bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Osteolytic Lesions in the Sacrum (S1-S3) Treated by Targeted Radiofrequency Ablation: A New Option for Metastases in the Sacrum
Authors: Müller-Broich Jacques Dominik , Kretschmar Tobias , Porten Marius , Demukaj Sadri , Saxler Guido
Published: April 2016

Introduction

Sacral metastases and myelomatous lesions often result in debilitating pain and significant morbidity in patients with prolonged life expectancy. Radiation therapy and cement augmentation are well described local therapies for controlling cytokine mediated osteolytic bone resportion and skeletal related events associated with metastatic and myelomatous sacral lesions. Ablative therapy has been reported in recent years as a minimally invasive therapy permitting both local treatment of bone lesions and immediate stabilization, when followed with cement augmentation. This case study reports multimodality minimally invasive treatment of patient with multiple painful osteolytic lesions using a novel articulating bipolar RF ablative therapy and an ultrahigh viscosity cement.

Material and Methods

A 75-year-old-patient with history of multiple myeloma and significant lumbar back pain presented with diffuse lytic spinal disease throughout the thoracolumbar and sacral spine. Following review by multidisciplinary tumorboard, percutaneous targeted radiofrequency ablation (t-RFA) was performed in T12-L4 and a unilateral sacral lesion (S1-S3) using an articulated bipolar electrode containing thermocouples to assess real time growth of the ablation zone followed by delivery of ultrahigh viscosity cement using RF energy warmed cement (RF-Targeted Vertebral Augmentation, RF-TVA). Pain was demonstrated preoperatively with 9 using the visual analog scale for both locations. On the first postoperative day pain was at 4(VAS), in the 6 weeks control pain was at 2(VAS). At the 3 months control pain was at 2(VAS).

Results

The combined approach of t-RFA and RF-TVA in the sacrum was technically and clinically feasible with an immediate pain reduction, improvement in quality of life and functionality at 6 weeks and 3 months after the procedure and no complications. CT performed 6 weeks post procedure confirmed the absence of cement leakage.

Conclusion

t-RFA combined with RF-TVA of the sacrum can be safely and effectively performed via a single access port resulting in significant palliative relief and functional improvement. In combination these procedures may provide an alternative palliative, minimally invasive treatment option for painful osteolytic lesions in the sacrum(S1-S3) requiring stabilization for patients in which radiation therapy may not be an option.
Surgical Treatment of Solitary Spinal Plasmacytoma
Authors: Abdel-Wanis Mohamed
Published: April 2016

Introduction

Solitary plasmacytoma of the vertebra is a rare condition. Treatment options include radiotherapy, surgery, radiotherapy combined with surgery, and vertebroplasty or kyphoplasty. Although radiotherapy is the treatment of choice for solitary plasmacytoma of the spine, recommendations for treatment have been based on limited data from retrospective studies.

Material and Methods

Thirteen patients of solitary spinal plasmacytoma were treated at Sohag University Hospital between 2003 and 2014. Patients were 12 males and 1 female. Age ranged between 35 and 74 (mean 57.7) years. Lumbar spine was affected in 7 patients and thoracic spine in 6 patients. Pain was assessed on Denis pain scale. On presentation 8 patients had pain grade P5, 4 patients had pain grade P4 and 1 patient had pain grade P2. The Frankel grading system was used to assess the neurologic outcome. On presentation, 6 patients had neurological deficits; 3 Frankel grade C, and 3 Frankel grade D. Indications for surgery included pathological fracture (9 patients) and neurological compromise (6 patients). All patients received operation through a single posterior exposure. The lesion was curetted and anterior reconstruction was achieved by spinal shortening (5 patients), or anterior bone grafting (6 patients), and anterior reconstruction was not needed in 2 patients. Then posterior fusion was performed. Radiotherapy began 3 weeks after the operation.

Results

All patients got neurological recovery to Frankel grade E and improvement of pre-operative pain (6 patients to P1, 5 patients to P2 and 2 patients to P3). No local recurrence occurred after follow up for 7–102 (mean 36.9).

Conclusion

Gross-total tumor resection on piecemeal basis with post-operative adjuvant radiotherapy for solitary plasmacytoma of the spine gives long-term local control of the tumor. It can help to improve patient's quality of life.
Incidence, Predictors and Post-Operative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 14,249 Patients from the ACS-NSQIP Database
Authors: Aoude Ahmed , Nooh Anas , Fortin Maryse , Aldebeyan Sultan , Jarzem Peter , Ouellet Jean , Weber Michael H.
Published: April 2016

Introduction

Hemorrhage and transfusion requirements in spine surgery are common. This is especially true for thoracic and lumbar fusion surgeries. There is limited data in the literature concerning predictive factors for transfusion and their effect on short-term post-operative outcomes.

Material and Methods

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

Results

A total of 14,249 patients were included in this study; 13,586 had lumbar fusion and 663 had thoracic fusion surgery. The prevalence of transfusion was 35% for thoracic fusion and 17.5% for lumbar fusion. The multivariate analysis showed that age between 50–60 (OR 1.38, CI: 1.23–1.54), age between 61–70 (OR 1.65, CI: 1.40–1.95), dyspnea (OR 1.11, CI: 1.02–1.23), hypertension (OR 1.14, CI: 1.02–1.27), ASA class (OR 1.73, 1.18–1.45), pre-operative blood transfusion (OR 1.91, CI: 1.04–3.49), and extended surgical time (OR 4.51, CI: 4.09–4.98) were predictors of blood transfusion requirements for lumbar fusion. While only pre-operative BUN (OR 1.04, CI: 1.01–1.06) and extended surgical time (OR 4.70, CI: 3.12–6.96) were predictors of transfusion for thoracic fusion. In contrast, higher pre-operative hematocrit was protective against transfusion. Patients transfused who underwent lumbar fusion had an increased risk to develop superficial wound infection, deep wound infection, venous thromboembolism, myocardial infarction and had longer length of hospital stay. Patients transfused who underwent thoracic fusion were more likely to have venous thromboembolism and extended length of hospital stay. However, mortality was not associated with blood transfusion.

Conclusion

This study used a large database to characterize the incidence, predictors and post-operative complications associated with blood transfusion in thoracic and lumbar fusion surgeries. Pre- and post-operative planning for patients deemed to be at high-risk of requiring blood transfusion should be considered to reduce post-operative complication in this population.
Adjacent Segment Degeneration after Lumbar Spinal Fusion Compared with Motion-Preservation Procedures: A Meta-analysis
Authors: Hai Yong , Pan Aixing
Published: April 2016

Introduction

Adjacent segment degeneration (ASDeg) or adjacent segment disease (ASDis) is a matter of concern after lumbar fusion. Whether the motion-preservation procedures could reduce the prevalence of ASDeg or ASDis is still controversial. This meta-analysis aimed to evaluate the efficacy of motion-preservation procedures preventing the ASDeg or ASDis compared with fusion in lumbar spine. Methods: PubMed, Embase, the Cochrane Library were comprehensively searched and a meta-analysis was performed of all randomized controlled trials (RCTs) and well designed prospective or retrospective comparative cohort studies assessing the lumbar fusion and motion-preservation procedures. We compared the ASDeg/ASDis rate, reoperation rate, operation time, blood loss, length of hospital stay and VAS/ODI improvement of the two procedures.

Results

A total of 15 studies consisting of 1474 patients were included in this study. The meta-analysis indicated that the prevalence of ASDeg, ASDis and reoperation rate on the adjacent level were lower in motion-preservation procedures group than in the fusion group ( p = 0.001; p = 0.0004; p < 0.0001). Moreover, shorter length of hospital stay was found in motion-preservation procedures group ( p < 0.0001). No difference was found in terms of operation time ( p = 0.57), blood loss ( p = 0.27), VAS ( p = 0.76) and ODI improvement ( p = 0.71) between the two groups.

Conclusions

The present evidences indicated that the motion-preservation procedures had an advantage on reducing the prevalence of ASDeg, ASDis and the reoperation rate due to the adjacent segment degeneration compared with the lumbar fusion. And the clinical outcomes of the two procedures are similar.
Anterior Lumbar Interbody Fusion (ALIF): Biometrical Results and Own Experiences
Authors: Kapustka Bartosz , Pawel Chodakowski , Kiwic Grzegorz , Marcol Wieslaw , Wysokinski Tomasz , Paruzel Krzysztof , Slosarek Zofia
Published: April 2016

Introduction

Lumbar fusion is a mainstay in the treatment of low back pain resulting from degenerative disc disease. Of the various fusion techniques available, anterior lumbar interbody fusion (ALIF) has become a good treatment technique to achieve this goal. Our aims were to describe our experience with lumbosacral ALIF performed in cooperation of neurosurgeons and vascular surgeons and analysis of improvement in function and a biometrical aspects.

Material and Methods

From 2011–14, 33 patients underwent ALIF, 45 were identified as having a single level procedure at L5-S1 from a mini-open retroperitoneal approach. The cases were reviewed to determine fusion status, incidence of complications and length of stay. Disc space heights were determined using a ratio of disc space height to superior end plate length. For each treatment group, anterior and posterior disc space measurements were collected on a lateral radiograph and averaged to obtain a measure for disc space height. Statistical analysis was performed using Statistica 8.0.

Results

The average length of hospitalization was 4 days. Most of patients had spinal cord stenosis. 3 patients had early complications like parestesis of lower limbs, but there were no major complications. Blood loss was less than 75 cc in all cases. The SynFix-LR implants were used for all - average size 12,31 mm and angle 11,61. The pre-op angle of lordosis was 12,3° and post-op +8,9° added. The average disc space before treatment was 10 mm and after +7,17mm added.

Conclusion

The mini-open ALIF approach for L5-S1 fusion is a reasonable alternative to the more extensive posterior approaches. Although no direct comparison with the more extensive approach has been performed, our initial experience suggests that this procedure may reduce pain, blood loss, complications and length of hospital stay. ALIF significantly restores the height of the intervertebral disc and provides stability. Based on these results, it would appear that in properly selected patients ALIF with neurosurgeon-vascular surgeon cooperation raises the standard of comparison for nonfusion methodologies with regards to short and long-term pain relief and functional recovery.
Incidence and Risk Factors for Adverse Outcomes after Open Surgery for Spinal Metastatic Fractures
Authors: Theiss Steven
Published: April 2016

Introduction

Several scoring systems have evolved to estimate life expectancy in the setting of spinal metastases. However, neither overall mortality rate nor risk factors for complications in open surgery for spinal metastatic fractures have been well defined. We hypothesize that the mortality risk for these patients is high, and that additional medical comorbidities add substantially to the risk of early postoperative death. Understanding these risks will help us to choose surgical candidates with more carefully.

Methods

A national database, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) files, from 2011–2013 were queried for patients who underwent open surgery for pathologic vertebral fracture in the setting of metastatic cancer. Patients were analyzed for rates of any adverse event (AAE), readmission, reoperation, and mortality. Bivariate and multivariate analyses were performed to determine independent risk factors for these events.

Results

Of the one hundred and fifty three patients identified, seventy-eight (51%) experienced AAE, fifteen (9.8%) required reoperation, thirty (19.6%) were readmitted, and nineteen (12.4%) died within 30 days. Risk factors for AAE included pulmonary comorbidity ( p = 0.049, OR=3.87) and chronic steroid use ( p = 0.045, OR=2.28). Reoperation risk factors included male gender ( p = 0.038, OR=4.00). No risk factors were identified for readmission. Regarding mortality, identified risk factors included dependent functional status ( p = 0.009, OR=5.75), diabetes ( p = 0.004, OR=5.55), and pulmonary comorbidity ( p = 0.041, OR=4.23).

Conclusion

Open surgery for spinal metastatic fractures carries significant morbidity and mortality. Greater than half of patients in this cohort experienced an adverse event, nearly 20% were readmitted, and greater than 10% died within 30 days. Patient factors, including pulmonary disease, diabetes, and dependent functional status, were identified as risk factors for poor outcomes. Thorough preoperative counseling should be performed for patients with our proposed risk factors, and the risk of mortality in surgery must be carefully weighed against life expectancy and neurological deficits.
Low Back Pain and Sciatica as the Prominent Clinical Manifestations of Pelvic Venous Congestion Syndrome. A Case Report
Authors: Delaportas Grigorios , Manolarakis Georgios
Published: April 2016

Introduction

Although back pain / sciatica are common conditions in the general population and their etiology is very well understood, there is a strong interest in non-musculoskeletal origins of pelvic pain masked by symptoms resembling radicular pain such as in the case of circulatory disorders in anatomic sites beyond the spine. This study presents a particular case of low back pain & sciatica as the main symptoms of pelvic venous congestion syndrome.

Material and Methods

A 25 year old female presented to the Spine Institute of New England complaining of 90% low back pain and 10% right lower extremity constant pain affecting the lateral aspect of her thigh and averaging around 6/10 with reported flare-ups up to 10/10 especially at the end of a long day full of activities and with prolonged standing. She has also been complaining of sleep disturbances over the last 6–9 months. She has tried land physiotherapies in the past unsuccessfully. She complained of mild dyspareunia as well. Clinical assessment suggested pain of discogenic and/or facetogenic nature, questionable meralgia paresthetica, and sciatica; however, plain radiographs were equivocal. One month prior to the patient's visit to our clinic, Gynecological laboratories ordered by primary care physician were unremarkable. The patient followed a conservative treatment plan consisted of simple analgesics, non-steroidal (Meloxicam), and steroidal (Methylprednisolone) anti-inflammatory medication, antidepressant (Fluoxetine) and antiepileptic drugs for neuropathic pain (Gabapentin). One month later, she reported no significant improvement especially on her right thigh stating that cortisone has helped initially; NSAID's were somehow helpful unlike Gabapentin, which did not help at all. The patient was followed up with MRI, which demonstrated a tubular fluid-filled structure in the region of the right adnexa in addition to mild effacement of the thecal sac at the L3-L4 level, not a strong evidence of discogenic/radicular pain. Subsequently, a transabdominal US revealed prominent pelvic veins bilaterally – more pronounced on the right side – reflecting the likelihood of pelvic venous congestion syndrome. EMG excluded nerve root compression at the spinal level, while a thorough gynecological clinical examination confirmed the aforementioned diagnosis at initial stage due to hormonal dysfunction.

Results

The patient has been placed on cortisone treatment for ovarian function suppression showing encouraging early outcomes.

Conclusion

Even though pelvic venous congestion syndrome is diagnosed via exclusion of other pathological conditions that most likely cause symptoms of low back pain and/or sciatica, this case report comes to highlight the importance of integrated initial systemic clinical assessment, particularly when more than one medical specialties are involved in the region of interest.
Influence of Psychiatric Comorbidities on Clinical Outcome Before and after Elective Spine Surgery. A Prospective Observational Study
Authors: Meyer Bernhard , Shiban Ehab , Shiban Youssef , Mühlberger Andreas
Published: April 2016

Introduction

It is widely accepted that psychiatric comorbidities have a negative influence on health-related quality of life and long-term outcomes following spine surgery. However, most published data are restricted to postoperative measurements and data from preoperative settings in lacking. Aim of this study was to assess the incidence and influence of psychiatric comorbidities on clinical outcome in patients undergoing elective spine surgery.

Methods

A prospective study of patients undergoing elective spine surgery was performed. Evaluation for depression (ADS-K score) and anxiety (STAI-S, STAI-T and ASI-3 scores) before surgery and at three months follow up were done. In addition SF36 physical composite score (PCS), Oswestry Disability Index (ODI) and pain visual analog scale (VAS) were completed preoperatively and 3 months postoperatively. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined.

Results

144 patients met all inclusion criteria. 78 patients were male (54,2%); mean age was 59.49 years. Most patients were married or in a steady relationship (77,8%). Abnormal STAI-S, STAI-T and ASI-3 anxiety scores were encountered preoperatively in 51,4%, 39,6% and 11.8% of cases but resolved in 38,6%, 31,9% and 11,1% of cases at 3 months follow up. 17,36%, 11,11%, 5,55% reported abnormal STAI-S, STAI-T and ASI-3 anxiety scores only following surgery, respectively. Abnormal ADK-S score were seen in 25% of cases before surgery and resolved in 14,6% of cases at 3 months follow-up. 5.55% of patients showed abnormal ASD-K scores only following surgery. Patients with an anxiety disorders at follow up had a worse clinical outcome compared with there counterparts (ODI: 43.07 vs 35.67, p = 0,304; VAS pain: 43.07 vs 5.54, p = 0.000, PCS: 42.08 vs 41.83, p = 0.949). Pathologic depression scores also had a negative influence on most clinical outcome measurements (ODI: 10.44.3 vs 26.4, p = 0.000; VAS pain: 10.49 vs 3.97, p = 0.000, PCS: 10.03 versus 48.93, p = 0,000).

Conclusions

The incidence of depression and anxiety disorders in patients undergoing elective spine surgery is very high. This was also associated with unfavorable outcome. Most cases of depression and anxiety were present prior to surgery. More patients are needed to asses the possibly of preoperative screening for such comorbidities as many of the patients psychiatric problems resolved after surgery.
Diagnostical Challenges of Tumor-Like Conditions of Cervical Neural Arch in Childhood
Authors: Hoffer Zoltan , Lazary Aron , Varga Péter Pál
Published: April 2016

Introduction

Neck pain is a rare symptom in childhood. However, if exists permanently, require a thorough checkup, because very often some serious pathology it is in the background. We present two consecutive cases of young patients with neck pain, where the differential diagnosis was challenging, and has proved two different tumor-like pathologies.

Material and Methods

The first case concerns a 17 years old boy, who represents a pain localizing to the scruff region, mainly during night and to have a rest. MR imaging showed a high intensity changes on T2-weighted, and low intensity changes on T1-weighted pictures at the top of C.7. spinous process. According to SPECT/CT and bone scan an osteoid osteoma was suspected. The second case concerns a 7 years old boy, who had been complaining for few months a temporary, however a sharp pain also at the scruff region, consequently during extension of the neck. MR showed especially on STIR pictures edema at the region of C.4, 5. spinous process. Bone scan proved a slightly increased uptake, also with the suspicion of osteoid osteoma, however the CT scan was negative.

Results

In the first case, based on the results of the radiological examinations, we have decided on “en bloc” resection of the malformation. The histology revealed pigmented villonodular synovitis (PVNS), which is according to the literature a really rare finding in this region, and require surgical solution. After the surgery, the patient became complaint free, with full function of his neck. On one year follow up MRI was negative regarding recurrence. On the second case pediatricians have excluded any organic rheumatologic disease, and although the inflammatory laboratory tests (We, CRP) were negative, they reckon the malformation as a chronic osteomyelitis and administered a prolonged antibiotic course under strict control for ten weeks. Because of the continuous improvement of the young boy during this therapy, biopsy was not necessary. After three months the patient became also complaint free, and the one year follow up MRI also revealed a normal status.

Conclusion

In case of permanent neck pain in childhood it is mandatory to perform a thorough checkup to find the reason behind these complaints to be able to exclude any tumor, or tumor-like malformations. If there are any morphological changes on the radiological examinations, the differential diagnosis could be very challenging, requiring individual therapeutical plan. The first proposed examination should have to be MR imaging.
Thoracic Volume Progressively Decreases in a Virtual Osteoporotic Vertebral Wedging Model with Increasing Severity of Kyphotic Deformity
Authors: Lee Po-Chih , Ledonio Charles , Polly David W. , Jones Kristen E. , Erdman Arthur
Published: April 2016

Introduction

Osteoporotic vertebral fractures commonly result in increased kyphotic angle. Several studies have shown that compared with controls increasing severity of osteoporotic kyphosis significantly decreases volumetric parameters of pulmonary function such as vital capacity. However the effect on the thoracic volume has been less fully studied. With the ability to accurately model thoracic volumes, we are now capable of virtually modeling the effect of increasing kyphosis on thoracic volume through the computer graphical software, Blender. We hypothesize the computed thoracic volume measured from a 3D virtual model decreases with progression of kyphosis from 50 to 100 degrees and the wedging fracture vertebrae only occur in sagittal plane.

Methods

Free opensource Blender software was used to create threedimensional thorax models with normal coronal and sagittal balance. By virtually wedging the vertebral bodies, the virtual osteoporotic models were progressively deformed by 10 degrees from 50100 degrees of kyphosis. Thoracic volume was simulated and measured via shrinkwrap modifier (Blender built-in function) applied to a sphere-shaped object within the virtual thoracic cavity.

Results

Virtual wedging of vertebral bodies was necessary to achieve virtual progression of sagittal curve. As kyphotic angle increased, more vertebral segments had to be virtually wedged. Thoracic volume in the virtual adult thorax with a 50 degrees kyphosis was 3643cc. The thoracic volumes approximately decreased in a linear fashion by means of 6.4% for every 10 degrees more of kyphosis. The final thoracic volume was 2472cc at 100 degrees of kyphosis, which was a 32.2% decrease in volume from baseline.

Conclusion

As the deformity progresses from 50 to 100 degrees, there is an overall 32.2% decrease in thoracic volumes. The decrease appears approximately linear. Although there is not a direct relationship between thoracic volume and pulmonary functions, adequate thoracic volume is a necessary condition for adequate pulmonary function. This study helps establish the relative magnitude of thoracicvolume decrease based on the sagittal Cobb angle.
Proposal of a New Trajectory for Screws in the Lateral Mass of the Cervical Spine
Authors: Ulloa Máximo-Alberto Díez , Amhaz-Escanlar Samer , Jorge-Mora Alberto-Agustin
Published: April 2016

There are several trajectories described for the insertion of screws in the lateral facets of the cervical spine (Magerl, An, Anderson, based on spinous processes,..), they all rely on milimeters and precise angles; but anatomical variety (osteophytes, mass anatomy, spinous process deformities...) might render them not fully reproducible. It is proposed to consider the lateral mass as an slanted cube rotated to present a crest stright posterior, and define a trajectory as close to the 3D diagonal as possible from inferomedial corner at dorsal-medial facet to the anterosuperior cornar of the antero-lateral facet of such a cube.

Hypothesis

That trajectory is free of biass and represents the longest posible one in a cubic body, so obtaining the strongest anchor possible.

Material and Methods

10 cervical spines (dry bone) from thew Anatomy Department of Santiago de Compostela University were gathered and 4 different trajectories were developed in each lateral mass from C3 to C6 (both sides) so getting 320 different trajectories. A Kirschner Wire 0.9 mm in diameter with an “ad hoc” guide were used to avoid destruction of the specimen. Spines were fixed to a table by a sargent clamp with the dorsal surface upwards, resembling an OR situation. The 4 trajectories tested were after the techniques originally published by Magerl, An and Anderson, and then, the new one (N), based on the spatial isolation of the lateral mass for the 3D diagonal. Variables: a) the length of each trajectory, b) violations of facet joint, c) potential injuries to vertebral artery (defined by a 3 mm wire passed through the tranverse processes) and d) potential injuries to the root (defined by the same kind of wire set exiting through the foramen). Then the results in each variable was compared among all trajectories to define the longest one and the safest one. Statistics: Linear model of mixed effects, REML adjusted for “length” and adjusted to the major probability (Laplace) for all lesions.

Results

a) Length: N longer than any and against each one. 16 mm vs <15 mm ( p < 0.0001) at C6 the longest one with any trajectory ( p < 0.001). b) facet violations: none. c) potential vertebral artery injury: 8/320, all right sided. N technique: 0; An technique:0. d) potential root injury: N the safest nad against each one ( p < 0.02), followed by An technique right side had a higher risk p = 0.001.

Conclusions

A new technique (N) is presented that allows for a longer screw insertion. Besides being longer, N technique is safer than any other relating to potential root injuries and also safer than Magerl and Anderson for potential vertebral artery injury. Right side seems more prone to both potential vertebral artery and root injury
Morphometry of Vertebrae in Saudi Population with a Comparison to Other Population
Authors: Hasen Mohammed , Al-Habeeb Husam , Molani Fadhel
Published: April 2016

Introduction

Precise anatomical knowledge of human vertebra is necessary for the safe placement of screws, pre-surgical planning and designing surgical instruments. There are no existed reports about the morphometry of vertebrae in Saudi population.

Methods

This is a descriptive study. A total of 50 spine CT was collected from the PACS system and reviewed for any abnormal pathology. Any CT with major pathology like tumor, fracture and deformity was excluded. Each vertebra was measured for the following parameters: 1- Pedicle Width. 2- Distance from Pedicle to Ant. Vertebrae. 3- Ant. Vertebrae width. 4- Canal Diameter. 5- Height of Pedicle. 6- Angle of Pedicle. All data was entered in statistical analysis program (SPSS) and compared with the existed date of other population. Result and Conclusion: The values of the parameters with the standard deviation have been concluded and compared with the Korean, Mexican, Israeli and Indian populations which shows remarkable difference and characteristic pattern important to be addressed in safe placement of screws, pre-surgical planning and designing surgical instruments. References Kang KS, Song KS, Lee JS, Yang JJ, Song IS. Comparison of radiographic and computed tomographic measurement of pedicle and vertebral body dimensions in Koreans: the ratio of pedicle transverse diameter to vertebral body transverse diameter. Eur Spine J 2011;20(3):414–421 Wolf A, Shoham M, Michael S, Moshe R. Morphometric study of the human lumbar spine for operation-workspace specifications. Spine 2001;26(22):2472–2477 Vega EU, Elizondo Omaoa RE, De la Garza Castro O, Lopez SG. Morphometry of pedicle and vertebral body in a Mexican population by CT and fluroscopy. Int J Morphol 2009;27(4):1299–1303 van Schaik JJ, Verbiest H, van Schaik FD. Morphometry of lower lumbar vertebrae as seen on CT scans: newly recognized characteristics. AJR Am J Roentgenol 1985;145(2):327–335
Biomechanical Study Examining the S2 Alar Iliac Screw Insertional Torque
Authors: Ledonio Charles , Donguyen Huy , Santos Edward , Sembrano Jonathan , Morgan Robert , Polly David
Published: April 2016

Introduction

Prior biomechanical studies have examined the role of the iliac screw in lumbosacral fixation [Lebwohl, 2002; Cunningham, 2010] and while found to be significant, the ideal screw device and fixation technique have yet to be identified. An initial effort to define this biomechanical fixation includes measurements of current screw insertion torque across screw length was developed. The objective of this study was to measure the intraoperative torque required to place an S2-Alar iliac screw for spino-pelvic fixation. This fixation method often results in variable screw fixation strength and an improved understanding of the local torques required along the length of the screw will aid in improving this surgical fixation.

Materials and Methods

This IRB approved study involves obtaining informed consent of patients receiving long spinal fusions either for adult deformity. The surgical trajectory for the S2-Iliac screw will be identified as is currently practiced using O-arm Stealth Navigation. Next, the insertion torque of the iliac screw will be measured using the standard driver handle fitted with a torque cell sensor by the surgeon under 3D navigation (Stealth).

Results

There were 6 patients who underwent spino-pelvic fixation. 12 S2-Iliac screws were placed however Insertional torque was recorded in only 6 screws. Screw maps show that peak torques range from 0.71 to 9.73 Nm. Highest torques recorded were when the head of the screw approached the bone during insertion. These peak torques recorded are 1.91 times higher than Iliac screw insertional torques reported in a previous study.

Conclusion

Peak insertional torques range from 0.71 to 9.73 Nm and occurred as head of the screw approached the bone during insertion. However higher insertional torques were not recorded because it went beyond the capacity of the driver.
Results of Posterior Occipito-Cervical Decompression and Fusion in Case of Basilar Invagination: A Case Series
Authors: Patel Ankit
Published: April 2016

Introduction

The term “Craniovertebral Junction” includes bony and neuro-vascular structures from base of occiput to 2nd cervical vertebrae. The subject of CV junction anomalies is under discussion and evaluation for over a century. Several classical reviews have attempted to clarify a variety of complex associated issues. Despite the volumes of publications on the subject, it appears that the last word has not yet been said. Basilar invagination is the most common craniovertebral junction anomaly. Basilar invagination implies that the floor of the skull is indented by the upper cervical spine, & hence the tip of odontoid is more cephalad protruding into the foramen magnum which causes the compression of medulla and brainstem. There are two types of basilar invagination: primary invagination, which is congenital or developmental and more common, and secondary invagination, which is acquired mostly due to trauma. Primary invagination can be associated with occipito-atlantal fusion, hypoplasia of the atlas, a bifid posterior arch of the atlas, odontoid anomalies. In basilar invagination, all three parts of the occipital bone (basiocciput, exoccipital & squamousoccipital bone) are deformed.

Material and Methods

Our study is short term prospective study. Study period extends from July 2012 to May 2015. Total 20 patients {male+female} of various age group {8 year to 65 year} with diagnosed cases of basilar invagination were taken for study purpose.

Results

Clinical outcomes: 17 patients showed improvement in their symptoms or gait with improved mJOA score, RANAWAT's neurological class and NURICK'S functional scale. 2 patients did not show any signs of improvement. 1 patient who had severe basilar invagination with os odontoideum with kyphotic deformity expired on 3rd postoperative day due to respiratory insufficiency. 1 patient had wound related complication with opening of stitches and exposed implant which required excision of exposed implant and wound recovered by secondary healing. On long term follow up 1 patient had loosening of implant from occiput bone on X-ray but she had no any clinical symptoms. Rest of patients had no long term complications. Radiologically: Using Mcrae, chamberlain line and Ranawat index, all 19 patients had reduction of dens below foramen magnum. Bone graft fused in all 19 patients between 6 to 8 months. So all over mortality rate of our study was 5%.

Conclusion

Basilar invagination anomalies are commonly occurring but rarely diagnosed anomalies. Developmental and congenital anomalies are more common than traumatic events. As per our prospective study excellent to good short term results can be achieved with acceptable safety but it needs further long term follow up in larger series to confirm good long term results. Good results depend on proper patient selection, good surgical skill, proper use of implants and post operative care.
Is There a Correlation between the Apical Vertebral Rotation and the Pelvic Incidence in Adolescent Idiopathic Scoliosis?
Authors: Kharrat Khalil , Sebaaly Amer , Assi Ayman , Ghanem Ismat , Rachkidi Rami
Published: April 2016

Background

Vertebral rotation is an important parameter in adolescent idiopathic scoliosis as it affects the hump and thus the esthetic aspect of the deformity. Nonetheless, it is one of the least explored parameters due to the difficulty of assessment using conventional AP and lateral standing radiographs and the high radiation of CT-scans. With the advent of EOS® technology, vertebral rotation is easily assessed using the 3D reconstruction with high accuracy and low irradiation. The objective of this study is to evaluate the apical vertebral rotation and study its correlation to the pelvic parameters.

Materials and Methods

This is a descriptive transversal study. 73 patients with adolescent idiopathic scoliosis patients (Cobb > 10°) aged between 9 and 36 years old with no prior history of spinal operation at initial examination were included. Subjects underwent antero-posterior and lateral radiographs of the whole spine and pelvis using the EOS® system. On the AP radiograph, the thoracic curve angle, the lumbar curve angle and the number of the involved vertebrae were measured. On the lateral view, pelvic incidence was measured. The rotation of the apical vertebra was obtained by stereoradiographic 3D reconstruction of the spine.

Results

The mean age of the cohort was 14 years and 11 months and 90% were females. The mean Cobb of the primary curve was 38.98 (16.9–104) with a mean vertebral rotation of 15.5° (0.3–43.5°). The mean Cobb of the compensatory curve was 31.35 (9.2–64°) with a mean vertebral rotation of 9.32° (0.1°-40.5°). While the apical vertebral rotation showed a strong correlation to the Cobb angle of the affected curve (r = 0.72, p < 0.001 for the main curve; r = 0.74, p < 0.001 for the compensatory curve), it correlated moderately to the pelvic incidence (r = 0.31; p < 0.05). Furthermore, apical vertebral rotation had the most strong correlation to pelvic incidence in thoracic curves (apex T5-T10; r=0.4, p < 0.05), whether in lumbar curves (apex L2-L4) there were a tendency to a negative correlation (r = −0.2, p > 0.05). Finally, the pelvic incidence did not correlate to the curve Cobb angle (r = 0.34, p = 0.08 for the primary curve; r = 0.27, p = 0.055 for the compensatory curve)

Conclusions

To our knowledge, this is the first study evaluating the correlation between apical vertebral rotation and pelvic incidence. Pelvic incidence is a well-known pelvic parameter that correlates significantly to the apical vertebral rotation in adolescent idiopathic scoliosis.
Three Column Fixation: A Dynamic Method in Scoliosis Surgery
Authors: Alam Shah , Karim Rezaul , Jonayed Sharif Ahmed , Munir Hasan Khalid Md. , Chakraborty Shubhendu , Alam Tashfique
Published: April 2016

Introduction

Scoliosis is a complex three dimensional deformity characterized by coronal, sagittal and horizontal plane deviation. Non operative treatment is a widely accepted approach. A significant number of cases need surgical intervention. Revolutionary design & capability of spinal instruments have drastically changed the principle of scoliosis correction by surgical intervention.

Material and Methods

During the period February 2009 to November 2014, 64 cases of different types of Scoliosis underwent surgical intervention at NITOR, BSOH and other private hospitals in Dhaka. 45 were female and 19 were male and age ranged from 14 to 38 years.

Results

The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved 3D correction and it has been accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complication. So, all cases were corrected by transpedicular screws and rods and 1 case stabilized by sub laminar wring. 61 cases were managed by only posterior approaches and 3 cases required both anterior releases, costoplasty, posterior stabilization as well. In every case fusion was done in selected segments.

Conclusion

Total follow up time was ~5 years (6 months-5yrs). All patients were assessed in terms of correction of deformities, cosmesis, and functional outcome. 64 patients had average coronal plane cobb's angle measuring ~70 degree pre-operatively and 17.12 degree immediate post-operative period. 4 patients (5.7%) developed neurological deficit. 3 regained completely but another one regaining her neurological deficit very slowly. There were malposition of screws in 9 (14%) cases, Painful prominence of screws in 6 cases (9%), full flexion lack in 8 cases (12.5%) & superficial infection in 1 case (1.5%). 80% patients improved cosmetically.
Video-Assisted Thoracoscopic Surgery (VATS) for Anterior Release of Rigid Thoracic Scoliosis
Authors: Elbadrawi Ahmed , Wafa Mohamed
Published: April 2016

Introduction

Standard anterior approach to the dorsal spine using thoracotomy carries a great morbidity; video-assisted thoracic surgery (VATS) has been used as a less invasive approach for many intrathoracic disease processes; among which anterior releases in rigid dorsal scoliosis. The authors performed (VATS) in patients with Adolescent Idiopathic Scoliosis (AIS), attempting to reduce the morbidity attributable to standard open thoracotomy surgery for anterior curve release; reporting their experience with thoracoscopy as part of the treatment for adolescent idiopathic scoliosis with rigid thoracic curves. Material and Method: A prospective randomized study of 34 cases of AIS with rigid thoracic curves underwent VATS for anterior release surgery between March 2008 and April 2013 was performed. The ages of the patients ranged from 11 to 27 years with a mean of 16.3 +/− 4.2 SD years. Spinal flexibility was assessed by the fulcrum bending technique. Cobb angle before and after the anterior release was compared. All patients had an anterior spinal release and posterior spinal fusion at two separate surgeries to evaluate the flexibility after anterior release without posterior instrumentation.

Results

The average follow up ranged from 22.3 to 39.2 months (mean 30.33 +/− 4.64 SD months). The mean preoperative Cobb angle was 78.4° +/− 8.87° SD on standing radiographs and 70.3° +/− 8.48° SD with the fulcrum-bending radiograph. After anterior release, the fulcrum bending radiograph showed reduction of mean Cobb angle to mean angle of 41.6° +/− 6.98°. The mean fulcrum bending flexibility index was improved from 10.41% +/− 3.97 SD (prior to VATS release) to 46.97% +/− 5.23 SD after release. VATS was successfully completed in all patients without major morbidities. The mean operative time for the anterior procedure was 123.96 minutes +/− 28.77 SD. The average number of excised discs was four.

Conclusion

Anterior spinal release using VATS may reduce postoperative morbidity and produces satisfactory degree of flexibility for rigid thoracic curves. It can be considered as a good and safe alternate to open thoracotomy for anterior release.
The Effect of Waiting for Surgery on Patients with Adolescent Idiopathic Scoliosis
Authors: Fallatah Salah , Sait Mohammed , Almutairi Fawaz
Published: April 2016

Introduction

The waiting time for surgical procedures is becoming longer in most specialities. This may have adverse effect on patients with Adolescent Idiopathic Scoliosis (AIS) with additional procedures being required or more complex surgery being performed. Material and Method This retrospective study was performed in the period between December 2007- January 2010 looking on the surgical waiting time on patients with AIS and its effect on curve progression and the type of surgery performed and the final outcome.

Results

215 patients met the inclusion criteria and have complete medical records to be included in the study. Mean age was 13.6 years, 184 patients (86%) were females, 172 were treat in public hospitals and 43 in a private hospital, mean cobb angle of the main curve was 71°. During the study period, 55 patients underwent surgery for scoliosis correction, with a statistical difference in the waiting time between public and private hospitals (36 and 9 weeks respectively), average curve progression was 24° during the waiting period with additional fusion levels being required in 15 cases. Patients with underlying intra spinal pathology and young patients showed the most significant curve progression.

Conclusion

Our study support the previous report of the optimal waiting time for surgical correction of scoliosis being less than 6 months and it suggest that younger patients and those with intra spinal pathology and the ones at higher risk for progression.
Impact of Longer Surgical Wait-List Times on Length of Hospitalisation, Return to Function and Cost of Surgical Treatment in Patients with Adolescent Idiopathic Scoliosis undergoing Posterior Spinal Fusion
Authors: Tarrant Roslyn , Moore David , Kiely Patrick
Published: April 2016

Introduction

Despite the known clinical and functional benefits of timely surgery in adolescents with idiopathic scoliosis (AIS), several patients still undergo surgery for scoliotic deformity correction when curves have progressed beyond 70°. More evidence is needed assessing the effect of long surgical wait-list times on patient outcomes including return to function, intrasurgical factors and cost of surgical treatment. This study aimed to report on surgical wait-list times in a cohort of patients with AIS undergoing posterior spinal fusion (PSF), and examine potential correlations with selected patient outcomes including: intrasurgical factors, length of hospitalisation, return to function and cost of surgical treatment.

Material and Methods

A prospective longitudinal cohort study involving the recruitment and follow up of 77 consecutive and eligible patients with a diagnosis of AIS, from two tertiary centres, over a two year period, until return to function (e.g., school/college, physical activity) was reported. Surgical wait-list times were analyzed in relation to timing of return to function, cost of surgical treatment (€), intrasurgical factors (surgical duration, estimated blood loss) and length of hospitalisation. In accordance with local criteria, a long surgical wait list time was defined as ‘greater than 6 months’. SPSS® was used to analyze the data; non-parametric Spearman correlation coefficient was used in all correlation analyses (rs).

Results

The median surgical wait-list time in the cohort was 33 weeks (interquartile range 19–56 weeks). Almost two thirds of patients waited beyond 6 months for surgery (62.3%; n = 48); twelve patients (15.5%) waited beyond 18 months. Patients who waited beyond 6 months had a significantly larger preoperative curve (65° ± SD 14 versus 58° ± SD 10) and the cost of surgical treatment per patient was significantly greater (mean €32,652 versus €27,629, P < 0.0001). In addition, longer surgical wait list times strongly correlated with a significantly longer surgical duration (rs = 0.565, P < 0.0001) and higher blood loss (rs = 0.27, p = 0.044). No significant correlations were found between surgical wait-list times and length of hospitalisation, timing of return to school/college or physical activity.

Conclusion

Efforts to support waiting list initiatives in the AIS population are likely to give rise to significantly reduced surgical cost, less complex surgeries and more manageable curvatures being dealt with in a timely fashion.
Posterior Vertebral Column Resection (PVCR) in Early Onset Spinal Deformities (EOSD)
Authors: El-Sharkawi Mohammad , Koptan Wael , Elkott Amer , Tammam Hamdy , Gad Wael , Aboloyoun Nariman , Shawky Ahmed
Published: April 2016

Introduction

Early onset spinal deformities (EOSD) are spinal deformities before five years. Early surgical intervention is often necessary to avoid the eventually disastrous complications due to deformity progression like restrictive pulmonary functions. Posterior vertebral column resection (PVCR) achieves the best correction in severe and complex deformities. We present our experience in PVCR in five cases with EOSD.

Patients and Methods

PVCR was done in five cases (2 males and 3 females) with congenital hemivertebra with a mean age of 4.3 years. Two cases were only kyphotic while the other three cases had additional scoliosis. One case presented with progressive lower limb spasticity. All cases were managed by one level PVCR. Shilla growth guiding technique was done in two cases to allow future growth. One patient had short segment fusion, and two had long segment fusion. The patients were followed up for a mean of 21 (12–36) months.

Results

The patient with paraplegia improved completely over the three postoperative months. The local kyphosis improved by 92% (59° to 4.5°). The mean thoracic kyphosis improved by35% (38.25° to 24.5°). The mean sagittal vertical axis decreased by 71% and 19% (38.37 to 11 to 30.8 mm) postoperatively and at last follow up respectively. Lumbar lordosis reduced by 22% (47.5° to 37°). The associated scoliosis completely corrected from 29° to 0°. The mean operation time was 482.5 minute, with 3075 ml blood loss. One patient with myelocele had pseudarthrosis and metal failure necessitated revision. The patient with short segment fixation developed an asymptomatic, non-progressive proximal junctional kyphosis immediately postoperatively. No revision or extension of fusion was needed.

Conclusion

PVCR appears to be an effective technique to treat severe EOSD with limitation of fused segments to allow further growth.