3.2 ± 0.5 vs. 3.5 ± 0.6, p = 0.0023). Overall, 28 (19%) pts had a reop. There were no significant differences between any HRQOL 2-year AUC values between pts with complications requiring reop and those with no reop ( p > 0.05 for all).

Conclusion

Static HRQOL analysis would suggest there is no difference between complication groups. Area under the curve (AUC) analysis suggests there is a significantly protracted mental recovery phase associated with patients that have at least one complication and the addition of reop does not affect the recovery kinetics.
Risk of Development of New Onset Postoperative Cervical Deformity in Thoracolumbar Adult Spinal Deformity and Effect on Clinical Outcomes at 2-Year Follow-Up
Authors: Soroceanu Alex , Passias Peter , Boniello Anthony , Scheer Justin , Schwab Frank , Shaffrey Christopher , Kim Han Jo , Protopsaltis Themistocles , Mundis Gregory , Gupta Munish , Klineberg Eric , Lafage Virginie , Smith Justin , Ames Christopher
Published: May 2015

Introduction

A high prevalence of residual cervical deformity (CD) has been identified following surgical treatment of adult spinal deformity (ASD). Development of the new onset CD is less understood and its clinical impact unclear. This study quantifies the incidence of new onset CD after ASD surgery, identifies predictors of development, and determines the impact outcomes.

Materials and Methods

Retrospective review of a prospective multicenter database yielded 215 patients (pts) with complete 2-year follow-up and full length X-rays including the cervical spine. CD was defined by T1S–CL > 20 degrees, C2C7 SVA > 40 mm, or C2C7 kyphosis > 10 degrees. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new CD. The impact of CD on health-related quality of life (HRQL) and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders.

Results

Of the 215, 88 pts with ASD did not have CD at baseline and 42 of them (47.7%) developed CD at 2 years' postoperatively. Univariate analysis revealed that pts who developed new CD in the postoperative period had a higher incidence of diabetes (14.29 vs. 2.17%, p = 0.036) increased preoperative C2C7 SVA ( p = 0.04) and C2 slope ( p = 0.038) and smaller diameter rods used at surgery ( p = 0.0328). Independent predictors of new CD at 2 years included diabetes (OR, 10.49; p = 0.046) and increased preoperative TS–CL (OR, 1.08/deg, p = 0.027). Ending instrumentation below T4 was a negative predictor of CD (OR, 0.31; p = 0.019). Pts with and without CD experienced improvements in 2-year SF-36 ( p = 0.0001), ODI ( p = 0.0001), and SRS ( p = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction ( p = 0.28).

Conclusion

Overall, 47.7% of pts without preoperative CD develop new postoperative CD after ASD surgery. Independent predictors of new onset CD at 2 years include diabetes, higher preoperative TS–CL, and ending instrumentation above T4. Significant improvements in HRQL scores occurred despite the development of postoperative CD.
Geographic and Ethnic Variation in Radiographic Disability Thresholds: Analysis of North American and Japanese Operative Adult Spinal Deformity Populations
Authors: Ames Christopher , Matsumoto Morio , Hosogane Naobumi , Smith Justin , Protopsaltis Themistocles , Yamato Yu , Matsuyama Yukihiro , Taneichi Hiroshi , Lafage Renaud , Ferrero Emmanuelle , Shaffrey Christopher , Schwab Frank , Lafage Virginie
Published: May 2015

Introduction

Regression analysis of adult spinal deformity (ASD) databases in North America (NA) has yielded radiographic disability thresholds for sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence to lumbar lordosis (PI–LL), which have been used in formulating the Schwab–SRS ASD classification. These thresholds are often used as correction goals for surgery planning, but it is unclear whether these thresholds vary in other geographic regions or ethnicities. This is the first comparison of radiographic disability thresholds between NA and Asian populations of ASD.

Patients and Methods

Retrospective, multicenter case series of 595 operative patients with ASD with baseline radiographs and Oswestry disability index (ODI) from 11 sites across USA ( n = 402) and Japan (JPN, n = 193). Patients were compared at baseline in ODI, ODI need for improvement (ODIni, calculated from age/ethnic normative values), and radiographs. Linear regression was used to define thresholds for disability.

Results

Differences existed in mean age (USA 52.5 ± 22.5 years vs. JPN was 56.5 ± 15.4 years, p = 0.012) and revisions (USA 48% vs. JPN 2%, p < 0.001), but not gender (USA 85% women and JPN 80% women). At baseline, there were no differences in sagittal parameters except PI, which was significantly smaller in the JPN cohort. Linear regression revealed differences in radiographic parameters corresponding to ODI of 30 to 40. JPN had higher PI–LL and PT for ODI 30 and 40 but similar SVA thresholds. Significant differences existed in Schwab classification curve type (JPN with more double curves, p < 0.001) and PT (JPN with lower grade) but not in PI–LL modifier. JPN had a significantly lower ODI (USA 43.7 vs. JPN 36.2, p < 0.001), without a significant difference in ODIni.

Conclusion

At baseline, patients in both cohorts had a similar sagittal deformity but different morphology. Disability thresholds for SVA appear to be maintained across ethnicities but with differences in pelvic morphology (PI–LL and PT). The JPN cohort had significantly smaller PI and multiple coronal curves compared with the USA cohort. Despite similar sagittal malalignment, the JPN cohort had a significantly lower ODI without a significant difference in ODIni.
Area under the Curve: Analysis of Approach-Related Recovery Time in 165 Operative Cervical Spondylotic Myelopathy Patients with a 2-Year Follow-Up
Authors: Challier Vincent , Smith Justin , Shaffrey Christopher , Kim Han Jo , Arnold Paul , Liu Shian , Scheer Justin , Chapman Jens , Protopsaltis Themistocles , Lafage Virginie , Schwab Frank , Massicotte Eric , Yoon S. Tim , Fehlings Michael , Ames Christopher
Published: May 2015

Introduction

Much debate about postoperative outcomes regarding surgical approaches for cervical spondylotic myelopathy (CSM) exists in the literature with no clear evidence of superiority. We propose a novel method for assessing health-related quality of life (HRQOL) outcomes by taking into account each patient's baseline at postoperative time points and analyzing the “area under the curve” (AUC), a proxy for suffering time.

Patients and Methods

Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 165 patients met the following inclusion criteria: symptomatic CSM, age older than 18 years, and 2-year follow-up with modified Japanese Orthopaedic Association (mJOA) and neck disability index (NDI). The anterior approach group (AAG) ( n = 110) and posterior approach group (PAG) ( n = 55) were compared at baseline, 1 year, and 2 years for each HRQOL. This comparison was repeated with normalization, using the patient's baseline as the anchor, followed by an integration and comparison of AUC. Results and Conclusion: For the first time, AUC analysis was applied to evaluating patients with CSM. Nonnormalized HRQOLs demonstrated the AAG started higher and met better standards at all times points compared with the PAG. Normalized mJOA demonstrated the PAG actually did better at 2 years, whereas NDI suggested that the AAG did better, although this was not significant. AUC analysis further supported the superiority of the PAG, with statistical significance at 1 and 2 years' time points, suggesting that patients who undergo the posterior approach may suffer less in the first 2 years of their postoperative course.
Clinical Results of Laminoplasty for Cervical Myelopathy Caused by Disc Herniation with Developmental Canal Stenosis
Authors: Fukao Shigeharu , Kidooka Minoru
Published: May 2015

Introduction

Anterior discectomy and spinal fusion have had acceptable surgical results, but many complications have been reported, especially adjacent segment degeneration and bone graft complications. To compare the surgical results of laminoplasty with those of anterior spinal fusion in patients with myelopathy caused by the cervical disc herniation, and to make a treatment strategy for cervical disc herniation depending on these results.

Patients and Methods

A total of 10 patients with cervical disc herniation were examined in this study, who underwent laminoplasty without resection of the herniated disc. The mean age was 60 years. As a control group, 31 patients (mean age, 53.4 years) who underwent anterior spinal fusion were examined. All patients in the laminoplasty group also had developmental spinal canal stenosis in which the anteroposterior canal diameter was less than 13 mm. The mean follow-up was 2.5 years in the laminoplasty group and 3.2 years in the anterior fusion group. Neurological and radiological results were examined. The severity of myelopathy was evaluated according to the Neurosurgical Cervical Spine Score (NCSS). Surgical outcomes were evaluated by the NCSS for determining the recovery rate.

Results

The recovery rate averaged 46% in laminoplasty and 48% in anterior spinal fusion. There were no significant differences between the groups. Cervical lordosis angle was diminished postoperatively without a significant difference between the two groups. In the laminoplasty group, one patient with kyphotic deformity after laminoplasty had transient motor weakness, and one patient underwent anterior spinal fusion after laminoplasty according to myelopathy caused by the cervical disc herniation. Follow-up magnetic resonance imaging showed regression of the size of the herniated disc in 5 of the 10 patients in the laminoplasty group.

Conclusion

Laminoplasty for patients with narrowed spinal canals showed favorable surgical results. Laminoplasty should be employed for cervical myelopathy caused by disc herniation in particular with developmental spinal canal stenosis to avoid secondary myelopathy.