bluuebunny/crossref_metadata_2025 huggingface dataset:
How Reliable is the Surgeon's Ability to Differentiate between Idiopathic and Degenerative Deformity in Adults; What Parameters Help them Decide?
Authors: Acaroglu Emre , Güler Ümit Özgür , Ayhan Selim , Mmopelwa Tiro , Sabat Montse Domingo , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Alanay Ahmet , Obeid Ibrahim , Kleinstuck Frank
Published: April 2016

Introduction

Adult spinal deformity (ASD) may be classified as idiopathic (I) or degenerative (D) (or other) based on classifier's perception, the reliability of and factors inherent to which remain unknown. Aim of study is to evaluate the inter and intraobserver reliability of surgeons' perception in differentiating I from D ASD and to identify the determinants of it.

Material and Methods

From a multicentric prospective database, 179 patients were identified with the diagnosis of I ( n = 103) or D ( n = 76); no previous surgery; and a lumbar coronal curve > 20°. Standing AP and lateral X-Rays were sent to five experienced spine surgeons to be identified as D or I (or other); followed by a second round after reshuffling. Weighted Kappa statistics was used, after which the patients were stratified by number of agreements as perfect (10/10) and very good (≥8/10); these were further compared for additional radiological parameters.

Results

Four observers completed both rounds while the 5th did only the first (a total of 10 observations/pt including the record). Agreement levels were moderate to good for intra but fair to moderate for interobserver comparisons (Table 1). There were 42 perfect and 80 with very good agreements for I patients but only 6 perfect and 17 very good agreements for D. Upon comparison of these, it was seen that they were different for some coronal parameters such as lumbar Cobb angle (larger in I, p < 0.001), CSVL modifier (C more common in I, p = 0.007) and presence of rotatory subluxation (less common in D, p = 0.017) but very different for sagittal parameters (lumbar lordosis, sagittal vertical axis, T2-sagittal tilt, pelvic tilt, sacral slope and global tilt; increased sagittal imbalance in D, all p≤0.001).

Conclusion

Surgeons in this study demonstrated reasonable intraobserver agreement but only fair agreement amongst them. These findings suggest that especially in patients with significant coronal curves, determination of curve etiology with only radiological data may not be accurate. In patients with good agreement, the most consistent radiologic determinant appeared to be the presence of sagittal imbalance.
Multiple Regression Analysis of Factors Affecting the Mental Component Score Constituents of SF-36 in Adult Spinal Deformity
Authors: Ayhan Selim , Yuksel Selcem , Niyazi Asli , Nabiyev Vugar , Güler Ümit Özgür , Mmopelwa Tiro , Sabat Montse Domingo , Pellise Ferran , Alanay Ahmet , Perez-Grueso Francisco Javier Sanchez , Kleinstuck Frank , Obeid Ibrahim , Acaroglu Emre ,   European Spine Study Group (ESSG)
Published: April 2016

Introduction

As surgical decision-making and preoperative planning for adult spinal deformity (ASD) need strongly be interrelated to health related quality of life (HRQOL), there are multiple studies focusing on factors with an impact on it. Based on the general perception of association between the treatment results and the psychological condition of patients with ASD, analyzing the factors governing the baseline psychological status of this group may be worthwhile. Aim of study is to develop an understanding of which factors have a greater impact on the SF-36 mental component score (MCS) and to establish a hierarchy of these parameters through multiple regression analysis.

Material and Methods

Prospectively collected data from a multicentric adult deformity database was analyzed using multiple regression analysis with SF-36 MCS designated as the dependent variable and demographic, radiological and the HRQOL parameters as independent variables. The regression model was started with a correlation analysis between SF-36 MCS and all independent variables then conducted by introducing the variables with the highest correlation with SF-36 MCS, sequentially.

Results

A total of 229 patients (181♀, 47♂) with a mean age of 49.4 (18– 85) years, were analyzed. A strong correlation between SF-36 MCS and Scoliosis Research Society (SRS)-22, Oswestry Disability Index (ODI), gender, and diagnosis were found ( p < 0.05). The distribution graph and results of regression analysis are summarized in Fig. 1. The overall R2 of this model was 0.254 ( p < 0.001).

Conclusion

This study has demonstrated that, among the evaluated parameters, the overall HRQOL (SRS-22 and ODI) as well as thoracic kyphosis (TK) and gender are the most important parameters affecting the mental component summary of SF-36 in ASD population. Although the strong association with SRS-22 and/or ODI was to be expected, less strong associations with TK (as a token of appearance?) and gender (due to different mechanisms of coping with disability?) were less expected and may warrant further consideration in our understanding of the population of ASD.
Mental Health and Self Image Perception of Non-disabled Adult Idiopathic Scoliosis Patients Having Mild to Moderate Curves Compared to Normal Population
Authors: Yilgor Caglar , Enercan Meric , Hamzaoglu Azmi , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Acaroglu Emre , Obeid Ibrahim , Kleinstuck Frank , Alanay Ahmet ,   ESSG European Spine Study Group
Published: April 2016

Introduction

There is little information about the effects of scoliotic curves on self image (SI) and mental health (MH) based on validated questionnaires. Aim was to analyze the effect of scoliosis on MH and SI in a non-disabled adult idiopathic scoliosis (AdIS) population having curves under surgical indication threshold (Main Thoracic (MT) Cobb (≤ 55°), and Thoracolumbar/Lumbar (TL) curve (≤ 45°).

Material and Methods

A retrospective analysis of a multicenter, prospective, consecutive patient series. Inclusion criteria were: non operated AdIS, ≥ 18 years of age, MT Cobb 20–55°, TL Cobb 20–45°, ODI <20, SRS 22 Pain score > 4. ODI and SRS22 pain score were used to distinguish patients that have pain and disability from the ones that do not. SRS- 22 and SF-36 normative data for different age groups were used for comparison. AP and lateral Cobb measurements, sagittal plane parameters and demographic data were analyzed in terms of correlations with SI and MH parameters.

Results

76 patients (64F, 12M) met the inclusion criteria. Mean age was 25.9 (18–44), mean MT Cobb was 38.5° (21–55) and TL Cobb was 34.6° (25–44). SRS-22 MH, SI and other domains were similar with SRS normative data (p > 0.05). SF-36 MCS and PCS domains for age groups 18–24, 25–34 and 35–44 were not significantly different than normative data (p > 0.05). None of the demographic and radiographic parameters were correlated with changes in SRS-22 function, SI, MH and SF 36 MCS, PCS parameters.

Conclusion

AdIS does not affect mental health and self-image in non-disabled patients with curve magnitudes below the surgical threshold. [Figure: see text]
Laminoplasty for the Treatment of Cervical Myelopathy. 5 Year Experience at University Clinic Colombia
Authors: Uribe Jorge E. , Chaparro Walter , Herrera Mario
Published: April 2016

Introduction

Cervical myelopathy affects primarily elderly people, caused mainly by a degenerative process of spondylosis in which both static (disc, ligament ossification, congenital stenosis, tumors) and dynamic (flexion-extension of cervical spine adaptive changes, nervous fiber elasticity, ischemia, trauma) factors that lead to the compression and diminished blood supply of the spine cord. The symptoms can range from mild paresthesias according to the compromised cervical level, gait disturbances, pain to as severe as paraplegia, with a natural history of chronic progression, Surgical treatment of this entity include anterior or posterior decompression with arthrodesis and laminoplasty. In this study we aim to report the result obtained with Cervical Laminoplasty described by O'brien during de years 2010 to 2015.

Material and Methods

An observational retrospective descriptive study was performed, reviewing the clinical records from preop to postop of patients with cervical myelopathy, Functional information was gathered using the scale of the Japanese Orthopaedic Association and Pain Analog Visual Scale. X-rays were evaluated measuring canal diameter, Chiba's line, Pavlov index and signs of instability. MRI studies were used to measure canal diameter in the axial plane and to identify signs of myelopathy. Inclusion criteria were patients older than 18 years, that had both clinical and image diagnosis for cervical myelopathy in which the O'brien laminoplasty was performed

Results

10 patients with an average age of 74 (64 to 84yrs) completed follow up according to our inclusion criteria. AVS improved from 7 to 3. The JOA Scale showed improvement in all the patients from 10 to 14 in the global score, which corresponds to a progression from a Functional class II to I. Images evaluation showed widening of the cervical canal as seen with a 0.76 Pavlov index preop to 0.96 postop and a 33% widening in the MRI sagittal view.

Conclusion

For the management of cervical myelopathy, proper documentation of the pathology both clinical and images allows to decide the adequate management of the patient. The O'brien technique for cervical laminoplasty proved to be an effective alternative in the treatment of this entity.
Rationale, Design and Early Trial Performance of AOSpine North America Multi-Center Double Blind Randomized Controlled Trial of Safety and Efficacy of Riluzole in CSM (CSM – Protect Trial)
Authors: Fehlings Michael , Kopjar Branko
Published: April 2016

Introduction

While surgical decompression is an effective treatment for CSM, many patients have substantial residual neurological and functional impairment. Compelling evidence from preclinical models suggest a benefit of adding a neuroprotective drug which targets sodium/glutamate excitotoxicity to the treatment of patients with CSM. The purpose of this study is to evaluate efficacy and safety of sodium-glutamate antagonist riluzole in improving neurological outcomes in patients with cervical spondylotic myelopathy (CSM) undergoing surgical treatment.

Material and Methods

Prospective multi-center double-blind randomized controlled trial in which a total of 300 patients undergoing surgical decompression for CSM will be randomized 1:1 to riluzole 2x50mg daily for 14 days before the surgery and 28 days after the surgery or to the placebo. Primary outcome measure is change in mJOA between baseline and 6 months. Secondary outcomes include ASIA, SF36v2, NDI, Eq. 5D, Pain VAS and complications. The sample size of 270 completed subjects will have 80% power to detect absolute difference of 0.9 in mJOA score between the investigational and the control group. The statistical analysis is organized as a sequential adaptive trial with one interim analysis at 65% of the accrued sample for early futility and efficacy. Adaptive statistical design allows for sample size adjustment at the time of interim analysis.

Results

To date, 212 subjects have been enrolled. Average age of the enrolled subjects is 58.1 years (SD 10.2); 56% males. The baseline mJOA is 11.9 (SD 1.5). Baseline NDI is 42.5 (SD 20.4) and the baseline SF36v2 Physical Component Score (PCS) is 32.8 (SD 9.9).

Conclusion

In spite of the benefits of the surgical intervention, patients with CSM experience significant residual impairment and neurological compromise. Adding neuroprotective treatment with riluzole may improve outcomes of surgery. This talk will emphasize the unique study design and the biological rationale for considering riluzole as a potential neuroprotective adjunct for patients undergoing surgery for CSM
Results of Multi-Level (Three and Four Levels) Cervical Disc Arthroplasty: Age-Weighted Linear Regression Analysis: Results from a Single Centre
Authors: Rajesh Mangattil , Khan Shoaib , Friesem Shabtai , Bhatia Chandra , Reddy Guru
Published: April 2016

Introduction

The clinical outcomes of Multi-level disc arthroplasties are variable in the literature. However, the outcome results related to age would have a significant bearing on our decisions in considering patients for surgery. We reviewed 51 patients who had 3 & 4-level cervical disc arthroplasties at our center.

Methods

The study involved a retrospective review of prospectively collected data on Multi-level (three and four levels) cervical arthroplasty patients with an average age of 54.64 (median age: 52, range: 34–80). Fifty one patients were followed up for 2 to 5 years based on clinical outcomes scores which were reviewed using data including NDI (Neck Disability Index), Depression, Anxiety, Bodily Pain, Visual Analogue score for Neck (VAS Neck), and Visual Analogue score for Arm (VAS Arm). Scores were collected pre-operatively and at each follow up at 3 months, 6 months, 1st and yearly afterwards. Linear Regression Analysis was performed to look at the impact of age on these scores.

Results

The study consisted of 24 females and 27 males. The average duration of symptoms was ~62 months (range: 0–300months) for Multilevel Cervical Arthroplasty patients. The indication for surgery was radiculopathy and a combination of radiculopathy and myelopathy. Linear Regression Analysis for NDI and age showed a Pearson Co-relation (r = 0.243); P Value: 0.051, for VAS Neck (r = 0.251); P Value: 0.044, VAS Arm (r = 0.392); P Value: 0.001. The slope on the scatter plots for these 3 outcome scores showed there was a better outcome with age. There was significant improvement in the score with age (< 0.05).

Conclusion

Our results indicate that there is a strong co-relation between age of the patient and their NDI, VAS Neck and VAS Arm scores in Multi-level Cervical Disc Arthroplasty. It would appear that the advancing age results are better. The reason is most likely multifactorial including duration of pre op symptoms, severity of pathology and patient expectations.
Change in Function, Pain, and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review
Authors: Tetreault Lindsay , Shamji Mohammed , Rhee John , Wilson Jefferson , Anderson Ian , Dembek Anna , Pagarigan Krystle , Dettori Joseph , Fehlings Michael
Published: April 2016

Introduction

The role of structured nonoperative treatment for the management of DCM is not well defined, and surgery is typically recommended as the default treatment option for patients with moderate and severe myelopathy. This study aims to conduct a systematic review of the literature to determine (1) the change in function, pain and quality of life following structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) the variability of change in function, pain and quality of life following different types of structured nonoperative treatment; (3) the differences in outcomes observed between certain subgroups (i.e baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from structured nonoperative treatment.

Material and Methods

A systematic search was conducted in Embase, PubMed, and the Cochrane Collaboration for articles published between January 1, 1950 and February 9, 2015. Studies were included if they evaluated outcomes following structured nonoperative treatment, including therapeutic exercise, manual therapy, cervical bracing and/or traction. Outcomes of interest were functional status (Japanese Orthopedic Association (JOA), Nurick), pain in upper extremities and neck, quality of life (Neck Disability Index), and/or conversion to surgery. The quality of each study was evaluated using the Newcaste-Ottawa Scale and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation Working Group.

Results

Of the 570 retrieved citations, eight met the inclusion criteria and were included in this review. There is very low evidence to suggest that structured nonoperative treatment for DCM results in a positive or negative change in function, pain and quality of life as evaluated by the JOA score. There is also limited evidence from three studies indicating that early structured nonoperative treatment (duration of symptoms < 1 year) may be associated with positive clinical outcomes. There were no studies that directly compared structured nonoperative treatment types and no studies that explored outcomes based on patient subgroups. The rate of conversion to surgery was reported to be between 23-54% in mostly cases of mild or moderate myelopathy (JOA≥12).

Conclusion

There is a lack of evidence to determine the role of nonoperative treatment in patients with DCM. However, in the majority of studies, patients did not achieve clinically significant gains in functional status following structured nonoperative treatment. Furthermore, rates of failed conservative treatment were between 23-54%.
Is there Sacral Defromity Predisposing to L4 Degenerative Spondylolysthesis?
Authors: Díez-Ulloa Máximo-Alberto , Barahona-Lorenzo Daniel , Gallego-Goyanes Adrian
Published: April 2016

Introduction

Degenerative spondylolysthesis results from anteroposterior instability, giving rise to a facet remodeling, generally at the L4L5 level. For istmic lythihc spondylolydsthesis an intrinsic sacral deformity has been described (Antoniades Spine 2000, Díez-Ulloa Proc Geer 2007). This sacral kyphosis, if present could contribute to a disbalance scenario that would render L4 more prone to olysthesis.

Hypothesis

A sacral kyphosis S1S2 could be a contributing factor to degenerative spondylolysthesis at L4L5.

Matherial and Methods

A control group (group C), matchable for age and gender, was compared with a series of 83 patients with L5 istmic lythis spondylolysthesis (group D). Proximal sacral kyphosis measured by the angle formed by the S1 posterior wall and the S2 posterior wall, if S1 was kyphotic on S2 then it was considered a positive angle, other wise being negative.

Statistics

SPSS 21.0, working with means or medians and appropriate tests after studying whether the variable showed a normal distribution.

Results

Group C lordosis -2° (minimum -8°; maximum +7°). Group D kyphosis +2° (minimum -14°; maximum +22°). There were statistically relevant differences between group C and group D.

Conclusion

An intrinsic sacral deformity might be a contributing factor to L4 degenerative spondylolysthesis in a degenerative environment.
Cost per Quality Adjusted Life Years Gained following Anterior Cervical Discectomy and Fusion in Elective Degenerative Pathology in Obese and Non-Obese Paients
Authors: Chotai Silky , Parker Scott , McGirt Matthew , Cheng Joseph , Devin Clinton
Published: April 2016

Introduction

Obese patients are at increased risk of co-morbidities and complications after spine surgery, which might result in increase cost and lower quality of life compared with their non-obese counterparts. The aim of present study was to determine the cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients.

Methods

A total of 299 consecutive patients undergoing elective ACDF for degenerative cervical pathology over a period of four-years were included in the study. One and two-year medical resource utilization, missed work, and health state values (QALYs), calculated from the EQ-5D with US valuation using time weighted area under the curve approach) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost (direct + indirect) was used to compute cost per QALY gained. Patients were defined as obese for body mass index (BMI) ≥35 based on the WHO definition of class-II obesity. A subgroup analysis was conducted in morbidly obese patients (BMI≥ 40).

Results

A significant improvement in pain (NP/AP), disability (NDI) and quality of life (EQ-5D and SF-12) was noted 2-year after surgery ( p < 0.0001). Mean total 2-year cost was $24524 for obese patients and $22492 for non-obese patients ( p = 0.06). Obese patients had lower mean cumulative 2-year gain in QALYs versus non-obese patients (0.39 versus 0.47 QALYs, p = 0.19, Fig. 1). Two-year cost-utility in patients obese versus non-obese patients was $65,805/QALY versus $47,634/QALY. Morbidly obese patients had significantly lower (0.15) QALYs gained and significantly higher cost $168,915/QALY gained at 2-years ( p < 0.0001) (Table 1).

Conclusion

ACDF provided a significant gain in health-state utility in obese patients, with a mean 2-year cost-utility of $65,805/QALY gained, which can be considered moderately cost-effective. Morbidly obese patients had lower cost-effectiveness; however, surgery does provide a significant improvement in outcomes. Obesity needs to be taken into consideration as physician and hospital reimbursements move toward a bundled mode
Value of Combination of Two Minimal Invasive Techniques in Elderly Patients with Multisegmental Lumbar Canal Stenosis and Spondylosis. Midterm Results
Authors: Abdelrahman Hamdan , Alhashash Mohamed , Boehm Heinrich
Published: April 2016

Introduction

Lumbar canal stenosis (LCS) and spondylosis are the major causes of morbidity among the elderly. LCS remains the most common indication for spinal surgery in elderly patients. These patients are complaining from neurogenic claudication as well as back complaint. LCS remains the most common indication for spinal surgery in elderly patients. These patients are complaining from neurogenic claudication as well as back complaint. Although the decompression Procedures improve the claudication, the back complaint persist or even increase. We assess the efficacy of combination of microscopic assisted percutaneous decompression (MAPD) and percutaneous transpedicular screw fixation (TPSF) with PEEK rod.

Material and Methods

Prospective study. Between 2009 and June 2012, 20 Patients with LCS and lumbar spondylosis were included in this study. We reviewed demographic information, preoperative (preop.) and postoperative (postop.) Visual Analog Scale (VAS) and Oswestry Disability Index (ODI).

Results

20 patients (14 males and 6 females; mean age 69.2 years), mean follow-up 14.2 months, co-morbidities are found in patients (cardiac 8, DM in 4, renal insufficiency in 4), ASA Score (Class I in 8, III in 10, III in 2). BMI; normal weight (7), overweight (6) and Obesity (7). Mean preop. VAS (back and leg) was 5.5 and 5.6 respectively; ODI was 57.2%, 3 months postop. VAS (2.65 and 1.3), ODI 26.4% and 18.2% at the last follow-up. The operated levels were (one level in 2 patients, two levels in 7, three levels in 7 and four levels in 4), eight patients with degenerative scoliosis (more than 10°) with mean cobb- angle of 15.4° preop. and postop. 5.75°. Mean Lumbar lordosis was 35.6° preop. and 39.5° postop. Sacral Slope was 27.8°preop. and postop. 30.3°. Mean operative time was 196 minutes and blood loss was 233.5 ml. Intraop. complications included 2 patients with dural injuries, no wound healing, Follow-up complications included one case with screw loosening.

Conclusion

Elderly patients are considered good candidates for lumbar surgical decompression using minimally invasive techniques. MAPD is a minimally invasive treatment option that affords a high level of safety, improved functions and decreased pain score. The spinal stabilization using PEEK rod possesses a good solution for spondyolotic back pain not
The Validity of Rasterstereography: A Systematic Review
Authors: Skwara Adrian , Mohokum Melvin , Schülein Samuel
Published: April 2016

Introduction

To investigate and monitor the progression of scoliosis and other spinal deformities in patients following idiopathic scoliosis (IS), non-invasive and radiation-free techniques are recommended because of the need for repeated radiographs. In a clinical setting, spine parameters can be quickly, cheaply and easily assessed using rasterstereography (RS). The objective of this paper was to assess the validity of the radiation-free technique RS based on surface topography compared with radiographs.

Material and Methods

MEDLINE, the Cochrane Library and EMBASE were systematically searched for studies which investigate the validity of rasterstereography compared with X-ray measurements. Studies published between January 1, 1990 and July 31, 2013 in English, German and French were included. Studies dealing with magnetic resonance imaging were excluded.

Results

Twelve studies with 570 patients were included; these articles were published between 1990 and 2013. The majority of studies investigated patients with IS, but other spinal pathologies included were thoracic hyperkyphosis and Scheuermann's disease. With regard to the quality assessment criteria for the included studies, three out of twelve studies were evaluated using a twelve point scale and two used a scale with eleven points.

Conclusions

RS facilitates clinical practice by analyzing the spinal column. It is completely radiation-free and could help to monitor scoliosis progression.
Oswestry Disability Index: Is Telephonic Administration Valid?
Authors: Yaszemski Alexandra , Ledonio Charles , Garber Tara , Polly David W.
Published: April 2016

Introduction

The Oswestry Disability Index (ODI) is a patient reported outcome questionnaire that assesses the functional status of a patient with back pain. It is widely used to assess the effectiveness of interventions for low back pain. The ODI is currently administered in outpatient clinics on a face-to-face basis, which can be expensive and time consuming. Telephonic administration of ODI, if valid, can be more convenient, may improve follow-up rates, and reduce costs. The objective of this study is to validate telephonic administration of ODI compared with face-to-face administration. Study

Methods

A convenience sample of employees and patients in an academic medical building were recruited. Face-to-face administration of ODI was done then retested 24 hours later over the phone. Reliability of each response from each section and overall scores were compared with determine test retest reliability by calculating the intraclass correlation coefficient.

Results

22 individuals completed the ODI questionnaire face to face, then via telephone 24 hours later. There was a mean 2%(±3) intrarater ODI score difference, range 0% to 12%. The Intraclass correlation coefficient overall was 0.98 (95%CI: 0.96, 0.99, p < 0.001) with a range of 0.95 to 1.0 revealing near perfect testretest reliability.

Conclusions

Administration of ODI questionnaire over the phone has excellent testretest reliability compared with face-to-face administration.
Bacterial Contamination in Osteosynthesis Material Removed after 6/8 Months Postoperative
Authors: Nirino Carlos Mariano , Nemirovsky Carlos Eduardo
Published: April 2016

Introduction

The aim of this paper is to describe the results obtained in 26 patients, which their osteosynthesis material was removed after 6–8 months of their first surgery following the surgery standards of temporary fixation of our service. They were operated between November 2014 and July 2015 in our department of Orthopedics and Traumatology in Corporación Medica of General San Martin in Buenos Aires, Argentina. All the patients were operated by the same surgeon, the same assistants and the same surgical scrub nurse. In all cases we used the same technique, which consists in a lozenge on the previous surgical wound and the removal of the polyaxial pedicle screws and the corresponding bars. After the removal of the material we proceeded to send one screw of each patient for cultivation and subsequent antibiogram. The results were surprising because in three cases our bacteriology service found a germ growth. None of the 26 patients studied presented during the 6–8 months that the osteosynthesis material was placed any signs or symptoms of infection.

Material and Methods

26 patients, 18 men and 8 women were evaluated in which the osteosynthesis material was removed according to the established protocols. All patients were studied by MRI and Rx and treated by the same surgeon, assistants and scrub nurse. In all cases the cultivation and antibiogram was performed by the same laboratory and the preliminary results were always between 72–96 hour. Surgical technique: Posterior approach, lozenge on the previous surgical wound and the subsequent removal of the polyaxial pedicle screws and the corresponding bars.

Results

In 3 of the 26 cases sent for cultivation and antibiogram we found positive samples. In one case the cultivation was for Pseudomonas aeruginosa and the remaining two cases were positive for Staphylococcus aureus. The rest of the samples sent were negative. None of the patients had postoperative complications. The entire surgical wounds healed normally, without any secretions or phlogosis. No patients required antibiotic therapy in the immediate postoperative nor in the following months. The following of them was held up to 6 months post surgery.

Conclusion

After an exhaustive study of each of our patients we conclude that in most cases where a postoperative infection occurs it is more due to patient factors such as nutritional status thereof; which keeps a close relationship with the immunological response of the patient; malnutrition or immunosuppression due to diabetes mellitus, alcoholism, chemotherapy agents or tumors than to factors which depend directly to the surgeon like the skin preparation or the operating room environment factors. Due to the type of sample sent; even though we took the necessary precautions; we cannot dismiss skin contamination.
Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine
Authors: Hassan Khaled , Elmorshidy Essam
Published: April 2016

Introduction

The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis.

Material and Methods

A total number of 42 patients with tuberculous spondylodiscitis of the thoracic and lumbar spine treated surgically were included in this study. Twenty patients (group A) underwent anterior debridement, decompression and instrumentation by anterior approach. Twenty two patients (group B) were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Operative parameters, clinical, radiographic and functional results for the two groups were analyzed and compared.

Results

The average follow up period was 15 months (range, 12 to 24) in both groups. The average operative time, blood loss and blood transfusion of anterior group were significantly less than the posterior one. There was significant better back pain relief, kyphotic angle correction and less angle loss in the posterior group than anterior. There was no significant difference between the 2 groups regarding neurological recovery, functional outcome and fusion rate.

Conclusions

Both anterolateral and posterolateral approaches are sufficient for achieving the goals of surgical treatment of thoracic and lumbar pott's disease but posterolateral approach allows significant better kyphotic angle correction, less angle loss, better improvement in back pain but unfortunately more operative time and blood loss.
Debridement, Internal Fixation and Interbody Fusion to Treat Single Level Thoracic Tuberculosis via Anterior Approach Only
Authors: Refae Hesham , Refae Hesham
Published: April 2016

Introduction

Tuberculosis of the dorsal spine is a very serious situation which may cause paraplegia and disability Purpose: We evaluated the clinical efficacy and feasibility of one –stage anterior debridement, internal fixation and interbody thoracic fusion in the treatment of single level thoracic tuberculosis. Materials and Methods: Forty three adult patients (mean age: 49.5-years) fixed with Z-plate by anteriortransthoracic-transpleural approach. Assessment was done using Frankel classification, blood-loss, operative-time, Cobb-angle, correction loss, union and Oswestry disability index (ODI).

Results

All cases were followed up for 48.5 weeks on average. Average mean operative time was 167 min, evaluated blood loss during surgery 1015 ml, rate of kyphosis correction79.2%, loss of corrected angle 0.8 ± 1.2° and Cobb-angle improved from 36.6 ± 8.4° to 7.5 ± 2.3°. Postoperative Cobb-angles were significantly better than preoperative ones. ODI was 3.4 ± 4.1. All patients achieved union with 100% cure rate. All but one patient achieved full neurological recovery. No severe complications or spinal cord injury occurred. Superficial infection. Occurred in one case. Lung parenchymal injury in two case and DVT in one case.

Conclusions

This approach can directly and successfully remove the focus of tuberculosis and give very good union and kyphosis correction rate that were maintained overtime.
Simultaneous Anterior Debridement and Posterior Instrumentation for Multiple Level Tuberculous Spondylodiscitis
Authors: Koptan Wael , El-Sharkawi Mohammad , ElMiligui Yasser
Published: April 2016

Introduction

The incidence of tuberculosis has rapidly increased in the last decade. The aim of this work is to compare the results of iliac crest and rib grafts and to assess the role of short segment posterior instrumentation in patients with multiple level affections.

Materials and Methods

The results of 48 patients with multiple level resistant tuberculous spondylodiscitis surgically treated were retrospectively reviewed. Patients were followed-up for an average of 6.5y. The average age was 47y and 27 patients had an associated neurologic deficit. The disease affected two levels (36 patients) and three levels (12 patients). All had anterior debridement and bone grafting by iliac crest autograft in 26 patients (Group 1) and rib autograft in 22 patients (Group 2); followed simultaneously by posterior short segment instrumentation.

Results

Postoperatively, the kyphotic deformity was corrected from an average of 41 degrees to an average of 5 degrees (Group 1) and from an average of 47 degrees to an average of 6 degrees (Group 2). At the last follow up, both groups had a similar fusion rate (95% and 96% respectively) and loss of correction (averaged 2.4 degrees and 2.1 degrees respectively). Group 1 patients had 7 donor site complications. All patients except one had an improvement in their neurologic status.

Conclusions

Radical anterior debridement of multiple level spondylodiscitis eradicated the infection; short segment posterior instrumentation applied immediate stability, allowed adequate graft uptake and long term correction of the kyphotic deformities.
Medium-Term Outcome of Posterior Surgery in the Treatment of Non-Tuberculous Bacterial Spinal Infection
Authors: Aljawadi A. , Dawoodi Aryan , Imo Eze , Sethi Gagan , Arnall Frances , Chaudhry M. , George Joshi , Mohammed Saeed , Verma Rajat , Tambe Anant , Yasin Naveed , Siddique Irfan
Published: April 2016

Introduction

The aim of this study is to evaluate the outcome after posterior spinal stabilization surgery for the management of de novo non-tuberculous bacterial spinal infection.

Materials and Methods

Patients presenting to a single tertiary referral spinal center between August 2011 and June 2014 were included in the study. 21 patients with non-tuberculous bacterial infection were identified and included in the study. All patients were managed surgically with posterior stabilization, with or without neural decompression, without debridement of the infected tissue. Neurological state was assessed using the Frankel Grading System before and after surgery. medium-term follow-up data was collected using Spine Tango COMI questionnaires and Euro Qol EQ-5D system with a mean follow-up duration of 20 months postoperatively.

Results

The mean improvement in neurological deficits was 0.91 Frankel grade (range 0–4). At a 20 month mean final follow-up, mean COMI score was 4.59, average VAS for back pain was 4.28. These symptoms had no or minor effect on the work or usual activities in 52%. 38% of patients reported a good quality of life. The average EQ-5D value was 0.569. There were no problems with mobility in 44% of patients. In 72% there were no problems with self-care.

Conclusions

Our study has shown that posterior surgery for the management of bacterial, nontuberculous spinal infection can improve neurological outcome in approximately half of the patients. At medium-term follow-up, around 50% of patients were able to return their pre-morbid work or usual activities. Outcomes were comparable to other techniques including anterior or combined surgery.
Post Operative Comparison of the Results of the Use of Antibiotic Prophilaxis One and Five Days in Patients Undergoing Lumbar Arthrodesis
Authors: Junior Charbel Jacob , Junior José Lucas Batista , Cardoso Igor Machado , Maia Thiago Cardoso , Brazolino Marcus Alexandre Novo , Debom Tadeu Gervazoni , Roncaglio Bruno
Published: April 2016

Introduction

antibiotic prophylaxis for patients undergoing lumbar spine arthrodesis is controversial in the literature. The objective of this article is comparing the results of post-operative patients undergoing lumbar spine arthrodesis using first generation cephalosporin antibioticoprofilaxiacom by one and five days.

Methods

we evaluated 43 patients aged between 16 and 76 years (mean 49.9 years), prospectively randomized, undergoing lumbar arthrodesis of 01 to 03 levels between November 2012 and April 2014, divided into two groups. At first it was used a period of antibiotic prophylaxis of a day and, in the second group, prevention was kept by 05 days. Following clinical and laboratory criteria were evaluated.

Results

the prevention of surgical infections requires far beyond the administration of antibiotics, according to the CDC's latest update, however, the dose, spectrum and time of use thereof remain controversial in the literature. The current recommendation for antibiotic prophylaxis in clean surgery of column is of single dose and, if a new dose is added, this should not exceed 24 hours the post-op.

Conclusion

A single dose of antibiotic prophylaxis with 1st generation cephalosporin is as effective as multiple doses scheme pre and post operative in lumbar arthrodesis surgery up to three levels, not justifying the costs and risks of submitting the patient hospitalization under medicated wide.
Complications and Re-operation Rate after Extra-foraminal Microscopic-Assisted Percutaneous Nucleotomy
Authors: Shawky Ahmed , Babic Dusko , Siam Ahmed Ezzat , Ezzati Ali
Published: April 2016

Introduction

Foraminal and extra-foraminal lumbar disc herniations are uncommon. Main presentation is radicular pain related to the exiting nerve root in the affected level. Different approaches for surgical intervention include median or para-median open microscopic-assisted techniques, endoscopic approach or trans-tubular microscopic-assisted percutaneous technique.

Patients and Methods

Between October 2012 and March 2014, 40 patients (18 females and 22 males) with foraminal or extra-foraminal lumbar disc prolapse were operated on in our center. Extra-foraminal percutaneous trans-tubular microscopic-assisted approach was used. Preoperative investigations included plain radiographs and MRI. Preoperative clinical evaluation included Visual Analogue Scale (VAS) for radicular pain and neurological state. The mean follow up period was 18 months (range 12 - 30).

Results

The mean age was 56 years. The most commonly affected level was L4/5 (22 patients = 55%). The mean preoperative VAS for leg pain was 82 mm, improved to 15 postoperatively. The average operative time was 69 minutes. There were no intraoperative complications. One patient had temporary postoperative quadriceps weakness (L4 radiculopathy) that was completely improved at 3 months follow up. Another patient had deep venous thrombosis after discharge and he was readmitted. Two patients had recurrence within the first 6 months postoperatively. They were re-operated using the same technique without complications. Both were followed up for one year without a second recurrence. Two patients with primarily severe degenerative changes and neuroforaminal stenosis had recurrence of symptoms with back pain and leg pain, re-operation as Transforaminal Lumbar Interbody Fusion (TLIF) was done

Conclusion

Trans-tubular percutaneous extra-foraminal microscopic-assisted nucleotomy is advantageous for foraminal and extra-foraminal disc herniations. It is a muscle splitting minimal-invasive approach with minimal morbidity. Re-operation rate is not different compared with microsurgical open or endoscopic techniques. Results seems to be better in cases with sequestrated disc lesion rather than degenerative neuroforaminal stenosis.
The Role of Minimally Invasive Spine Surgery for Thoraco-Lumbar Fractures in Patients with Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Authors: El-Maghraby Hussien , Nagaraja Sanjoy , Bletechi Radu
Published: April 2016

Introduction

Unstable spine fractures commonly occur in the setting of a poly-traumatized patients. The aim of management is to balance the need for early stabilization with quick patient's mobilization and reduction of additional trauma due to the major open surgery.

Material and Methods

To assess the operative data, clinical and radiological outcomes of patients undergoing minimally invasive management of Thoraco-lumbar fracture.

Design

Retrospective review of prospectively collected data.

Methods

101 patients underwent minimally invasive percutaneous fixation of Thoraco-lumbar fractures percutaneous fixation with or without vertebroplasty. All patients were post-operatively either neurologically intact or improved. There were 60 males and 41 females with an average age of 44 years.

Results

The mean follow-up was 18 months (3–44 months). The mean operative time was 100 minutes (range 35–240 minutes) and the mean blood loss was < 100mL. VAS was significantly improved from 8.7 to 1 at last follow-up. No patient worsened his or her neurological condition postoperatively.

Conclusion

Minimally invasive percutaneous fixation of Thoraco-lumbar fractures in poly-traumatized patients appears to be a safe and effective technique to manage Thoraco-lumbar fractures without neurological impairment and allowing early rehabilitation.
Clinical Outcomes among Patients with Chronic Low Back Pain Treated with Pregabalin Monotherapy in Fort Portal Regional Referral Hospital in Western Uganda: Case Series Report
Authors: Pariyo Godfrey
Published: April 2016

Introduction

Chronic low back pain associated with rediculopathy is a common reason for physician visits but no guidelines are available for management of these patients in Uganda. A placebo controlled trial on efficacy of Pregabaline among patients with lumbosacral radiculopathy in Germany was inconclusive on the benefit of Pregabaline1 in reducing pain. In another study in USA using Pregabaline showed inferior effect of Pregabaline monotherapy to combination with Celecoxib on resolution of symptoms.2 We evaluated clinical response to Pregabaline monotherapy on low back pain associated with radiculopathy at the Orthopedics clinic of Fort Portal Regional Referral Hospital in Western Uganda.

Methods

In this prospective study conducted from February to July 2015, 15 patients with chronic low back pain associated with rediculopathy exceeding 3 months were seen in the orthopaedic outpatient clinic at Fort Portal Regional Referral and all were treated with a 4 week course of oral Pregabaline (75mg taken once a day) and evaluated for clinical improvement. Visual Analogue Score (VAS) for pain was used to assess the degree of pain among patients after 4 weeks of treatment. Structured questionnaires were used to capture sociodemographic and clinical data.

Results

Of the 15 patients 10 were females and 5 were males, with age range of 28 -75 years and mean age 53 years. Three patients were unable to walk before treatment due to pain. Before treatment with Pregabaline all the patients had Visual Analogue score of 8–10. After 4 weeks of treatment with oral Pregabaline 13 patients showed significant improvement with reduction in the Visual Analogue score to 0–2 while 2 patients had modest reduction in Visual Analogue score of 6–8.

Conclusion

Oral Pregabaline has good effect on the treatment of patients with low back pain associated with rediculopathy. However further research is needed with sufficient sample, randomization and longer follow up. References Baron R, Freynhagen R, Cloutier C, et al. The efficacy and safety of pregabaline in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain 2010;150(3):420–427 Romanò CL, Romanò D, Bonora C, Mineo G. Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain. J Orthop Traumatol 2009;10(4):185–191
Radiation Exposure in Single Level Lumbar Fusion: Our Experience in Robotic Guidance Compared to Literature Review of Minimally Invasive Fusions
Authors: Sudarshan Pramod , Panda Aditya , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan
Published: April 2016

Introduction

Lonizing radiation used in fluoroscopy leads to significant radiation exposure to the surgeon, operating room staff, and the patient. Low dose exposure can cause skin burns, nausea, and cataracts where as in sufficient doses increase the lifetime risk of cancer among spine surgeons and patients. Moreover, accumulating low dose exposure over a lifetime may lead to heritable changes at a genetic level. Minimally invasive lumbar fusion, though becoming increasingly popular has significant exposure to radiation. Robotic guidance is the latest tool in spinal fusions and this study focuses on radiation exposure in single level lumbar fusions performed at our institution as compared with literature data.

Material and Methods

Seventy patients who underwent robotic guided lumbar fusion (Renaissance, Mazor robotics) performed by a single surgeon were analyzed retrospectively for radiation exposure. The age of patients ranged from 38 to 80 (mean, 56 years). Robotic guidance data included execution rate, accuracy of guidance, total surgical time, and time required for robotic guidance. Radiation-related data included the average preoperative computed tomographic effective dose, radiation dosage for calibration, registration, placement of Kirschner wires, and total procedure radiation time.

Results

Average operative time was 134.7 minutes (82–150). Mean robotic guidance took 16 minutes. Average operative radiation time was 6.2 seconds (5.2–8.6). The screw execution rate was 99%, with an accuracy of 99.5%. Mean radiation exposure dosage to the operating room was 3.7 mgy (3.1–5.2mgy) in robotic guided patients. This exposure is relatively 20 times lesser when compared with published data on radiation exposure in minimally invasive lumbar fusions.

Conclusion

Radiation exposure to the surgeon and the operating room staff in our series of single level lumbar fusion using robotic guidance was significantly lower than other published results on fluoroscopy guidance and navigated fusion. Robotic guidance reduces the radiation exposure maintaining a high accuracy rate, thereby promising as a safer alternative.