bluuebunny/crossref_metadata_2025 huggingface dataset:
Ilio-sacral Stabilization of Sacral Jumper's Fractures using the AO-Spine Fracture System: A Novel Surgical Technique
Authors: Mameghani Alexander T. , Jeanneret Bernhard , Schären Stefan
Published: April 2016

Introduction

Jumper's fractures are severe dissociation injuries of the spinopelvic junction. These U-shaped fractures are due to an axial trauma. The treatment of these fractures associated with neurological complications includes emergency decompression combined with reduction and stabilization of the fracture-dislocation. Usually, stabilization from L4 or L5 to the ilium combined with decompression of the spinal canal is advocated, thus fusing one or two additional healthy lumbar motion segments. We report on three patients with jumper's fractures, in whom we successfully performed a posterior decompression and open stabilization from S1 to the ilium, therefore sparing the motion segments L4/S1.

Material and Methods

3 patients (40, 45 and 49 years old) had been admitted to the emergency room after they attempted suicide and jumped from a greater height. All three had a jumper's fracture with fragments into the sacral canal and epidural hematoma. Indication for emergency decompression was present. In prone position a midline incision was performed and decompression of the sacral canal was achieved. After decompression bilateral long monoaxial USS II screws were placed into the ilium. Schanz’ screws from the USS fracture system were then introduced bilaterally in S1. The rods were rigidly mounted to the monoaxial ilium-screws. Fracture reduction and stabilization was performed under fluoroscopic control with the same maneuver as used for reduction of lumbar burst fractures. Fracture reduction and healing was examined with postoperative CT scan and controlled after 3 and 9 month.

Results

Bony healing was achieved in all three patients. In all 3 cases implant removal was performed after bony healing was proved as seen in computed tomography. At 1 year follow-up, neurological exam was normal in 2 patients. 1 patient still had persistent incomplete bladder and bowel function disorders. All patients were able to walk without assistance.

Conclusion

Ilio-sacral stabilization seems to be a reliable way of achieving reduction and bony healing in jumper's fractures. The reduction manoeuver is the same as described by Magerl and later on by Dick for lumbar burst fractures. As the lumbosacral motion segments (L4/5 and L5/S1) remain untouched, this technique offers the advantage of sparing important motion segments of the lumbar spine, thus being less invasive than the usually advocated techniques. However, this technique only is possible, if the segment L5/S1 is intact.
Outcomes of Lumbopelvic Fixation in the Treatment of Complex Sacral Fractures Using Minimally Invasive Surgical Techniques
Authors: Jazini Ehsan , Nwodim Emeka , Tannous Oliver , Banagan Kelley , Koh Eugene , Ludwig Steven , Gelb Daniel
Published: April 2016

Introduction

Complex sacral fractures with vertical and anterior pelvic ring instability treated with traditional fixation methods are associated with high rates of failure and poor clinical outcomes. Supplemental lumbopelvic fixation(LPF) has been utilized for additional stability to help with fracture union. The purpose of this study was to determine if minimally invasive LPF provides reliable fracture stability and acceptable complication rates in complex sacral fractures.

Methods

Twenty-eight patients were retrospectively chosen from a pool of 105 at our level 1 trauma center (2008–2014) who had undergone LPF. Patients underwent posterior sacroiliac fixation, with or without anterior fixation, followed by minimally invasive LPF. Main outcomes were return to the operating room (OR) for instrumentation revision secondary to loss of correction or failure of fixation, return to the OR for treatment of infection, radiographic evaluation to assess for loss of reduction. ISS score, transfusion requirements, length of hospital stay, postoperative day at mobilization, and mortality were also evaluated.

Results

Three patients returned to the OR for infection (11%). One patient required revision surgery for instrumentation malposition and neurologic deficit (3.5%). No patients required return to the OR for revision due to failure of instrumentation or loss of correction. The average length of surgery was 3.9 hours and estimated blood loss was 192 mL. The average transfusion requirement was 2.2 units of packed red blood cells and the majority of patients were mobilized at postoperative day 4. There were no mortalities.

Conclusion

This is currently the largest series of high energy complex sacral fractures treated with minimally invasive LPF. The results demonstrate reliable maintenance of reduction with a low complication rate.
Non-contiguous Cervical Spine Injury in a 14-month old Child; Case Report and Review of the Literature
Authors: Shawky Ahmed , Ezzati Ali
Published: April 2016

Introduction

Cervical spine injuries in children are relatively rare. Pattern, severity and level of these injuries are age dependant. Most of the available literature differentiates between two age groups, younger and older than 8 years. The incidence of upper cervical injuries is higher among children younger than 8 years. Most of the available literature is retrospective analysis of databases or case reports. Patients and Methods: a 14-month old child was presented to our emergency unit after involvement in a road-traffic accident. A stiff neck cervical collar was applied at the accident scene. The child was conscious, oriented. He had tendency to move the right upper and lower limb better than the left side. He had torticollis with the head rotated to the left side. Neurological examination revealed a left-sided hemiparesis. He had no other injuries. Under general anesthesia CT and MRI of the skull and the cervical spine were done. These investigations showed a fracture of the axis with a rotary subluxation of C1/2, cord edema at the level of C1 predominantly on the left side and a disco-ligamentous injury at the level of C3/4. Controlled closed reduction under image intensifier and Minerva cast was applied for 3 weeks, and then replaced with a modified Minerva-Hartmann orthosis for another 3 weeks. A review of the literature for patients below the age of 3 years with cervical spine injuries was done in a trial to define an algorithm to clear the cervical spine and to outline the management of this age group.

Results

The patient was followed for one year with normal MRI findings at 6 months and normal clinical findings at one year follow-up with complete improvement of the neurological deficits.

Conclusion

Clearance of the cervical spine after trauma in children below the age of 3 is challenging. Articulation and cooperation during clinical examination and imaging investigation is limited. Imaging should be done under general anesthesia. Immobilisation is also demanding and definitive immobilisation for conservative treatment is usually using custom-made orthoses. results of conservative treatment are excellent if closed reduction and immobilisation were achieved.
Validity and Reliability of Spine Raster-stereography in Adolescent Idiopathic Scoliosis Patients
Authors: Tabard Anne , Bonnefoy-Mazure Alice , Lascombes Pierre , Armand Stéphane , Dayer Romain
Published: April 2016

Introduction

Previous studies have evaluated the validity and reliability of the Formetric-4D system. They concluded to a good accuracy compared with radiographs and a high intra- and inter-day reliability in healthy volunteer patients. However, to the best of our knowledge, the validity and reliability were not assessed on patients with Adolescent Idiopathic Scoliosis (AIS). Therefore, the aim of this study was to evaluate the validity and reliability of the Formetric 4D system on AIS adolescent patients with Cobb between 10¡ and 40¡ in terms of sagittal, frontal and transverse parameters.

Materials and Methods

This study included 35 AIS adolescents (male=13) aged 13.1 ± 2.0 years. To evaluate the validity of scoliosis angle (SA) provided by the Formetric-4D System, a comparison was performed with the Cobb Angle of major curve (CA) on a 2D EOS¨ radiography (XR). Mean differences of measurements computed by each system were evaluated using paired Student t-test and Pearson correlation coefficient. To evaluate interrater reliability three repeated-measurements were independently performed in a neutral orthostatic position using the Formetric-4D System by two operators the same day. To evaluate the intrarater reliability three more repeated-measurements were performed by the first operator one week later. The parameters measured were vertebra surface rotation, thoracic kyphosis, lumbar lordosis, pelvic obliquity, trunk length and the scoliosis angle. The data analyses used were Intraclasse Correlation Coefficients (ICC).

Results

The 2D radiographic Cobb Angle (CA) and its rasterstereographic equivalent Scoliosis Angle (SA) were strongly correlated (R = 0,70) with a non-significant difference. The ICC for intrarater (same day: ICC (1, 1), n = 35, one week later: ICC (1, 3), n = 29) as interrater reliability coefficients (ICC (3, 3), n = 16) were excellent (ICC > 0.75) for all variables except for pelvic obliquity with the highest for sagittal and rotation parameters and lowest for the pelvis obliquity.

Conclusion

This study showed that the Formetric 4D system allows evaluating AIS patients with a good validity and an overall excellent intra- and interrater reliability. Based on these results, this automatic, fast and non-invasive system will not replace XR clinical analysis but it can reduce the exposure to radiation for the patients and can improve the monitoring of scoliosis evolution with no limits of use, no risks for patients and at lower price than XR.
Case Series of First Trolley Gliding Vehicle Device used in Patients with Early Onset Scoliosis as a Growth Guiding System
Authors: Aoude Ahmed , Simoes Leonardo , Aldebeyan Sultan , Ouellet Jean
Published: April 2016

Introduction

Current surgical treatment modalities available for the treatment of early onset scoliosis, either spine based Duel Growing Rods, or rib based VEPTR construct, require repetitive lengthening surgeries with no apical control of the deformity. The overall results of these techniques have shown to provide some benefits. However they remain with a high rate of complications, in part related to frequent repetitive surgeries. A new gliding spinal anchor know as Trolley Gliding Vehicle (TGV) and a new surgical technique has been developed with the hope to address some of these short coming. Here we present this innovative device and the new surgical technique.

Material and Methods

Six patients with Early Onset Scoliosis were treated with TGV by a single surgeon at three institutions. The implant was made available via a special access program from Health Canada, as the implant is only available in Europe (CE mark). Patient perioperative data was collected for all patients. Any intra-operative or immediate post-operative complications were also documented.

Results

The average age of the patients was 8.3 years of age. The pre-operative diagnoses included congenital myopathy, congenital idiopathic scoliosis, Padder Willi syndrome, cerebral palsy, “cri du chat” syndrome, and idiopathic early onset scoliosis. The average age of the patients at time of surgery was 8.3 years of age (5–14 years old). The average follow-up was 6 months. The average pre-operative Cobb angle was 71.33 degrees with average correction at last follow up equal to 29.66 degrees. No intra-operative complications were noted. One patient required one revision surgery consisting of adding TGV for fluctuating bursa over distal fixation due to excessive motion.

Conclusion

We present early results of a new spinal gliding implant in six patients. The Trolley Gliding Vehicle showed good correction of spinal deformity with low short-term complications rate. Results cannot provide any long term conclusion. A prospective clinical study has been started in Europe and will be undertake in Canada once Health Canada approves the implant.
Morphometric Study of Lumbar Vertebrae Pedicle through Tomographic Exams of Outpatients from a Brazilian University Hospital Center
Authors: Sandon Luiz Henrique , Brock Roger Schmidt , Teixeira Manoel Jacobsen
Published: April 2016

Introduction

The knowledge of the pedicle size in the lumbar vertebrae is important for safe and effective placement of screws in cases of instrumentation in this region. This importance is even more relevant when it is about fixing through a minimally invasive way. Most of the minimally invasive techniques for lumbar spine instrumentation is described recommending parameters for introduction of pedicle screws (25mm) based on measurement of the pedicle length in model populations (North American / European mostly). It is our purpose in this work to establish the morphometric parameters of the lumbar vertebrae pedicles in the Brazilian population, which has no such parameters well studied yet.

Material and Methods

Cross-sectional study of 100 adult patients (between 26 and 90 years old), 50 males and 50 females (all without trauma, tumor, inflammatory / infectious diseases or post-surgical condition) who underwent simple tomography of the lumbar spine from January to December 2012 at the Institute of Radiology of the Hospital of São Paulo in Brazil, 1000 pedicles of lumbar vertebrae were evaluated. And Literature Review conducted by PUBMED by Keyword: Lumbar Spine pedicles

Results

We describe for each lumbar level (L1 through L5) two measure: (Measurements made for both sides (left / right) of each pedicle): Measure A (length of the longitudinal axis of the pedicle base to the intersection of 90 ° with the imaginary line that goes from the anterior border of the spinal foramen) / Measure B (length of the longest longitudinal axis of the pedicle, the base to the junction with the anterior cortex of the vertebral body, line tangential to the spinal foramen and without crossing the midline). Measurements were obtained by electronic measurement system in iSITE Radiology in the axial plane of the major axis of each pedicle on CT scans without contrast cut standard 0.5mm Based on this assessment, we noticed that the average measure (to measure A) of the pedicles in the studied population was 17,12mm to L1, L2 to 16,22mm, 15,40mm to L3, 14,83mm to L4, L5 to 14,64mm

Conclusion

Thus the measure advocated for introduction of pedicle screws in minimally invasive techniques is appropriate for this population
A Novel Quantitative Automated Measurement of CSF Area for the Diagnosis of Lumbar Spinal Stenosis
Authors: Pei-Ching Lin , Jiann-Her Lin , Yung-Hsiao Chiang , Chao-Cheng Wu
Published: April 2016

Introduction

A grading system for LSS is needed to allow precise communication between clinicians and for assessment of treatment responses. At present, there are two categories of grading systems- qualitative and quantitative. However, there are always individual subjectivity of radiologists in those qualitative classifications systems. The quantitative classifications systems are time-consuming and not relevant to clinical symptoms even with the same values for DSCSA or DSAPD. Herein, we propose a novel quantitative automated method to measure the cross-section area of the CSF. This study is to introduce this novel quantitative automated method, evaluate its reliability, and compare it to other two semiquantitative CSF-based classification systems.

Methods

All lumbar MRI studies were selected at random. Each study included T1/T2-weighted axial and sagittal images taken between April 2012 and July 2013. Two practicing neurosurgeons with spine specialty participated in this study and did the reviews of the grading for each disc level. Each of two neurosurgeons independently measured DSCSA (dural sac cross-sectional area, mm2) on T2-weighted axial images manually. The final DSCSA were the average of two results at each disc level of the lumbar spine. They also graded each disc level according to the qualitative grading system- the Lee's and Schizas' grading systems. The final grading of each disc level of the lumbar spine was determined by the most consistent grade out of the four results obtained from the two trials of two neurosurgeons. CSF area of each disc level (ACSFA) was calculated automatedly by the algorithm we developed. For each disc level, linear regressions were performed between DSCSA and ACSFA, and ACSFA was categorized based on the final grading of Lee's and Schizas' grades.

Results

Seventeen female and six male patients were studied (mean age, 65.21 ± 12.1years). The inter-reader reliability of Lee's and Schiza's grading systems were “moderate” and “good” (o.437 and 0.739), respectively. ACSFA was correlated well with DSCSA linearly (r=.8988,p,.001)(Fig. 1). Using one-way ANOVA, ACSFA was able to differentiate each grade of Lee's or Schizas' systems ( p < .0001 and p < .0001)(Fig. 2 & 3).

Conclusion

This novel automated quantitative measurement of CSF area can provide at least the some diagnostic value for the diagnosis of LSS, and, at the same time, it avoids the variability of the quantitative system between readers and overcomes the disadvantages of the present qualitative system (DSCSA). This method can serve as a useful diagnostic tool for the clinicians.
Pendulum Rule versus Spinopelvic Parameters how the Explain the Sagittal Shape of the Spine?
Authors: Norotte Gilles
Published: April 2016

Introduction

Usually, the analysis of the spinal sagittal shape is based on a vertebral semantic, focusing on the curves (lordosis, kyphosis) and the spinopelvic parameters (pelvic incidence, sacral slope, pelvic tilt, sagittal balance). This analysis failed in defining a normal shaped spine, and in relating strictly the incidence to the lordosis. The author proposes a very different analysis of the sagittal spinal shape, named “ the Pendulum Law.” It enables to define an ideal biomechanical shaped spine and classify the sagittal shape precisely.

Material and Methods

300 sagittal shapes have been studied. A vertical analysis (according to gravity) is performed, reintegrating the spine into an analysis of the muscular body's scheme and relating it to the respiration. The biomechanical spine is assimilated to three intricated Mongol bows. Different apex (contact between the vertebral body and the plumb line) are defined. They are related to muscular tension lines or attaches. The lungs apex are paramount to explain the spine. The trunk is always swaying but lungs pressure (when breathing in) stabilizes it either in an anteroposterior plan or in the sagittal plane. The repartition of the apex has been assessed in all the spine drawing specific lines.

Results

More than 95% of the studied spine abide by the “Pendulum law” which states that: “ whatever the spine is (including the common variation or abnormalities), the standing position consists in placing the Superior Lung apex according to the following rules: In the anteroposterior view: the plumb line equidistant from the lung apex is maintained above the sacral apex. In the sagittal view: the plumb line from the superior lung apex is equidistant of the thoracic apex and the lumbar apex. The two Pelvico-thoracic lines (the line linking the sacrum apex to the antero-inferior lung apex and the line linking the center of the femoral head to the postero-inferior lung apex) cross each other in the point “E,” exactly above the plumb line dropping from the superior lung apex and in front of the lumbar apex. Therefore, the Pendulum Law relates the sagittal shape to the gravity, the muscular body's scheme and the breathing. An ideal biomechanical sagittal shape lines up the thoracic apex and the sacral apex vertically. The alignment of the symphysis, the lumbar apex and the thoracic apex cross the vertebral bodies obliquely and harmoniously. The lumbar apex (in front of the upper plate of L4) is placed above the center of the femoral head.

Conclusion

The Pendulum Law relates the sagittal shape to gravity, the muscular body's scheme and respiration. Most of the commons Abnormalities are integrated according to this rule. The Pendulum is the “vertical tension” of the body's scheme that enables us to move harmoniously. (As the length of the femur is strictly related to the ideal flexion/extension of the Knee). Lordosis is related to pneumatic stabilization of the trunk and definitively not to the pelvic incidence.
An imaging Study of Partiallythreaded Screw Fixation of C2 Pedicle Fracture
Authors: Wang Qing , Xu Shuang , Wang Gaoju
Published: April 2016

Introduction

The purpose of this study was to observe the imaging features of partiallythreaded screw fixation using in various kinds of C2 pedicel fracture.

Material and Methods

CT image materials of 160 Chinese Han patients who suffered from atlantoaxial injury without vertebral body and pedicle fracture of C2 was included in this study, including 120 males and 40 females.Pedical trajectory selected according to Ebraheim method in three dimensional CT reconstruction was analyzed in ADW 4.4 workstation.The posterior wall fracture of C2 vertebral body, isthmus fracture and fractures under C2 laminar were simulated according to clinical observation.The trajectory length(partially threaded screw length)from entry point to anterior cortical bone of C2, bolt shank length from entry point to fracture line simulated and fillet of screw length from fracture line to anterior cortical bone of C2 were measured. Relations between height gender and partiallythreaded screw length bolt shank and fillet of screw length was evaluated.

Results

Male height was 167.0 ± 7.9cm on average and female was 156.0 ± 6.6 cm.The length of partiallythreaded screw was 29 mm in male and 25 mm in female on average.Height and gender was positively correlated with partiallythreaded screw length.In posterior wall fracture of C2 vertebral body, length of bolt shank was an average of 17 mm in male and 15mm in female, while fillet of screw length was 12 mm in male and 10 mm in female. The mean length of bolt shank was 14mm in male and l 3 mm in female. while mean fillet of screw length was 15 mm in male and 12 mm in female in isthmus fracture. In fractures under C2 laminar, length of bolt shank was 10 mm in male and 9 mm in female on average. while mean fillet of screw length was 18 mm in male and 15mm in female. Conclusion:The length of partiallythreaded screw used in posterior axial pedicle fracture may have a close correlation to length and height. The length of bolt shank and fillet of screw was different aecording to the position of the fracture.
Influence of PMMA Screw Augmentation on the Primary Stability of an Anterolateral Plating System in Osteoporotic Vertebrae
Authors: Rüger Matthias , von Rüden Christian
Published: April 2016

Introduction

Expandable anterolateral plates facilitate the reduction of posttraumatic deformities of thoracolumbar spine injuries and are commonly used in cases of unstable injuries or compromised bone quality. In this human cadaver study, the craniocaudal yield load of the bony fixation of an anterior angle stable plating system and the influence of Polymethyl Methacrylate (PMMA) augmentation on the primary stability of the screw–bone interface during kyphosis reduction was evaluated in twelve osteoporotic thoracolumbar vertebrae.

Material and Methods

The anterolateral stabilization device used for this study is comprised of two swiveling flanges and an expandable midsection. It facilitates the controlled reduction of kyphotic deformities in situ with a geared distractor. Single flanges were attached to twelve thoracolumbar vertebrae. Six specimens were augmented with PMMA by means of cannulated bone screws. The constructs were subjected to static, displacement controlled craniocaudal loading to failure in a servohydraulic testing machine.

Results

The uncemented screws cut out at a mean of 393 +/− 66 N, whereas the cemented screws demonstrated significantly higher yield load of 966 +/− 166 N ( p < 0.02). No significant correlation between bone mineral density and yield load was detected in this setting.

Conclusion

The results of this study indicate that PMMA augmentation is an effective method to increase two- to 3-fold the primary stability of the screw–bone interface of an anterolateral spine stabilization system in osteoporotic bone. We recommend the system in cases of severely compromised bone quality to reduce the risk of screw loosening during initial kyphosis correction and to increase long-term construct stability.
Posterior Only Vertebral Column Resection (PVCR) for Fixed Angular Kyphosis (FAK)
Authors: El-Sharkawi Mohammad , Koptan Wael , Elmorshidy Essam , Tammam Hamdy , Hasan Khaled , El Miligui Yaser
Published: April 2016

Introduction

VCR is the most suitable osteotomy for rigid angular kyphosis especially if the correction needed is high. The prospective cohort study assessed the efficacy of Posterior Vertebral Column Resection (PVCR) in management of Fixed Angular Kyphosis (FAK).

Patients and Methods

Thirteen cases of FAK managed by PVCR in Assiut University Hospital and followed up for a mean of 20.31 (12–48) months. Seven cases (53.8%) were females and six cases were males, the mean age was 13.77 years. Eleven cases were congenital (84.6%) and two cases were post tuberculous. Five cases (38.5%) affected the thoracic region, six cases (46.2%) affected thoracolumbar region and two cases (15.4%) affected lumbar region. VAS, ODI, SRS-22, and neurology together with local kyphotic angle were compared pre, post and at last follow up visit. One case suffered progressive paraplegia.

Results

Five osteotomies were at L1; four at D11, and one osteotomy at D10, D12, L2 and L3. The VAS improved from 6.57 ± 2.14 to 1.29 ± 0.75 ( p = 0.001). The mean ODI improved from 56.22 ± 20.59 to 22.81 ± 11.33 ( p = 0.001). Total SRS-22 score improved from 2.11 ± 0.60 to 3.35 ± 0.65 ( p = 0.002). The mean local kyphotic angle improved from 65.38°±29.95 to 14.69°±19.78 ( p = 0.001), the mean operative time was 465.38 ± 76.44 (320–600) minutes and the mean blood loss was 3323 ± 934.6 (1600–4500) cc. The preoperatively neurologically impaired case recovered completely. Four cases suffered complications (30%), one case suffered postoperative weakness of quadriceps which improved with physiotherapy, two cases suffered asymptomatic proximal junctional kyphosis and one case experienced pull out screws which was revised.

Conclusion

PVCR seems to be highly effective tool for correction of fixed angular kyphosis avoiding the morbidity of anterior or combined approaches.
Posterior Selective Fusion with Pedicle Instrumented Correction in Thoracic and Thoracolumbar Idiopathic Scoliosis
Authors: McConnell Jeffrey R. , Debnath Ujjwal K.
Published: April 2016

Introduction

To evaluate clinical and radiological outcome of selective fusion for adolescent idiopathic scoliosis (AIS) in thoracic and thoraco-lumbar curves i.e., Lenke 1C and 5C curves.

Material and Methods

32 consecutive patients (22 females, 10 males) with 20 Lenke 1 C and 12 Lenke 5C were operated through posterior approach for AIS. Risser stage at the time of operation was 0–3 in 24patients and more than 3 in 4patients. Mean age was 13.5 years. Not every vertebra was instrumented with pedicle screws. Apical vertebral derotation and translation on the concave side were performed for correction. All patients underwent a selective fusion (1C only thoracic curve fused; 5C only thoracolumbar/lumbar curve fused). The data were prospectively collected preoperatively and at 6 weeks, 1year and 2 years post-operatively. Cobb angle, sagittal and coronal balance, and lowest fused vertebral tilt were documented at all time-points. Uninstrumented compensatory curves were measured at all time points.

Results

Lowest instrumented vertebra (LIV) was distal end vertebra in 15 patients and was one below distal end vertebra in 3 patients in Lenke1C curves. The main thoracic curve correction in Lenke1C was 66%, from 60° ± 12° preoperative to 20° ± 7° at 6 weeks. The Cobb angle was 20° ± 10° at 1 years and 24° ± 10° at 2 years. The apical vertebral rotation improved by 38%, the non-instrumented lumbar curves improved 50%. The last instrumented vertebral tilt decreased from 22° ± 8° preoperatively to 5° ± 5° postoperatively. The average thoracolumbar/lumbar (TL/L) preoperative Cobb angle in Lenke5C curves was 46° ± 8° which was corrected to 14° ± 7° (70% correction) at a 2-year follow-up. 25% of the uninstrumented thoracic curve had spontaneous correction. The coronal balance improved significantly ( p < 0.05) and remained stable from the first postoperative visit to the 2-year follow-up visit. The SRS-22 total scores improved significantly from before surgery to 2years after surgery ( p < 0.0001). No pseudarthrosis or reoperation was observed. One 12 girl with Lenke1C (65°) had intra-operative loss of neural monitoring signals who was paralysed postoperatively for a period of 2 weeks. She recovered completely by 2 months.

Conclusion

Posterior correction of thoracic and thoracolumbar AIS with pedicle screw instrumentation is safe and produces a long-term stable correction and high patient satisfaction. In Lenke 1C and 5C AIS deformity patterns fused selectively, the uninstrumented compensatory curves do not seem to progress. Selective fusions, when successfully performed, will optimize mobile segments of the spine in AIS patients.
CT-Myelogram Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy: Results of a Systematic Review
Authors: Waly Feras , Abduljabbar Fahad H. , Fortin Maryse , Weber Michael
Published: April 2016

Introduction

Magnetic resonance imaging (MRI) is used routinely to diagnose cervical spondylotic myelopathy (CSM). However, in cases where MRI is contraindicated, CT myelogram remains the preferable imaging modality for the diagnosis of CSM. There remains no confirmed consensus on the use of specific CT myelogram parameters and their relationship with regards to CSM disease severity, clinical presentation and prognosis after surgical treatment. The purpose of this study is to determine the CT myelogram imaging parameters in patients diagnosed with CSM that correlate with severity of CSM and predict postoperative patient outcome

Materials and Methods

An electronic database search was performed using Ovid Medline and Embase. CT mylogram studies investigating the correlation between imaging characteristics and CSM severity or postoperative outcomes were included. Two independent reviewers performed citation screening, selection, qualitative assessment and data extraction using an objective and blinded protocol. All authors involved in the study have no disclosures related to present study. No funding was needed for this study.

Results

We found no studies investigating the correlation between CT myelogram parameters and CSM severity. A total of 5 studies (402 patients) were included in this review and investigated the role of CT myelogram parameters in predicting outcome after surgical treatment. All studies were retrospective cohort studies. CT mylogram characteristics included the transverse area of the spinal cord at maximum level of compression, spinal canal narrowing, number of blocks, spinal canal diameter and flattening ratio. There is low evidence suggesting that patients with a transverse area of the spinal cord >30 mm2 at the level of maximum compression have better postoperative recovery and outcome.

Conclusion

Patients with greater transverse area of spinal cord at the level of maximum compression on CT myelogram are more likely to have better neurological outcome after surgery. There is insufficient evidence to suggest that any of the other CT mylogram parameters investigated are predictors of postoperative outcomes in patients with CSM.
Clinical Outcome of Anterior vs Posterior Approach for Cervical Spondylotic Myelopathy
Authors: Cahueque Mario , Cobar Andres , Ortiz Alfredo , Caldera Gustavo
Published: April 2016

Introduction

Cervical spondylotic myelopathy is a common cause of neurological morbidity. The decompression of the neural elements is the gold standard procedure for this pathology, but there is still a lot of controversy for the selection of the approach, anterior, posterior or combined.

Methods

42 patients were enrolled with the diagnosis of cervical spondylotic myelopathy, the 42 underwent surgery with either anterior or posterior approach at the hospital Centro Médico Nacional de Occidente, Guadalajara, México, a follow up for up to one year was made, comparing the results with the modified score for the Japanese Association of Orthopaedics (mJAO) and the Nurick score.

Results

Patients were divided into two groups. homogeneity analysis were made, finding similar results between both groups ( p < 0.05) Group A. 19(45%)patients received surgery by an anterior approach (Corpectomy with expandable cage and anterior plate fixation) and group B. 23 (55%)underwent posterior approach, from this 23 patients, 18(43%) had a laminectomy with posterior instrumentation and fusion, and 5 (12%) had a laminoplasty. 38% female patients and 62% male patients, median age was 75 years old. Functional outcomes were measure with the modified score for the Japanesse Association of Orthopaedics (mJAO) for up to one year follow up. Group A had a lower score (x:15.52) compare with group B (x:17.13) (15.52 versus 17.13, p < 0.05. While in the Nurick score Group B got a higher score (x:0.73) compare with group A (x:0.30) (0.73 vs 0.30, p < 0.05).

Conclusions

The election of the surgical approach in the cervical spondylotic myelopathy should be individualize according to the characteristics of the injured elements, it should be focused in the decompression of the neural elements and the recovery to the sagittal balance. In this study a statistical difference was found according to the mJAO and the Nurick scale in favor of the posterior approach, but the anterior decompression may also have good results according to the one year follow up ( p < 0.05). More studies should be made with a bigger population and a longer follow up
The Minimum Clinically Important Difference of the modified Japanese Orthopaedic Association Scale in Patients with Degenerative Cervical Myelopathy
Authors: Tetreault Lindsay , Kopjar Branko , Cote Pierre , Nouri Aria , Fehlings Michael
Published: April 2016

Introduction

The modified Japanese Orthopaedic Association (mJOA) score is the most frequently used clinician-administered tool to assess functional status in patients with degenerative cervical myelopathy (DCM). By defining the minimum clinically important difference (MCID) for this scale, clinicians can evaluate treatment outcomes for this condition and better interpret evidence from clinical studies. This study aims to establish the MCID of the mJOA in patients with CSM.

Material and Methods

Three different methods were used to determine the MCID of the mJOA: 1) distribution-based, 2) anchor-based and receiver operating characteristic (ROC) analysis and 3) professional opinion. The first two methods were accomplished using data from 517 patients enrolled in the AOSpine CSM-North America or CSM-International studies. Distribution-based methods were used to estimate the MCID by computing the half standard deviation and standard error of measurement. Using anchor-based methods, mJOA at 12-months after surgery was compared between patients who “slightly improved” on the Neck Disability Index (NDI) and those who were “unchanged.” ROC analysis was then performed to compute a discrete integer value for the MCID that yielded the smallest difference between sensitivity and specificity. Finally, MCID estimates were obtained by surveying members of AOSpine International. We repeated the anchor-based methods for patients with mild (mJOA: 15–17), moderate (mJOA: 12–14) and severe disease (mJOA < 12).

Results

Our cohort consisted of 315 men and 202 women, with ages ranging from 21 to 86 years (mean age: 56.37 ± 11.60). The mean baseline mJOA score was 12.48 ± 2.71. One hundred and twenty-nine patients were classified as mild (mJOA = 15–17) preoperatively, 208 as moderate (mJOA = 12–14) and 180 as severe (mJOA < 12). Based on the NDI at 12-months following surgery, 76 (14.70%) patients worsened (NDI < −7.5), 130 (25.15%) were unchanged (−7.5≤NDI < 7.5), 87 (16.83%) slightly improved (7.5≤NDI < 15) and 224 (43.33) showed marked improvements (15≤NDI). The half standard deviation of the baseline mJOA was 1.36 and the standard error of measurement was 1.21. The difference in mJOA between patients who “slightly improved” on the NDI and those who were “unchanged” was 1.11. ROC analysis yielded a value of 2 for the MCID (Fig. 1). The survey of 416 spine professionals confirmed these estimates: The mean response was 1.65 ± 0.66, although the most commonly selected answer was 2 (39.42%). The MCID significantly varied depending on myelopathy severity: ROC analysis yielded a threshold of 1 for mild patients, 2 for moderate patients and 3 for severe patient.

Conclusion

The MCID of the mJOA is estimated to be between 1 and 2 points and varies significantly with myelopathy severity. This knowledge will enable clinicians to identify meaningful functional improvements in surgically treated CSM patients.
Degenerative Changes in the Cervical Spine are More Common in Middle-aged Patients with Thalidomide Embryopathy than in Healthy Individuals
Authors: Jahani Shadi Afarin Ghassemi , Daielsson Aina , Ab-Fawaz Rana , Hebelka Hanna , Danielson Barbro , Brisby Helena
Published: April 2016

Introduction

The aim of the study was to compare the degree of degenerative changes in the cervical spine of thalidomide embryopathy (TE) patients−in whom upper limb malformations often necessitate help with grip function through the mouth or by head motion, and may thereby add extra load to the spine−with that in a control group (CTR).

Material and Methods

Twenty-seven middle-aged TE patients and 27 age- and gender-matched healthy CTR were examined by cervical MRI. The presence of malformations, disc herniations, osteophytes, nerves and medullary compression, were evaluated. Disc degenerations (DD), were graded according to the Pfirrmann classification.

Results

Similar frequencies of disc herniation and disc space narrowing were observed in both groups, but there was more foraminal narrowing in the TE group (ρ < 0.002). Significantly more DD were seen in the TE group than in the controls (ρ < 0.001). Evaluation of all discs ( n = 135 per group) showed Pfirrmann grade I in 0% of the TE group and 2% of the controls. Grade II was found in 3% and 36%, respectively, grade III in 46% and 50%, grade IV in 38% and 11%, and grade V in 13% and 0% (ρ < 0.001). DD were observed frequently at all levels for the TE group, however mainly in the two lower levels for the CTR.

Conclusion

The more frequently observed degenerative changes of foraminal narrowing and disc signal changes in the TE group support the theory that a higher load on the cervical spine leads to earlier development of DD.
Surgery for Spinal Tuberculosis: A Multi-Center Experience of 582 Case
Authors: Alam Shah , Phan Kevin , Karim Rezaul , Jonayed Sharif Ahmed , Munir Hasan Khalid Md. , Chakraborty Shubhendu , Alam Tashfique
Published: April 2016

Introduction

Tuberculosis of the spine is a common form of TB infection for 50% to 60% of osseous tuberculosis. Although uncommon, spinal TB still occurs in both developed and developing countries. The diagnosis of spinal tuberculosis is difficult and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity.

Material and Methods

A total of 582 patients with tuberculosis of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January, 2003 to July, 2014. Thoracotomy along with anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were done in 113 cases. Posterior decompression, posterior interbody and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods were done in the remaining 469 cases. Appropriate anti TB drugs were given to all patients for 18–24 months. The follow-up period was 3 months to 10 years.

Results

The average age was 32.5 years. All patients survived surgery. There were 7 cases of superficial infections (1.2%) while there were 4 cases (0.7%) of deep infections. Revision surgery was performed in 6 patients (1.0%). Implant failure occurred in 4 cases (0.7%) while malposition of screws occurred in 12 cases (2.1%). Perioperative bleeding complications were reported for 4 patients (0.7%). Neurological improvement occurred in all patients except for 2 cases (0.3%). Preoperatively, the majority of patients ( n = 221, 38%) were classified with Class A on the American Spinal Injury Association (ASIS) neurological impairment scale. This was significantly reduced postoperatively to 0.4%.

Conclusion

For patients with spinal tuberculosis anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion.
Spondylodiscitis 10 Years Experience of 40 Cases in a Third Level Hospital in Bogotá, Colombia
Authors: Bedoya Constanza , Alvarado Fernando , Morales Luis Carlos , Rodriguez Andres , Farfan Miguel Andres , Rodriguez Andres Felipe , Tafur Daniela
Published: April 2016

Introduction

Spondylodiscitis is an infrequent pathology and may be overlooked in clinical practice. Diagnosis requires a high level of suspicion by physicians; a multidisciplinary approach is essential. The objective was to describe the incidence, risk factors, clinical characteristics, management and outcomes of patients with spontaneous spondylodiscitis.

Material and Methods

Medical records of patients treated for infectious discitis at a third level hospital in Bogotá, Colombia, between January 2003 and August 2014 were reviewed. Postoperative infections and vertebral osteomyelitis were excluded.

Results

Spontaneous spondylodiscitis was diagnosed and treated in 40 patients (mean age 60,8 years, 60% male, 40% female). Most patients presented with subacute pain, 25% with fever, one patient with hypoesthesia in both legs, normal physical exam was observed in 24% of patients and no patient had paresis/paralysis. Among comorbid diseases, type 2 diabetes mellitus was the most relevant (20%). Concomitant infection at diagnosis was present in 7.5% of patients. WBC count and PCR were the most frequent laboratory test and MRI the most performed radiological test being positive in all cases. Procalcitonine was assessed in 10% of patients. Lumbar segments were involved in 62,5% of patients. S. Aureus and S. Epidermidis were the most common isolated microorganism (10% of patients) 55% of patients received I.V. inhospital antibiotic for less than 1 month, followed by 2–6 weeks of oral antibiotics in 75% of patients. Linezolid, Rifampicin and Vancomycine were the most frequently used antibiotics (alone or in combination). 20% of patients underwent surgical treatment. Abscess was observed in 7 patients (17,5%) all of whom went to surgical treatment. 2 patients developed infectious endocarditis and 1 patient died. 8 patients presented recurrence of the disease. Mean inhospital length was 30 days.

Conclusion

Spondylodiscitis diagnose must be suspected in patients presented with persistent back pain and specific risk factors (i.e., Diabetes Mellitus, Immunosuppression). Appropriate images and laboratory tests (MRI, WBC count, PCR and procalcitonine) must be assessed to reach an early diagnosis and antibiotic treatment guided by causative organism. Surgical treatment must be considered in specific cases. Recurrence is not common and must be prevented.
Demographics of Tuberculosis of Spine and Factors Affecting Neurological Improvement in Patients Suffering from Tuberculosis of Spine - A Retrospective Analysis of 312 Cases
Authors: Sharma Ayush , Chhabra Harvinder , Chabra Tarun
Published: April 2016

Objective

The purpose of the study was to study demographics of tuberculosis of Spine and analyze factors that might affect neurological improvement in patients suffering from tuberculosis of spine. Materials: Of the 638 suspected cases of spinal tuberculosis, 312 cases with confirmed diagnosis with at least one year follow up were selected for retrospective analysis. 200 cases that presented with neurological deficit were further divided into three groups- completely improved, partially improved, and no improvement according to AIS (American Spinal Injury Association impairment scale) grading. All continuous variables and categorical variables were compared across groups.

Results

66.99% patients had typical clinical presentation. 84.62% had typical MRI presentation. Thoracic levels (T1–10) were most commonly affected in 45.78% followed by thoracolumbar levels 27.52%(T11-L2). In 80.32% disease was restricted to one or two adjoining vertebrae. At presentation 35.89% patients were neurologically intact whereas 31% were AIS-D, 20.83% were AIS-C, 2.5% were AIS-B and 9.61% were AIS-A. The three groups of patients with complete improvement, partial improvement, and no improvement were significantly different in their levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration on statistical analysis.

Conclusion

Age, sex, radiological presentation, co–morbidities and presence of pulmonary tuberculosis has no significant effect on neurological improvement. Levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly effects the final neurological improvement in cases of tuberculosis of spine.
Early Clinical and Radiographical Results of Single Level Cervical Arthroplasty with Discocerv®
Authors: Oh Sung Kyun
Published: April 2016

Introduction

Cervical disc arthroplasty has been shown to be as effective as fusion in radiculopathy in appropriately selected patients. Discocerv(Alphatec Spine, Carlsbad, USA) was introduced to reduce the difficulty of end plate preparation. Aim of this study is to evaluate the early results of clinical and radiographic outcome in patients implanted with Discocerv, which is semiconstrained mobile prosthesis made of ceramic bearings.

Material and Methods

From December 2008 to June 2012, 14 patients were enrolled in this retrospective study. They all suffered from single level radiculopathy due to acute disc rupture, and underwent total disc replacement with Discocerv. The mean follow-up period was 28 months (12~60 months). There were 8 males and 6 females and the mean age was 46.9 years old (39–66). The clinical outcomes were analyzed by using preoperative and postoperative follow up Korean version of neck disability index(K-NDI) and visual analogue scale(VAS). Also segmental motion was assessed by using dynamic flexion –extension lateral view, and heterotopic ossification or other complications were assessed.

Results

The mean VAS score improved significantly from 8 preoperatively to 0.3, 0.6 at one year, two years respectively and mean NDI score also improved from 28 preoperatively to 9, 6.4, 8.75 at three months, one year, two years respectively after operation. The mean segmental motion was 3.2 degree preoperatively and 4.7, 4.6, 6.6 degree at postoperative six months, one year, two years respectively and after 3 years, mean segmental motion decreased to 3.1 degree and to 1.9 degree at four years. Heterotrophic ossification was not detected in all cases, but anterior osteophyte formation at implanted segment was seen in 3 cases after three years. There was no radiologic complication related to wear. But 2 patients complained subjective discomfort as if they felt friction sound of their artificial joint.

Conclusion

Single level cervical arthorplasty with Discocerv showed good clinical outcomes and motion preservation sustained up to postoperative 3 years. Also, there were no major complications or no heterotopic ossification. However, 14% of patients felt friction sound by themselves.