bluuebunny/crossref_metadata_2025 huggingface dataset:
Polymer-based Silver Nanoparticle Coated Pedicle Screws Inhibits Biofilm Formation-a Novel Experimental Model in Rabbits
Authors: Hazer Derya Burcu , Sakar Mustafa , Dere Yelda , Altinkanat Gulsen , Ziyal Mustafa Ibrahim , Hazer Baki
Published: April 2016

Introduction

Infection in spinal implant is of great concern. Anti-infection strategies must be tested in relevant animal models that will lead to appropriate clinical studies. A novel spine implant model was designed to study the antimicrobial effect of a modified Titanium (Ti) pedicle screws with methiciline resistant Staphyloccoccus Aerous (MRSA) in multiple surgical sites in the lumbar spine of a rabbit.

Material and Methods

Twenty two New Zealand White rabbits were divided into two groups: group 1: infected unmodified Ti screw group ( n = 10), group 2: infected polyethylene glycol grafted polypropylene based Silver nanoparticle (PP-g-PEG-Ag) covered Ti screw group ( n = 10), and two rabbits as control-sterile group. In all groups left L4- right L6 vertebra levels were exposed and screws were drilled to transverse processes after contamination of burr holes with 0.1 ml of 106 CFU MRSA solutions in group 1 and 2. After 21 days, samples were collected and infection was analyzed via light and scanning electron microscopy and culturing. Silver nanoparticles (Ag-NP) on the screws and tissues were assayed pre and postoperatively.

Results

The bacterial colony count for modified-Ti screw group was lower compared with unmodified Ti screw (17,2 vs 200 × 103 CFU/mL, p = 0,029) with less biofilm formation. There was no difference in duration of surgery among groups and within the surgical sites. Ag-NPs were detected on the screw surface postoperatively.

Conclusion

This novel experimental design of implantation in rabbits is easy to apply and resembles human stabilization technique. Modified Ti screws were shown to have antimicrobial effect with especially inhibiting the biofilm formation. This anchored Ag NPs which remained after 21st day of implantation shows that it is resistant to tapping forces of the screw.
An In-vitro Study on the Effects of Spinal Canal Curvature on Cord Interstitial Pressure during Spinal Cord Distraction
Authors: Jarzem Peter , Bassi Mahdi , Mansi Mohammed
Published: April 2016

Study Design

This is an in-vitro study examining the effect of spinal canal curvature on spinal Cord Interstitial Pressure (CIP) during porcine spinal cord distraction. In this study we examined CIP developed in spinal cords during distraction in three conditions: 1) linear cord distraction (stretch) 2) simulated 45 degree scoliotic curve and 3) simulated 90 degree scoliotic curve.

Summary of Background Data

Spinal cord distraction is a known cause of spinal cord injury (SCI). Several papers published on the pathophysiology of the cord distraction injury suggest that the underlying mechanism of injury is a micro-vascular ischemic event4. We have previously described an increase in CIP with spinal cord distraction,12,18 and have shown that spinal cord distraction can lead to spinal cord injury in live animal experiments13. Distraction spinal cord injury is known in scoliosis correction but rare in other spine injuries. With this experiment we wish to determine if simulated spinal curvature may potentiate the spinal cord distraction elevation in CIP noted during our experiments.

Objectives

To determine if increasing degrees of spinal curvature lead to increasing CIP during in-vitro spinal cord distraction.

Methods

Ten freshly thawed porcine spinal cords were tested in a saline bath in linear, 45° degree and 90° degree curved surfaces while CIP was monitored using the modified Whitesides technique27. Multiple linear regressions were then performed.

Results

We noted a close correlation between applied tension (T) and CIP. The greatest pressure elevations were noted for the 90° curve mode, intermediate elevations were noted for the 45° curve modes and the smallest pressure elevations were noted for the linear mode of distraction ( p <  = 0.05).

Conclusion

High CIP can be achieved through spinal cord distraction. This CIP is not only directly proportional to tension, but also proportionally increased by the degree of spinal curvature. This may suggest that spinal curvature may tend to increase generated CIP during distraction, and be a potentiating factor for spinal cord injury during scoliosis correction.
Effect of Treatment Complications on the Outcomes in Adult Spinal Deformity: A Decision Analysis Approach
Authors: Acaroglu Emre , Güler Ümit Özgür , Yavuz Aysun Çetinyürek , Yavus Yasemin , Ayhan Selim , Sabat Montse Domingo , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Alanay Ahmet , Obeid Ibrahim , Kleinstuck Frank
Published: April 2016

Introduction

Treatment of adult spinal deformity (ASD) is known to be associated with a fairly high rate of complications whereas the impact of these complications on treatment outcomes is less well known. Aim of this study is to analyze the impact of treatment complications on outcomes in ASD using a decision analysis (DA) model.

Material and Methods

From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical –NS), 164 surgical –S), constitute the population of this study. DA was structured in two main steps of: 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference –utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Complications were analyzed as life threatening (LT) and non-life threatening (NLT) and their probabilities were calculated from the database as well as a thorough literature review. Outcomes were analyzed as improvement (decrease in ODI > 8pts), no change and deterioration (increase in ODI > 8pts). Death/complete paralysis was considered as a separate category.

Results

All 535 patients (371 NS, 164 S) could be analyzed in regard to complications. Overall, there were 78 NLT and 12 LT complications and 3 death/paralysis. Surgical treatment was significantly more prone to complications (31.7% versus 11.1%, p < 0.001) (Table 1 a). On the other hand, presence of complications did not necessarily decrease the chances of improvement, surgical patients tending to rate better in this respect (Table 1b). Likewise, QALE was not particularly affected by the presence or absence of complications regardless of the type of treatment (Table 1c).

Conclusion

This study has demonstrated that surgical treatment of ASD is more likely to cause complications compared with non-surgical treatment. On the other hand, presence of complications neither has a negative impact on the likelihood of clinical improvement nor affects the QALE at the first year detrimentally.
Multilevel XLIFs, TLIFs and Grade 2 Posterior Osteotomies for Surgical Correction of Compensated Sagittal Imbalance: Outcomes in 25 Consecutive Adult Degenerative Deformities at Minumum 2 Years Follow-up
Authors: Ramieri Alessandro , Costanzo Giuseppe
Published: April 2016

Introduction

Sagittal imbalance in the adult degenerative spine requires surgical correction to improve pain, mobility and quality of life. Aim of our surgery is to obtain a harmonic, balanced sagittal profile operating a series of adult degenerative kyphoscoliosis by means of XLIFs, TLIFs, SPOs and posterior pedicle screws. Actually, XLIF seems to be the less invasive alternative to PSO to restore LL and achieve anterior fusion, while Grade 2 posterior osteotomies can be useful to further decrease kyphosis.

Material and Methods

We treated by XLIFs, SPOs and pedicle instrumentations 25 thoraco-lumbar and lumbar degenerative deformities, characterized by a sagittal compensated imbalance (SVA < 50mm), with or without coronal deformity, and distinguished according to the SRS-Schwab classification. All patients were submitted to X-ray screening during pre, post-operative and follow-up periods.

Results

Mean age was 64 (50–74; M/F 1: 4). Sixteen deformities were type L and 9 type N. Loss of LL was moderate (+) in 14 cases and marked (++) in 11. We performed 50 XLIFs, 15 TLIFs, 48 SPOs. Complication rate was minimal. PT, LL, SVA and TK improved ( p < 0.05), post-operative values were similar to those pre-operatively calculated in 90% of cases and clinical follow-up (mean 29.5; range 24–36), scored using VAS and ODI, was satisfactory in all cases, except for two due to sacro-iliac pain.

Conclusion

Current follow-up does not allow definitive conclusions. However, the surgical approach proposed seems to be a viable choice usable in these compensated adult deformities, avoiding risks and complications of aggressive PSOs.
Sagittal Plane Correction Using Lateral Transpsoas Approach: Effect of Cage Angulation and Surgical Technique on Segmental Lordosis
Authors: Yoon S. Tim , Melikian Rojeh , Kim Jin Young , Park Kun Young , Yoon Caroline , Hutton William
Published: April 2016

Introduction

Lordotic cage insertion through lateral transpsoas approach is being used increasingly for restoration of sagittal alignment. However, the degree of correction achieved by varying cage angle as well as ALL release and posterior element resection is not well defined. The objective of this study is to determine the degree of segmental correction which could be achieved through lateral transpsoas approach by varying cage angle as well as adding anterior longitudinal ligament (ALL) release and posterior element resection.

Material and Methods

Thirteen human cadaveric lumbar motion segments between L1 and L5 were dissected into single motion segments. Segmental angles and disk heights were measured under both 50N and 500N loads under the following conditions: Intact specimen, discectomy (collapsed disk simulation), insertion of parallel cage, 10° cage, 30° cage with ALL release, 30° cage with ALL release and spinous process (SP) resection, 30° cage with ALL release, SP resection, facetectomy and compression with pedicle screws.

Results

Segmental lordosis was not increased by with either parallel or 10° cages as compared with intact disks, and contributed small amounts of lordosis when compared with the collapsed disk condition. Placement of 30° cages with ALL release increased segmental lordosis by 10.5°. Adding SP resection increased lordosis to 12.39°. Facetectomy and compression with pedicle screws further increased gains in lordosis to 26.4° in the 50N group and 25.8° in the 500N group. Neither group experienced a decrease in either anterior or posterior disk height.

Conclusion

Insertion of parallel or 10° cage has little effect on lordosis. 30° cage insertion and ALL release resulted in an increase of lordosis by ~10.5°. The addition of SP resection and facetectomy allowed increases in correction of up to 26.4°. No interventions resulted in decrease in either anterior or posterior disk height suggesting gains were achieved without causing foraminal stenosis.
Vertebroplasty and Kyphoplasty for Metastatic Spinal Lesions: A Systematic Review
Authors: Sadeghi Mohsen , Janani Leila , Aarabi Shahram , Shokraneh Farhad , Rahimi-Movaghar Vafa
Published: April 2016

Introduction

The spine is the most common site of bone metastases, with 33–70% of cancer patients acquiring spinal metastasis during the course of their disease. Vertebroplasty (VP) and Kyphoplasty (KP) have been proposed as potential minimally invasive therapeutic options for metastatic spinal lesion (MSL) pain. However, the efficacy of VP and KP on MSL pain is currently unclear. The Objective of the present review was to assess the effects of VP and KP on pain, disability and quality of life following MSL.

Material and Methods

We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) assessing VP or KP for the treatment of pain following MSL without cord compression. We searched MEDLINE, EMBASE and CENTRAL with no limitation in terms of study status (ongoing or completed), publication date, type or language.

Results

The literature search revealed 387 citations. Of these, nine trials met all eligibility criteria and included in the qualitative analysis. In total, there were 622 patients enrolled in the trials and of these 432 were in surgical treatment group (92 received KP, 97 received VP, 134 received VP and chemotherapy, 68 received VP and radiotherapy and 41 received KIVA implant) and 190 were in non-surgical treatment group (83 received chemotherapy, 46 received radiotherapy and 61 received other treatment). Using the grade approach, there is low quality of evidence that VP plus chemotherapy improve MSL pain and functional score more than chemotherapy alone (Pain: mean difference (MD): -3.01; 95%CI: -3.21 to -2.80; functional score: MD: 15.46; 95%CI: 13.58 to 17.34)

Conclusion

Pain and functional score improved more in VP plus chemotherapy group than in the chemotherapy group. Based on the analysis of published trial data, it is not known whether VP for MSL provides benefits over KP.
Posterior Spinal Osteotomies for Sagittal Imbalance
Authors: El-Sharkawi Mohammad , Tammam Hamdy , El-Sherif Essam , Adam Faysal , Refae Hesham
Published: April 2016

Introduction

Surgical treatment of spinal deformity offers superior clinical and radiographic outcomes than non operative approaches. This prospective study aimed at assessment of outcomes of posterior only spinal osteotomies in treatment of sagittal imbalance.

Patients and Methods

Thirty cases of symptomatic sagittal imbalance were managed with posterior spinal osteotomy in Assiut University Hospitals. Half of them were males, age ranged from 5–57 years (20 ± 12.9). Eleven cases were congenital (36.7%) and five cases were Scheuermann kyphosis (16.7%), with other causes (46.7%) including degenerative, junctional, ankylosing spondylitis, post tuberculous, neuromuscular and Idiopathic types. Curves were angular in 14 cases (46.7%) and smooth in sixteen (53.3%). Ten cases (33%) were thoracic, eight (27%) were thoracolumbar, six (20%) were lumbar and six cases were diffuse. VAS, ODI, SRS-22, neurology, and radiological parameters (SVA, TK, LL T1SPA, PI, PT and SS using Surgimap 2.0.8.4664) were compared pre, post and at last follow up visit. Operative time, bleeding amount, and correction achieved were compared. The mean follow up was 21 months (12–60 months).

Results

Seventy five osteotomies (59 Ponte Osteotomies “PO” in 19 cases, Six Pedicle Subtraction Osteotomies “PSO” in 4 cases and ten Posterior Vertebral Column Resections “PVCR” in10 cases) had been done. Thirty nine osteotomies (52%) were thoracic, 17 thoraco-lumbar and 19 were lumbar. The VAS, ODI and total SRS-22 were improved ( p = 0.001) with no difference between the three osteotomy types. The local kyphosis improved from 61° to 10.57° ( p = 0.001) with 82.7% final correction and no difference between PVCR and PO ( p = 0.017). TK improved from 43.86° to 30.47 ° ( p = 0.020). The mean SVA improved from 54.68 mm preoperatively to 33.48 mm postoperatively and was 35.16 mm at final follow up ( p = 0.023). The amount of blood loss and the mean operative time was less with PO than PSO and VCR ( p = 0.001 and p = 0.039). Two cases developed deep infection and were successfully managed with debridement and antibiotics. Four cases developed asymptomatic proximal junctional kyphosis. Two cases with postoperative neurological complications were encountered. One of them recovered spontaneously during the follow up. The other one had proximal junctional failure and atraumatic subluxation of the upper dorsal spine. Urgent reduction and proximal extension of the fixation and fusion was done. Complete neurological recovery was observed during the follow up.

Conclusion

Posterior only spinal osteotomies appear to be highly effective in correcting sagittal imbalance and may avoid the morbidity of anterior or combined approaches.
Incidence of Cancer and Infertility, in Patients Treated for Adolescent Idiopathic Scoliosis 25 Years Prior
Authors: Simony Ane , Carreon Leah Y. , Christensen Steen Bach , Andersen Mikkel Ø.
Published: April 2016

Introduction

Adolescent females with idiopathic scoliosis are exposed to substantial amounts of radiation during treatment and follow-up for AIS. The purpose of this study was to determine the amount radiation exposure patients received during treatment for AIS and report the incidence of infertility and cancer in adulthood. Material and Method: 219 consecutive AIS patients treated at Rigshospitalet, Copenhagen between 1983 and 1990 were identified and requested to return for clinical and radiographic examination. The incidence of cancer was determined through chart review and follow-up interviews. In addition, the subjects and age-matched controls were queried regarding infertility, age at first pregnancy and spontaneous abortions. Using X -ray reports that included patient position, mAs and kV used and the number of X-rays taken, a radiation physicist calculated the total radiation dose during treatment and follow-up adjusted for BMI and sex.

Results

159 (78%) patients participated in the follow up study, and medical charts were available in 209 patients. 2 patients had passed away, one due to cardiac arrest and one to breast cancer. 8 patients had emigrated. Radiation information was available in 211 patients. The mean calculated mean total radiation exposure was 1.58 mSv (0,44–6,9). An average of 16.3 (range, 8–34) X-rays were taken during treatment. The rate of infertility (10%) and spontaneous abortion (23%) is similar to the normal controls. The AIS patients had an average of 1.4 children, which is 1 child less than the 2.5 children in the control cohort. Nine (4.3%) AIS patients developed cancer, mostly breast (3) and endometrial (4). Risk Ratio for cancer = 20.93 (95% CI:2.67–164.19) p = 0.000132. The patients with endometrial cancers have a low BMI 16.4 (15.9–16.6) at first radiation exposure, and the patients with breast cancers were older with BMI 20.4 (18.0–22.4). The incidence of cancer in this cohort is 17 times greater than the incidence of 0.25% in an age-sex matched cohort from the Danish Cancer Society Annual Report.

Conclusion

The infertility and spontaneous abortion rate was similar between AIS patients and an age matched cohort. The cancer rate in the AIS patients is 17 times higher than expected compared with the age-matched Danish population. [Table: see text][Table: see text]
Nutritional and Vitamin D Status in a Brazilian Sample of Patients Undergoing Spinal Surgery
Authors: Neto Diego Benone Santos , Pratali Raphael , Martins Samuel Machado , Barsotti Carlos Eduardo Gonçales , Oliveira Carlos Eduardo
Published: April 2016

Introduction

Several systemic parameters can affect the rate of complications in spinal surgeries and then have influence in the clinical outcomes. Among these parameters the nutritional status, which may be detected by the serum albumin concentration, is primordial. The vitamin D is a fat-soluble steroid hormone with important function at the bone metabolism and homeostasis, also diminishing surgical complications as bone mineral density compromises fixation. The aim of the study was to evaluate the epidemiologic profile of a Brazilian population sample specifically undergoing spinal surgery about malnourishment, identified by hypoalbuminemia, and vitamin D.

Material and Methods

This is a prospective observational study including patients undergoing spinal surgery in an only spine center. There were no exclusion criteria. The patients had a preoperative serum albumin and vitamin D concentration analysis on the day before their surgical procedure. Demographic variables were extracted. The results of the preoperative analysis were correlated with the demographic variables using the ANOVA and T-student's test, with the threshold of significance was set at P < 0.05.

Results

A total of 75 patients were included, 47 women (62.7%) and 28 men (37.3%). 74 had albumin concentration analysis and 64 vitamin D. The mean of the serum albumin result was 3,76 g/dL (DP: 0,53 g/dL), with 70.3% of the patients considered normal and 29.7% presenting hypoalbuminemia. About vitamin D, the mean of the value was 16,64 ng/mL (DP: 7,43 ng/mL), with 64.1% of patients considered deficient, 32.8% inadequacy and only 3.1% considered normal. There was a significant difference in the albumin concentration related with age ( p = 0.007), with older age group presenting poorer albumin levels. The hypoabluminemia occurrence was significantly higher in patients with 60 years or older ( p < 0.001). There wasn't correlation between vitamin D and age ( p = 0.603). The correlation analysis between the exam results and the gender didn't show any significant difference in none parameter.

Conclusion

Our study presented data about the serum albumin and vitamin D status in a Brazilian population sample of patients undergoing spinal surgery, information still unpublished. There was correlation between hypoalbuminemia, representing malnourishment, with patient in higher age groups. Almost all the patients presented some degree of hypovitaminosis D, without correlation with age.
Complications with and without the Use of Computer-Assistance in Lumbar Fusion Surgery: Analysis of 15,222 Patients in ACS-NSQIP Database
Authors: Aoude Ahmed , Nooh Anas , Fortin Maryse , Aldebeyan Sultan , Jarzem Peter , Ouellet Jean , Weber Michael H.
Published: April 2016

Introduction

The objective of this paper is to demonstrate the difference in post-operative complication rates between Computer-assisted surgery (CAS) and conventional techniques in spine surgery. Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CAS. Yet, few studies have compared the incidence of post-operative complications between CAS and conventional techniques.

Material and Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent posterior lumbar fusion from 2011 to 2013. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between CAS and conventional techniques in spine surgery.

Results

Out of 15,222 patients, 14,382 (95.1%) were operated with conventional techniques and 740 (4.90%) were operated with CAS. Multivariate analysis showed that patients in the CAS group had less odds to experience adverse events post-operatively (OR 0.57, p < 0.001). Minor adverse events occurred in 2905 (20.2%) patients in the conventional group and 98 (13.2%) patients in CAS group (OR=0.57, p < 0.001). Blood transfusion was present in 2488 (17.3%) of the patients in the conventional group compared with 98 of the patients in CAS group (10.95%)(OR=0.56, p < 0.001). The mean operative time in the conventional group was 205.2 ± 106.1 minutes, and 227.0 ± 111.9 minutes in the CAS group. This difference was statistically significant (r=20.14, p < 0.001).

Conclusion

This paper examined the complications in lumbar spinal surgery with or without the use of CAS. These results suggest that CAS may provide a safer technique for implant placement in lumbar fusion surgeries.
Intramedullary Lesion Length has a Negative Effect on Neurological Recovery in Cervical Spinal Cord Injury Patients with AIS Grades A-C
Authors: Aarabi Bizhan , Sansur Charles , Ibrahimi David , Hersh David , Le Elizabeth , Akhtar-Danesh Noori , Diaz Cara , Massetti Jennifer
Published: April 2016

Introduction

Experimental spinal cord injury and clinical studies indicate a relationship between MRI lesion length and outcome. In patients with AIS grades A-B, IMLL expands at a rate of 900 µm/hour, culminating in an intramedullary lesion (IML) which measures ~50 mm at 3 days post-injury. We performed a retrospective analysis to measure the effect of IML length on long-term neurological recovery and to determine the significance of intramedullary lesion length (IMLL) in long-term AIS grade conversion in traumatic cervical spine injury (TCSI).

Methods

Ninety-five adult patients who underwent decompressive surgery for cervical TSCI were included. Post-decompression IML length was measured and long-term AIS grades were recorded. A regression analysis was performed.

Results

AIS grade was A in 51, B in 26, and C in 18 patients. Mean IML length on postoperative MRI imaging was 72.6 mm. AIS grade conversion was noted in 46 (48.4%) patients. Conversion was noted in 27.5% of AIS grade A, 65.4% of AIS grade B and 83.3% of AIS grade C patients. Timing of decompression (18.2 hours) had no effect on AIS grade conversion, but conversion was significant in older patients, those with higher ASIA motor score, lower injury severity score, shorter IML length and better evidence of decompression on postoperative MRI. Regression analysis indicated a significant relationship between AIS grade conversion and IML length on postoperative MRI (OR 0.953, 95% CI  = 0.9313–0.9761, p = 0.001).

Conclusions

In AIS grades A-C cervical TSCI, post-decompression rostrocaudal IML length was significant predictor of AIS grade conversion and neurological recovery. The timing of decompression did not correlate with recovery of function.
The Sympathetic Nervous System Mediates Functional and Robust Respiratory Recovery following Acute Cervical Spinal Cord Injury
Authors: Awad Basem
Published: April 2016

Introduction

The organization of the respiratory network has traditionally been described through descending medullary tracks. The diaphragm is innervated by the phrenic nucleus (C4-C6). However, the intercostal muscles are innervated by the intercostal motor nucleus (T1-T11) located at the thoracic spinal cord segments. Therefore, cervical spinal cord injury (SCI) can typically cause respiratory motor system dysfunction. From the literature, ventilation failure within the human lower cervical SCI population typically occurs 4.5 ± 1.2 days after injury, affecting 26.6% of patients. Also, the risk of apnea following low cervical SCI is increased during sleep. However, while intercostal muscles contribute to respiratory recovery post injury the pathways mediating this effect have never been fully elucidated.

Methods

Following complete C7 spinal cord transection in rats, we demonstrated the presence of intercostal-EMG activity synchronized to the inspiratory bursts of the diaphragm. We explored the anatomical, and latent, pathway that enables synchronized activation of the intercostal muscles after complete cord transection. Experimental work, in the form of bilateral dorsal/ventral rhizotomies, unilateral transection of the phrenic nerve and sympathetic chain ganglia and systemic application of salubutamol, suggested that intercostal activities is mediated through the sympathetic chain ganglion by means of connection to the ipsilateral phrenic nerve.

Results

In anesitised and unventilated rats, rhythmic inspiratory activity was present in the intercostal muscles following acute C7 transection and bilateral dorsal/ventral rhizotomies. This activity persisted up to five days following the initial trauma. Unilateral transection of the phrenic nerve and sympathetic chain ganglia eliminated ipsilateral intercostal motor activity. Systemic application of salubutamol (β2-agonist), not only increase intercostal activity but also restored it in transected rats which had not retained this activity following transection.

Conclusions

These data provide the first evidence of sympathetic nerve activity mediating synchronized and robust intercostal inspiratory muscle activity following severe, lower cervical transection. This activity occurs up to 5 days following trauma, an effect which correlates with the induction of ventilation failure and respiratory dysfunction in human patients with SCI. The clinical implications of this finding are provocative. 60% of patients undergo some degree of respiratory distress following acute C5–8 injuries. Using this pathway, it may be possible to modestly stimulate or activate sympathetic activity to further aid intercostal muscle activity and respiratory function following acute SCI. This thus represents a novel target for the treatment of respiratory dysfunction following spinal trauma. [Figure: see text]
A Systematic Review of the Measurement Properties of Patient-Reported Outcome Measures in Spinal Cord Injury
Authors: Abedi Aidin , Seyedpour Simin , Mokkink Lidwine B. , Shokraneh Farhad , Rahimi-Movaghar Vafa
Published: April 2016

Introduction

Over the past decades, a large number of patient-reported outcome measures (PROMs) have been developed for use in spinal cord injury (SCI) research and practice, which evaluate the patient's own perceptions and opinions. However, little is known about the measurement properties of the PROMs used in this population. The objectives of this systematic review were to appraise the methodological quality of the studies on reliability, validity, responsiveness and interpretability of the patient-reported SCI outcome measures and to evaluate and summarize the quality of the measurement instruments.

Material and Methods

A systematic search of literature in EMBASE, MEDLINE, PsycINFO and CINAHL was performed. Articles were included when they concerned the development of PROMs or the evaluation of their measurement properties in SCI population. Methodological quality of the studies was evaluated using the four-point rating system of the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. The overall quality of the measurement instruments was rated using a pre-defined criteria. The selection process, data extraction and quality assessment were performed by two independent reviewers and disagreements were resolved by consensus. In case of remaining controversy, a third reviewer made the final decisions.

Results

A total of 9337 articles were screened for eligibility. A wide variety of PROMs measuring different constructs, including quality of life, participation, physical activity, rehabilitation needs, pain, and spasticity were identified. Reliability was the most frequently evaluated measurement property. There was a paucity of literature addressing the responsiveness, measurement error, content and cross-cultural validity of the PROMs. The methodological quality of a majority of the studies was fair to poor and small sample size was a common drawback among the low quality studies. There were many validity studies with indeterminate results due to lack of pre-defined hypotheses.

Conclusion

There is an urgent need for high quality studies on measurement properties of PROMs in SCI population. Considering the importance of scientifically sound measurements, cautious use of the PROMs is advised until further evidence is available.
Diagnostic Work-Up and Treatment of Traumatic Spondylolisthesis of the Axis: Case Series and Literature Review
Authors: Yurac Ratko , Zamorano Juán José , Valencia Manuel , Marré Bartolomé , Izquierdo Guillermo , Illanes Juan Cristobal
Published: April 2016

Introduction

Traumatic spondylolisthesis of the axis represents a spectrum of injuries affecting the C2-C3 level, secondary to bilateral fracture of the pars of C2 due to extension and/or compression forces. The integrity of the C2-C3 disc and the posterior longitudinal ligament are key elements for segmental stability and should be thoroughly assessed before deciding the treatment modality. The aim of this study is to describe the diagnostic work-up and treatment decision in a case series of patients with traumatic spondylolisthesis of the axis. We also present a review of the available literature about this type of injuries.

Material and Methods

We reviewed the medical records and images of patients with a traumatic spondylolisthesis of the axis treated in two centers between January 2008 and March 2015. Details regarding demographics, injury mechanism, type of lesion (using the Levine & Edwards classification) and treatment modality (surgical or non-surgical and its justification) were analyzed. We also performed a literature review, focusing on the diagnosis and treatment of these injuries.

Results

Case series including 7 patients (4 males, mean age at the time of the injury of 37.9 years [23–55]). Six patients (85.7%) were injured in a motor vehicle accident and 28.6% (2/7) presented other spine fractures. All of the patients were neurologically intact. Five cases (71.4%) had a type I injury. Magnetic resonance imaging was obtained as part of the initial assessment in 5 patients (71.4%), none of these patients were considered to have a disrupted posterior longitudinal ligament, while 2 (28.6%) presented hyper intensity at the C2-C3 disc on T2-weigthed images. Surgery was promptly indicated only in one case (type III lesion with a disrupted C2-C3 disc on magnetic resonance imaging, in which an instrumented posterior C2-C3 fusion was performed). The remaining 6 patients (85.7%) were originally treated non-surgically with a hard collar, but 2 of them (both with type I injuries) had surgery one week after the accident (one anterior and one posterior instrumented C2-C3 fusion) due to progressive listhesis and angulation at the C2-C3 level. No treatment-related complications were identified in both surgically and non-surgically treated patients. The available literature emphasizes the importance of the assessment of the C2-C3 disc and the posterior longitudinal ligament via magnetic resonance imaging before deciding the treatment modality in these patients.

Conclusion

Initial imaging work-up, particularly regarding the C2-C3 disc and posterior longitudinal ligament's integrity on magnetic resonance imaging, together with close radiological follow-up are key elements to consider in the treatment of traumatic spondylolisthesis of the axis.
Single-Level, Multi-Level (Two, Three and Four Levels) and Hybrid Cervical Disc Arthroplasty: Age and Sex-Weighted Linear Regression Analysis, Results from a Single Centre
Authors: Rajesh Mangattil , Khan Shoaib , Friesem Shabtai , Bhatia Chandra , Berg Andrew , Reddy Guru
Published: April 2016

Introduction

The clinical outcomes of single, multi-level and Hybrid cervical disc arthroplasty are reported in the literature. However, there is less detail on the outcome results related to age and sex on these groups. We reviewed 405 patients who had single level, multi-level (two, three & four) and Hybrid cervical disc arthroplasty at our center.

Methods

The study involved a retrospective review of prospectively collected data on single level, multi-level (two, three & four) and Hybrid cervical disc arthroplasty patients with an average age of 54.64 (range: 34–80). 405 patients were followed up for 2 to 8 years based on clinical outcomes scores. These included NDI (Neck Disability Index), Visual Analogue score for Neck (VAS Neck), and Visual Analogue score for Arm (VAS Arm). Scores were collected pre-operatively and at each follow up at 3 months, 6 months, 1st and yearly afterwards. Linear Regression Analysis was performed to look at the impact of age and Two sample T-Test was used to look at the difference between males and females.

Results

The study consisted of 215 females and 190 males. The duration of symptoms was on an average 60 months. The indication for surgery was radiculopathy and a combination of radiculopathy and myelopathy. Linear Regression Analysis for NDI and age showed a Pearson correlation r of 0.002; P Value: 0.968; for sex difference - P value of 0.730 showed no statistically significant differences between male and female groups. For VAS Neck, the Pearson correlation was r = 0.008; P Value: 0.873; for sex difference – P value of 0.178 showed no statistically significant differences between male and female groups. For VAS Arm, the Pearson correlation was r = 0.064; P Value: 0.198; for sex difference – P value of 0.953 showed no statistically significant differences between male and females.

Conclusion

Our results suggest that there is no correlation between age of the patient and their NDI, VAS Neck and VAS Arm scores for all groups of Cervical Disc Arthroplasty. Similarly, there were no statistically significant differences in the outcomes between males and females.
Reduced Rate of Proximal Junctional Fractures above Long-Segment Instrumented Constructs Utilizing a Tapered Dose of Bone Cement for Prophylactic Vertebroplasty, A Biomechanical Investigation
Authors: Zavatsky Joseph , Shah Anoli , McGuire Robert , Serhan Hassan , Kelkar Amey , Kodigudla Manoj , Agarwal Aakash , Briski David , Goel Vijay
Published: April 2016

Introduction

PJK is a well-described post-operative complication associated with long instrumented fusion constructs. The surgical creation of a stiff upper segment along with patient osteoporosis has been suggested as etiologies.

Materials and Methods

Fifteen fresh-frozen ligamentous T6 - pelvis specimens were divided equally into three Groups: Group 1 - Bilateral pedicle screw and rod instrumentation from T10 to S1, no cement; Group 2 - Instrumentation + 4cc of cement injected into T10 (UIV) and 4cc into T9 (UIV + 1), 2cc of cement injected through each pedicle; & Group 3 - Instrumentation + 4cc of cement in T10 (UIV), 3cc total in T9 (UIV + 1), and 2cc total in T8 (UIV + 2). The pelvis and T6 vertebra were potted. Eccentric axial compression was applied 10mm anterior to the center of T6 using an MTS actuator. Maximum load to failure was measured in newtons (N). The spines were evaluated using fluoroscopy and CT.

Results

There was a significant reduction in the number of fractures in Group 3 versus Groups 2 and 1 ( p = 0.0019). There was only one fracture in Group 3, which occurred at T8 (UIV + 2); all five specimens suffered a fracture in Group 2; and five in Group 1. Posterior ligamentous rupture occurred in four specimens in Group 3; three in Group 2; and only one in Group 1. The mean peak load-to-failure values showed an increasing trend from Groups 1 to 3 ( p = 0.38). There was no difference in specimen DEXA values ( p = 0.71). There was no hardware failure in any Group. FEA mirrored the cadaveric data and the maximum load to failure increased from Group 1 to 3. Endplate stresses were reduced in Group 3 versus Groups 1 and 2.

Conclusions

In both cadaveric and FEA models, this novel technique of tapering the dose of prophylactic vertebroplasty cement in the UIV, UIV + 1, UIV + 2 decreased the endplate stresses, increased the load required for failure, and significantly reduced the incidence of VCFs above long-segment instrumented constructs. Clinically, this technique may reduce the risk of PJK, PJF, and revision surgery.
Impact of the Intraoperative Neurophysiologic Monitoring in Idiopathic Scoliosis Surgery
Authors: Rech Paulo Renato , Lanna Raquel , Menezes Cristiano Magalhães , Sakamoto Roberto , Dias Anderson , Vargas Rogerio de Almeida
Published: April 2016

Objective

The aim of this study is to analyze the use of intraoperative neurophysiological monitoring (MNIO) in idiopathic scoliosis correction surgery.

Methods

Retrospective study of 80 patients undergoing idiopathic scoliosis correction surgery between December 2008 and January 2015 using the MNIO. Among the patients, 85% were female ( n = 68) and 15% males ( n = 12), the average age on the day of surgery was 17 years and the prevalent type of scoliosis curve classification was Lenke 1-A-N (37.5%/ n = 30). We reviewed the significant changes in MNIO, duration of surgery, number of pedicle screws needed to correct deformities, screw time, onset of neurological deficits, Coob angle and effectiveness of MNIO.

Results

There were significant changes or loss of the MNIO data in 15 patients (18.75%). Complete recovery after intervention was seen in 12 patients (80%). Three patients (20%) had some neurological deficit in the immediate postoperative period. The mean duration of surgery was 320.76 minutes and were used on average 18.84 screws to correct deformities, with an average time of 8.27 minutes for the passage of each pedicle screw. The thoracic curves averaged 52.80 degrees and 47.40 degrees for lumbar curves.

Conclusion

Long constructions, osteotomies and more severe curves are related to most of the changes found in evoked potentials. The joint use of somatosensory evoked potentials and motor allows a direct evaluation of sensory and motor functions of the spinal cord and dramatically increased the sensitivity and specificity in the detection of neurophysiological changes, helping in decision making during surgery. The interpretation in real time by neurophysiologist possible interruption of operations by temporarily verge of nerve injury with immediate change of the surgical strategy.
Multiple Adjacent Level with Pott's Disease with Sever Vertebral Sequestration (Case Presentation)
Authors: Elsabrout Almoataz , Elkott Amer
Published: April 2016

Pott's disease is a known disorder that affects the spine causing various degree of disability for the patients that ranges from mild to severe kyphosis with or without neurological deficits. In most cases single level is affected and in fewer numbers two levels are affected. Rarely more than two levels are affected. In this case we present a case of Pott's disease affecting five adjacent segments with vertebral sequestration. This is 43 years old female patient presented to Assuit university hospital with history of repeated attacks of back pain and mild fever since 4 years the patient received empirical antibiotic after which she said that she partially improved and after then the patient became accustomed to repeat the antibiotic with no medical consultation. Later on the pain became sever but no neurological manifestations then she had X-ray and MRI with diagnosis of long segment vertebral osteomyelitis affecting T7-T12. Posterior costotransversectomy approach was done and the sequestrated vertebral bodies and intervening discs were excised and sent for culture sensitivity and biopsy and mesh cage was applied to bridge the defect and pedicle screws are inserted from T5 to L2, and later on antituberculous regimen was started after the diagnosis was established. Postoperatively the neurological status was intact and the pain improved; 6 month follow up showed good bone healing. Stable cage and pedicle screws and much improvement in the general status of the patient.
Development of Validated Computer-Based Preoperative Predictive Model for Proximal Junction Failure (PJF) or Clinically Significant PJK with 86% Accuracy based on 510 ASD Patients with 2-year Follow-up
Authors: Scheer Justin , Smith Justin , Schwab Frank , Lafage Virginie , Hart Robert , Bess R. Shay , Line Breton , Diebo Bassel , Protopsaltis Themistocles , Jain Amit , Ailon Tamir , Burton Douglas , Klineberg Eric , Ames Christopher ,   International Spine Study Group
Published: April 2016

Introduction

Proximal Junction Failure (PJF) and Proximal Junction Kyphosis (PJK) are significant complications. It remains unclear what are the specific drivers behind the development of either. This study attempts to develop a preoperative predictive model to identify patients at risk to develop PJF or PJK.

Material and Methods

Inclusion criteria: age ≥18, adult spinal deformity (ASD), ≥4 levels fused. Variables included in the model were: demographics, primary/revision, use of 3-column osteotomy, UIV/LIV levels and anchor (screw, hooks), number of levels fused, and baseline sagittal radiographs (PT, PI, PI-LL, TK, and SVA). PJF was defined as requiring revision for PJK and PJK was defined as an increase from baseline of PJK > 20° and with deterioration by at least 1 SRS-Schwab sagittal modifier grade from 6wks postop. An ensemble of decision trees were constructed using the C5.0 algorithm with 5 different bootstrapped models, and internally validated via a 70:30 data split for training and testing. Accuracy and the area under a receiver operator characteristic curve (AUC) were calculated. Final model utilized 13 preoperative variables.

Results

510 patients were included, with 357 for model training and 153 as testing targets (PJF: 37, PJK: 102). The overall model accuracy was 86.3% with an AUC of 0.89 indicating a good model fit. The 6 strongest (importance ≥0.95) predictors were (% target): age (>64yrs, 41.4%), PI-LL (>48.7deg, 35.6%), UIV (T10-L3, 35.1%), SVA (>13.5cm, 32.5%), LIV (sacroiliac, 31.6%), and UIV Type (screws, 29.8%). If a patient met these criteria, they had a 66.7% chance of developing PJF or PJK with deterioration of sagittal alignment.

Conclusion

A successful model (86% accuracy, 0.89 AUC) was built predicting either PJF or clinically significant PJK. This model can set the groundwork for preoperative point of care decision making, risk stratification, and need for prophylactic strategies for patients undergoing ASD surgery.
Long-term Results of Implant Related Complications after Lumbar Fusion Using a Non-rigid Transpedicular Pedicle Screw-Rod System
Authors: Bank Andras , Varga Péter Pál
Published: April 2016

Introduction

Transpedicular fixation is associated with the risk of hardware failure, such as screw/rod breakage and/or loosening at the screw-rod interface and difficulties in the system assembly, which remains a significant clinical problem. Removal or revision of the spinal implants is often required. This is a retrospective radiological study of the single- and two-level lumbar stabilization procedures (TLIF, PLIF or PLF) performed from January 2002 to December 2012 using a non-rigid transpedicular implant system. The purpose of this study was to retrospectively analyze the radiological outcome of 1280 patients focusing on implant related complications.

Material and Methods

1280 patients were included into the study. The female/male ratio was 56%/44%, the mean age was 59 years (18–88), the mean FU time was 32 months. Indications for surgery were DDD, FBS and spondylolisthesis (DDD: 77%, FBS: 18%, spondylolisthesis: 5%). There were 727 single-level stabilizations and 553 two-level stabilizations in this cohort. The radiological status of the implants was assessed on lateral and AP X-rays and available CT scans by independent radiologists. We investigated the occurence of screw breakage, screw loosening and element rod breakage, rod slipping and movement.

Results

In the single-level group 8 screw breakage (1.1%), 27 screw loosening (3.7%), 9 element rod breakage (1.2%) and 47 element rod slippage or movement (6.5%) were detected. In the two-level group 9 screw breakage (1.6%), 30 screw loosening (5.4%), 14 element rod breakage (2.5%) and 37 element rod slippage or movement (6.7%) were present.

Conclusion

Comparing the result of this retrospective radiological study with the available literature data, we can state that the rate of implant related failures in case of the nonrigid transpedicular system is lower than in the previously published studies. Low implant complicationn rate can be associated with the effect of the non-rigid stabilization on bony remodelling at the surroundings of the transpedicular screws. The influence of non-union rate and sagittal alignment on the outcome needs further evaluations.