bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Results of Discover Single Level Total Cervical Disc Replacement: A Single Center Study of 100 Patients with a Minimum 4-Year Follow-Up
Authors: Rozankovic Marjan , Marasanov Sergej , Lupret Velimir , Vukic Miroslav
Published: May 2015

Introduction

Anterior cervical discectomy and fusion is still the “gold standard” for surgical treatment of patients with single-level cervical disc disease but in the past decade it has been challenged by total cervical disc replacement which offers several advantages over it.

Materials and Methods

A total of 100 patients with a single level cervical disc disease who fulfilled the inclusion and exclusion criteria were treated with total cervical disc replacement using Discover artificial cervical disc (DePuy Spine Inc., Raynham, Massachusetts) between May 2008 and September 2010. All patients were evaluated with pre- and postoperative serial radiographic studies (MRI, standard and functional cervical spine X-rays), and clinically. For clinical evaluation we used neck disability index (NDI), visual analog scale (VAS) for neck and arm pain and neurological status at 3, 6, 12, 24, and 48 months.

Results

The results of our study show that total cervical disc replacement using Discover provides excellent radiological and clinical outcomes in long-term follow-up during minimally 48 months. Patients showed significant improvement in clinical parameters, NDI and VAS (arm and neck) at follow-up visits. None of the patients developed adjacent disc disease. During the follow-up period in 15 of our patients heterotopic ossification occurred with complete loss of range of motion at the treated level (15%). Also we had one patient with the prosthesis migration at the 2-year follow-up visit who was reoperated. There were no other major surgery-related complications.

Conclusion

Discover total cervical disc replacement is according to our study safe and efficient method for surgical treatment of a single level cervical disc disease in selected patients with excellent outcome at long-term follow-up.
A Prospective Clinical and Morphological Study of Facet Joint Integrity following Implantation of Two Different Cervical Disc Replacements
Authors: Trouillier Hans , Gebhard Harry , Hintermann Beat , Kampe Jan
Published: May 2015

Introduction

The ideal patient for a disc replacement with a mechanical prosthesis, such as Discocerv of Scient̀X or a M6 of spinal kinetics with a soft core, is under 60 years of age with monosegmental, symptomatic degenerative disc disease without degeneration in the facet joints. Following implantation of prosthesis any changes in load through the facet joints appear as changes in bone mineral density at the operative and adjacent levels. A comparing study was designed to investigate whether facet joint sclerosis and degeneration occurs following the implantation of the two different disc types.

Materials and Methods

In this prospective study, suitability for disc replacement was determined by CT scan and clinical assessments. Patients were followed up 6 and 12 months postoperatively. X-ray and CT-controlled osteoabsorptiometry were used to assess any changes in bone mineral density following implantation of the two different disc models. A 3D reconstruction enabled visualization of the bone density distribution in the facet joints. Pain and function was assessed using standard outcome scores (visual analog scale [VAS] back pain score, Oswestry disability index [ODI], and short form-36 [SF-36]). Mobility was determined by flexion/extension X-rays.

Results

In total, 20 patients received disc replacement, 10 patients in each group. The postoperative location of the areas of maximum bone mineral density did not change compared with the preoperative condition. There was a reduction in subchondral mineralization density in the facet joints of the operated segments and, to a lesser degree, in the neighboring segments. The mean improvement in the VAS back pain score 6-months postoperatively was 60%. Function, as measured by ODI and SF-36 scores, had improved by up to 70% at the same postoperative time point. Improvements in pain and function scores were maintained 12 month postoperatively. On average, normal movement and weight bearing was observed 8 weeks postoperatively. Mobility increased by a mean of 8 degrees in the operated segment. There was no big difference between the two disc designs.

Conclusion

Facet joint sclerosis and degeneration did not occur following cervical disc replacement. There was no big change in the location of the areas of maximum density, indicating that mobility approached normal physiological levels. The reductions in subchondral mineralization density suggest normalization away from degenerative sclerosis in both disc types. This did not appear to be due to adoption of postoperative postures as normal movement and weight bearing was achieved. Further study is needed to assess these two different disc designs and the degree to which restoration of segmental mobility leads to the normalization of degenerative sclerosis.
Persistent Axial Neck Pain after Cervical Disc Arthroplasty
Authors: Kang Daniel , Wagner Scott , Lehman Ronald
Published: May 2015

Introduction

There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty (CDA). In addition, there is very little literature examining optimal radiographic parameters for placement of CDA. Therefore, we set out to perform a single-center evaluation of the radiographic outcomes and association with complications following CDA.

Methods

We performed a retrospective review from August 2008 to August 2012 of all patients from a single military tertiary medical center undergoing cervical disc arthroplasty. Preoperative, immediate postoperative, and final follow-up films were evaluated. The clinical outcomes and complications associated with the procedure were also examined.

Results

A total of 312 patients were included in the review, with an average radiographic follow-up of 14 months and a 15.1% rate of persistent axial neck pain. For patients with persistent neck pain, the rates of heterotopic ossification (HO) formation and osteolysis were 27.7% and 14.9%, respectively, while the rates were significantly lower for patients without neck pain (12.8% and 6.2%, respectively, p = 0.01). There were no differences in preoperative facet arthrosis, pre- or postoperative disc height, segmental range of motion, or placement of the device relative to the posterior edge of the vertebral body. However, patients with implants more centered between the uncovertebral joints were more likely to experience posterior neck pain ( p =0.03).

Conclusions

We found that posterior, axial neck pain is relatively frequent after cervical disc arthroplasty, and patients with persistent neck pain were significantly more likely to develop heterotopic ossification or implant-related osteolysis. We also found that patients with implants that were placed off-centered were less likely to also complain of neck pain, though the reasons for this finding are unclear.
Short Link N as a Therapeutic Agent to Treating Early Intervertebral Disc Degeneration
Authors: Algarni Nizar , Epure Laura , Grant Michael , Salem Omar , Antoniou John , Mwale Fackson
Published: May 2015

Introduction

Although the disc has limited endogenous repair activity, induced repair of disc tissue may be possible by the intradiscal injection of growth factors to stimulate the production of disc matrix. We previously demonstrated that Link N (DHLSDNYTLDHDRAIH), a naturally occurring peptide generated by the N-terminal proteolytic fragmentation of link protein during tissue turnover, can act as a growth factor in the disc. It can stimulate matrix production in vitro, in vivo, and in intact ex vivo human intervertebral discs (IVDs). We have recently discovered that AF cells have the ability to proteolytically process Link N resulting in a fragment spanning amino acid residues 1 to 8 (US patent 61870394)—short Link N (sLink N). Our in vitro data indicates that the biologically active sequence is preserved within this fragment and, thus, sLink N could represent a potential stable growth factor able to stimulate disc repair. Separately, we developed a long-term organ culture model with vertebral bone. The purpose of the present study was to evaluate the effect of sLink N and compare its efficacy to Link N in this novel organ culture model of early disc degeneration.

Material and Methods

Caudal IVDs from the tails of 20 to 24-month old steers were isolated with adjacent vertebral bone. After 7 days of preconditioning in culture, degeneration was induced in IVDs by a single injection of 50 µg trypsin into the NP. After 7 days after induced-degeneration, the trypsin-treated discs were injected with either sLink N or Link N (100 µg/disc, n = 6 discs/group). Four of the trypsin-treated degenerate discs were injected with PBS alone to serve as a control for degeneration while four discs served as nondegeneration controls. At 2, 4, and 8 weeks posttreatment, two discs from each treatment and control groups were processed for biochemical analyses. Proteoglycan (predominantly aggrecan) synthesis in the NP was monitored as sulfated glycosaminoglycan using the 1,9-dimethylmethylene blue dye-binding assay, and Western blotting was performed to determine the expression of aggrecan and type II collagen in the tissue.

Results

Without intervention, at all-time points, the GAG content in degenerate discs dropped to approximately 50% of that in nondegenerate controls. In contrast, sLink N or Link N, significantly increased the GAG content of the discs compared with the GAG content in degeneration control discs. However, sLink N was more potent at inducing proteoglycan and type II content than Link N.

Conclusion

The results revealed that sLink N or Link N have the ability to restore tissue content and that sLink N is more potent than Link N in an early state of the disease. These results have implications in relation to using either sLink N or Link N when regenerating a functional NP in the degenerated IVD or in repairing cartilage.
A Comparison of Ocular Radiation Exposure Utilizing Three Types of Leaded Glasses
Authors: Waddell Bradford S. , Waddell Hunter , Zavatsky Joseph M.
Published: May 2015

Introduction

Minimally invasive spine (MIS) surgery has an increased reliance on fluoroscopic X-ray. Compounded radiation exposure to the surgeon has become increasingly concerning and ocular radiation has been associated with cataract formation. Leaded eye protection can reduce ocular radiation exposure. We evaluate the efficacy of three types of leaded eyeglasses during typical views of MIS spinal surgery.

Materials and Methods

Utilizing anthropomorphic patient and surgeon phantoms, radiation exposure to the lens of the surgeon phantom was measured. Four groups were analyzed: Group 1—no glasses (NO); group 2—lead lens without leaded sides (WOLS); group 3—lead lens with lead sides (WLS); group 4—sport wrap around leaded glasses (sport). A total of 15 individual 20-second exposures in the anteroposterior and lateral X-ray positions with phantom head positions at 0, 45, and 90 degrees were performed. All glasses were 0.75 mm lead equivalent. Radiation dose was measures using a solid-state dosimeter (Unfors EDD-30; Billdal, Sweden). Average radiation dose for each position, total radiation dose, and percent reduction to the lens was calculated for each pair of glasses. Student t-test was used to calculate significance.

Results

All three glasses (WLS, WOLS, and sport) had significant reductions in ocular radiation versus no glasses at all individual head positions ( p ≤ 1.31 × 10−34). Sport had a significantly lower ocular radiation dose than WLS at all positions except at 90 degrees AP (0.323 vs. 0.334, p = 0.001). Sport also had a significantly lower ocular radiation dose than WOLS in all cases except 0 degrees AP (0.376 vs. 0.285, p = 0.0003) and 90 degrees lateral (0.988 vs. 0.862, p = 7.38 × 10−28). WOLS had a significantly lower radiation dosage at all positions over WLS except at 45 degrees AP (0.286 vs. 0.279, p = 0.303). Average total radiation dosage was 36.47 µgray without glasses, 3.13 µgray for WOLS, 4.134 for WLS, and 3.32 µgray for sport. All glasses resulted in a significant reduction in total radiation dose over no glasses ( p ≤ 8.37 × 10−32). There was no statistical difference in the total radiation dosage of WOLS versus Sport ( p = 0.6) and both Sport and WOLS were significantly lower than WLS ( p = 0.009 and 0.003, respectively).

Discussion

Our study demonstrates a significant reduction in radiation exposure to the eye with all three types of leaded glasses. This study confirms other reports showing varying degrees of exposure with different angles and X-ray views. Furthermore, we show that contrary to intuition, leaded glasses with lead sides (WLS) may have adverse effects by possibly trapping radiation and increasing ocular radiation exposure. Based on our results, we recommend the use of sport-wrap type leaded glasses or those without lead sides (WOLS).
Patient and Surgeon Exposure to Radiation in Intraoperative CT-Based Spine Navigation
Authors: Mendelsohn Danny , Strelzow Jason , Batke Juliet , Dvorak Marcel , Fisher Charles , Street John , Dea N.
Published: May 2015

Introduction

Intraoperative imaging is critical in spine surgery for determining the spinal level, visualizing alignment, and guiding implant placement. Imaging modalities include plain X-rays, fluoroscopy with C-arm and intraoperative CT scanning (O-arm). These imaging modalities emit ionizing radiation to the surgical team and the patient. The amount of radiation emitted to the patient and the surgeon with intraoperative CT-based spine navigation were compared. The impact of intraoperative CT on the use of intraoperative X-rays and postoperative X-rays and CTs was investigated.

Material and Methods

An ambispective review of surgical cases using intraoperative CT at Vancouver General Hospital over 1 year was performed. The number of intraoperative X-rays, fluoro and CT dosages were recorded and standardized to effective doses. The number of perioperative imaging investigations was compared with a cohort of surgical cases involving only intraoperative X-rays and fluoroscopy. A literature review was performed to enable a comparison of radiation exposure to historical values for fluoroscopic-guided spine instrumentation.

Results

A total of 73 surgical cases involving an average of 5.44 levels of instrumentation were reviewed. Thoracic and lumbar spine instrumentations were associated with the highest radiation emission from all modalities compared with cervical and cases (TL: 5.65 mSv vs. C: 2.19 mSv). Major deformity and degenerative cases involved more radiation exposure than trauma and oncology cases (5.81 vs. 3.54 mSv). On average, the patient was exposed to 5.9 times more radiation compared with the surgical team. Patient exposure was three times the values reported in the literature for open thoracolumbar fusions. In comparison, radiation exposure to the surgeon was reduced by 35% compared with conventional fluoroscopically guided open thoracolumbar fusions and 70% less than minimally invasive thoracolumbar fusions. The average radiation total radiation exposure to the patient was 6.05 mSv, a value less than a single lumbar CT scan (7.5–10 mSv). The use of intraoperative CT did not reduce the number of postoperative X-rays or CT scans acquired during the admission or within 1 year following surgery.

Conclusion

Intraoperative CT increases the radiation exposure to the patient and reduces the radiation exposure to the surgeon when compared with the fluoroscopic-guidance radiation exposure reported in the literature. Thoracolumbar instrumentations for major deformity and degenerative diagnoses are associated with the highest radiation exposure. Although intraoperative CT can improve the accuracy of spine instrumentation, surgeons should be aware of the increased radiation exposure to the patient compared with conventional fluoroscopy-guidance.
Reduction in Fluoroscopy Time, Radiation Dosage, and Complications Using an Innovative Guide Wire for Percutaneous Pedicle Screws
Authors: Briski David C. , Waddell Bradford S. , Cook Brandon W. , Zavatsky Joseph M.
Published: May 2015

Introduction

Despite the benefits of minimally invasive spine surgery (MIS), inherent risks to the patient and surgeon exist. Numerous studies demonstrate increased radiation exposure with MIS secondary to the need for increased fluoroscopy, thereby increasing the risk of cataracts and malignancy. Additionally, inadvertent advancement of standard guide wires through the vertebral body can occur, placing vital ventral structures at risk. This study evaluates the benefit of utilizing a novel split-tip guide wire for percutaneous pedicle screw placement.

Methods

A total of 30 consecutive cases of MIS transforaminal lumbar interbody fusion (TLIF) at L5–S1 were retrospectively evaluated. Group 1: Standard straight guide wire, 15 patients; group 2: split-tip guide wire, 15 patients. Except for the type of guide wire utilized, the same operative technique was used in each case, including bicortical S1 screw fixation. Total fluoroscopy time, radiation dosage, operative time, and complications were evaluated. Technique: (1) S1 pedicles are cannulated with standard Jamshidi needles. (2) Y-wires are placed through Jamshidi needles. (3) A cannulated Steffee probe cannulates the distal sacral promontory over the Y-wire. (4) The Steffee probe is retracted 50% and Y-wire is repositioned (Y-wire design prevents inadvertent advancement through sacral promontory). (5) The proximal S1 pedicle can be tapped over the Y-wire (not required). (6) Cannulated pedicle screws are placed over the Y-wire, engaging the distal sacral promontory for bicortical S1 purchase.

Results

Mean total fluoroscopy time per case for group 1 was 231.1 seconds versus 154.2 seconds for group 2 ( p = 0.017). Mean radiation dosage for group 1 was 16.22 versus 8.69 rads in group 2 ( p < 0.001). There was no significant difference in operative time ( p = 0.18). Inadvertent advancement of two S1 guide wires occurred in two different patients in group 1. Postoperative abdominal CT scans with contrast were negative.

Conclusion

Utilizing a split-tip guide wire for percutaneous pedicle screw placement significantly decreased fluoroscopy time by 33% and radiation dosage by 46%. Cannulating the sacral promontory allows for bicortical S1 screw purchase, but removes the mechanical stop preventing inadvertent guidewire advancement. The split-tip guidewire may prevent wire advancement and decreases the need for fluoroscopic surveillance. This, in turn, reduces the risk of injury to structures ventral to the spine, while reducing the exposure to harmful radiation.
Cervical Spondylotic Myelopathy Treated by Cervical Laminectomy: Prevalence of Pre- and Postoperative Symptoms
Authors: Zaater Ahmed
Published: May 2015

Introduction

This is a retrospective study to find out the prevalence of symptoms before and after cervical laminectomy surgery in a series of patients with cervical spondylotic myelopathy (CSM).

Material and Methods

A total of 45 patients with CSM (29 males and 16 females; mean age, 54.2 year) treated by laminectomy with or without posterior fixation were included. Cases were followed up for an average of 26 months. The modified Japanese Orthopedic Association (mJOA) score for CSM to evaluate the severity of myelopathy, the prevalence was assessed by the presence or absence of a full mJOA score for each function. The persistence rate (%) of each function impairment is (postoperative prevalence/preoperative prevalence × 100) was also assessed postoperatively.

Results

The preoperative motor function impairment prevalence was 74.2% in the upper extremities and 78.4% in the lower extremities, whereas the sensory function impairment was 58.2%. The preoperative prevalence of urinary bladder function impairment was 41.2%. The persistence rate of motor function impairment was 51.2% in the upper extremities and 73.5% in the lower extremities, whereas that of sensory function impairment was 74.2%. The urinary bladder function impairment persistence rate was 48.2%.

Conclusion

The preoperative prevalence of motor function impairment in the upper and lower extremities is higher than that of other function impairments, and impairments in lower extremity motor function and sensory function often persist after surgery.
Outpatient Cervical and Lumbar Spine Surgery is Feasible and Safe
Authors: Helseth Øystein , Lied Bjarne , Helseth Eirik
Published: May 2015

Introduction

There is an increasing demand for surgery of the degenerative spine. Limited health care resources draw attention to the need for cost-effective treatments. Outpatient surgery, when safe and feasible, is more cost-effective than inpatient surgery. The aim of this study is to study types and rates of complications following outpatient lumbar and cervical spinal decompressions.

Material and Methods

Complications were recorded prospectively in 1449; 1073 lumbar, 376 cervical; outpatients undergoing microsurgical decompression for degenerative spinal disease, at the private Oslofjord Clinic, in the time period 2008 to 2013.

Results

Surgical mortality was 0%. A total of 49 (3.4%) minor and major complications were recorded in 49 individual patients. Three (0.2%) patients had to be admitted to a hospital the day of surgery. Twenty-two (1.5%) patients were admitted to a hospital within 3 months due to surgery-related events. The encountered complications were postoperative hematoma (0.6%), neurological deterioration (0.3%), deep wound infection (0.8%), dural lesion with CSF-leakage (1.0%), persistent dysphagia (0.1%), persistent hoarseness (0.1%), and severe pain/headache (0.4%). All of the life-threatening hematomas were detected within 6 and 3 hours after cervical and lumbar surgery, respectively.

Conclusion

This series of 1,449 consecutive outpatient microsurgical spinal decompressions adds to the growing literature in favor of outpatient spinal surgery, in properly selected patients. Approximately 99% of the patients were successfully discharged either to their homes or to a hotel on the day of surgery. The surgical mortality was 0%, the overall complication rate was 3.4, and only 1.5% had to be admitted to a hospital within 3 months after surgery.
Development of a Classification System (OF-Classification) and a Score for Therapeutic Decision-Making (OF-Score) for Osteoporotic Thoracolumbar Fractures
Authors: Schnake Klaus John , Hahn Patrick , Franck Alexander , Blattert Thomas , Zimmermann Volker , Ullrich Bernhard , Gonschorek Oliver , Müller Michael , Katscher Sebastian , Hartmann Frank
Published: May 2015

Introduction

The prevalence of osteoporotic fractures is continuously on the rise. The adequate treatment of the predominantly geriatric patients is quite challenging. Osteoporosis can either be the cause of thoracolumbar fractures (nontraumatic fracture) or act as a contributing factor in traumatic fractures. No commonly accepted classification for osteoporotic fractures currently exists. The goal of the “osteoporotic fracture” working group was to develop a classification system and a score to aid therapeutic decision-making process for patients with osteoporotic thoracolumbar fractures.

Material and Methods

The development of both the classification and the score followed an established methodological pathway. Extensive literature research followed by in-depth discussions in nine consecutive sessions of expert meetings resulted in the proposed classification and scoring system. Between the sessions the classification and the score were applied by the group members in daily practice. The radiological and clinical data of 707 consecutive patients were subsequently collected in 16 clinics and evaluated. Interobserver reliability was calculated after evaluation of 146 fractures by 6 raters.

Results

The OF-classification consists of five subgroups: OF 1—no deformation (edema in MRI STIR-sequence); OF 2—deformation without or with only minor involvement of the posterior wall (< 1/5); OF 3—deformation with distinct involvement of the posterior wall (> 1/5); OF 4—loss of vertebral frame structure, vertebral body collapse, or pincer type fracture; OF 5—injuries with distraction or rotation. Interobserver reliability showed substantial agreement (Kappa 0.63). The OF-score contains the following parameters: fracture morphology (OF-classification), bone mineral density, potential sintering of the fracture, pain, neurological deficit, potential mobilization, and general health status of the patient (ASA grading), respectively. According to the OF-score, 29% of patients should have received conservative treatment and 49% surgical treatment, respectively. The final choice of treatment in the participating clinics correlated in 85% of cases with the OF-score.

Conclusion

The OF-classification consists of five subgroups and shows substantial interobserver reliability. In comparison to other classifications, the OF-classification is easy to use and provides a superior differentiation of the typical osteoporotic fracture morphologies. The OF-score takes the clinical status of the predominantly geriatric patients into account to aid the decision-making process in adequate therapeutic strategies. The generated treatment recommendations reflect the actual treatment strategies of specialized clinical centers.
Imaging Detection of Adjacent Ligamentous Injury Associated with Traumatic Cervical Spine Fractures: Implications for Treatment
Authors: Awad Basem I. , Carmody Margaret , Lubelski Daniel , Claridge Jeffry , Como John , Mroz Thomas E. , Moore Timothy , Steinmetz Michael P.
Published: May 2015

Introduction

Magnetic resonance imaging (MRI) is a vital tool for detection of instability and soft tissue trauma following cervical spine injuries (CSIs). However, high cost, prolonged imaging time, and limited use in hemodynamically unstable patients necessitates that the utility of MRI on all CSI patients be scrutinized.

Methods

A retrospective review was performed of all patients treated for a CSI at a level I trauma center between 2005 and 2010. Patients were identified using CT imaging and a subgroup underwent MRI. Adjacent level ligamentous injury (ALLI) was defined as supraspinous and interspinous ligaments and classified concerning the fracture level. We identified correlations between fracture type, level, and treatment strategy to develop guidelines for necessary MRI use.

Results

MRI was performed on 240/787 patients. Evidence of soft tissue injury was identified in 54.6% of these patients. ALLI was the most common soft tissue injury occurring in 80/240 of cases, which were then subdivided to either above (31/80), below (31/80) or both above and below (18/80) the concurrent fracture level. Patients with ALLI were significantly more likely to have injured C3 ( p < 0.01) and C5 ( p < 0.03), and present in association with widened disc space (13 vs. 4%, p = 0.03) and multiple CSI (1.7 vs. 1.5, p = 0.008). None of the patients who presented with ALLI above and below, and underwent surgical fixation, had the whole ALLI levels included in the fixation strategy. Contrary, 100 and 87% of patients with ALLI only above and only below, respectively, had the whole ALLI included.

Conclusions

MRI found an associated soft tissue injury in only 50% of imaged patients. Multiple fractured cervical levels, fractures particularly at C3 and C5, and widened disc space should all raise the treating physician's level of suspicion for ALLI. Our data shows MRI-directed treatment has substantial value in a select group of patients.
Avoiding Infertility after Spinal Cord Injury by Hyperbaric Oxygenation Therapy
Authors: Falavigna Asdrubal , da Silva Pedro Guarise , Conzatti Lucas Piccoli , Coberlini Louise , Cardoso Scheila , Peletti-Figueró Manuela , Paschoalotto Fabio
Published: May 2015

Introduction

After a primary mechanical injury in the spinal cord, a cascade of inflammatory events is triggered leading to the degeneration and death of potentially viable neuronal tissue. Besides motor loss, the injured patients suffer from erectile and ejaculatory dysfunctions, and spermatogenesis deficiencies. The objective is to study the efficacy of hyperbaric therapy in the acute phase in rats with spinal cord injury (SCI) to recover spermatogenesis.

Materials and Methods

Experimental study approved by the ethics and research committee. Eighteen rats were submitted to T9 spinal cord trauma by a 25 g weight drop using the MASCIS Impactor. They were allocated randomly to the hyperbaric therapy (HBT) and control group. The rats submitted to HBT had 1 hour sessions daily at 2 atmospheres of oxygen for 7 days. Previous works by the authors of this study support the HBT protocol chosen. The control group had supportive treatment. Testicular biopsies were performed by median abdominal incision in all rats on the 1st and 28th day of study. The samples obtained were soaked in hypoosmotic solution to evaluate the concentration of sperm per mL, number of round cells per field, number of infectious cells per field (peroxidase-Endtz test), and sperm viability (HOS test). The data were analyzed using SPSS software v.20, described by mean and standard deviation, and compared using the Student t-test or Mann–Whitney U-test according to the parametricity of the variable. A p-value of < 0.05 was considered significant.

Results

The mean concentration of sperm per mL did not change in the HBT ( p = 0.41) and control groups ( p = 0.74) over the 28 days of the study. The number of round cells and inflammatory cells per field was significantly greater in both groups on the 28th day. Sperm viability from day 1 to day 28 diminished two times more in the control ( p = 0.001) than in the HBT group ( p = 0.017) and sperm viability was significantly greater on day 28 in the HBT group as compared with the control group (86.67 ± 5.59% vs. 48.75 ± 21.83%) ( p < 0.001). The other variables analyzed did not present a statistically significant difference between the groups.

Conclusion

The SCI promote spermatogenesis deficiencies that can be partially recovered by the HBT performed in the acute phase of SCI. Sperm viability was two times greater in the HBT group when compared with the control group 28 days after the injury.
Cerebrospinal Fluid Phosphorylated Neurofilament Subunit NF-H (pNF-H) is a Specific Biomarker and Its Pattern is Predictive for Spinal Cord Injury
Authors: Iencean Stefan Mircea , Iencean Andrei Stefan
Published: May 2015

Introduction

In this study, we measured the phosphorylated neurofilament subunit NF-H (pNF-H) in the cerebrospinal fluid (CSF) of patients with spinal cord injury (SCI) and we set the correlation between the pNF-H levels and the severity of the injury.

Patients and Methods

The study included 20 patients with acute traumatic SCI: 12 patients with complete SCI and 8 patients with incomplete SCI. All patients were classified according to the American Spinal Injury Association Impairment Scale and all patients underwent surgery during the first 24 hours (decompression, stabilization). We measured daily the heavy phosphorylated neurofilament subunit (pNF-H) concentration by sandwich ELISA test in CSF of all patients and we correlated the values of pNF-H with the clinical evolution.

Results

For all patients with SCI, pNF-H was detectable in CSF samples and the values were different in the cases of complete SCI compared with the cases of incomplete SCI and the cerebrospinal pNF-H level was more elevated in cases of complete SCI. The level of CSF pNF-H was 10 to 100 times higher in complete SCI than in incomplete SCI, where the level was close to normal. The patients with a favorable neurological evolution after treatment had a specific pattern of daily values of NFP-H: a sudden increase up to a maximum value then a progressive decrease until normal. The maximum values were different in each case, from 10 times up to 200 times higher than the normal.

Conclusions

The phosphorylated form of the high molecular weight neurofilament subunit NF-H (pNF-H) in CSF is a specific biomarker for SCI and it can distinguish the severity of SCI. pNF-H is a predictive biomarker because its value pattern can show the reducing or stopping of the secondary lesion and the favorable result.
Clinical Outcomes of Sacral Chordoma Surgeries
Authors: Li Yan Michael , Rhines Laurence
Published: May 2015

Introduction

Chordoma is the most frequent primary spine tumor, with majority involved in the sacrococcygeal region. Because chordoma is rare, slowly growing, and locally aggressive, it is difficult to evaluate the effectiveness of treatment protocols and prediction of outcome. En bloc resection of primary sacral tumors is the primary modality. Rates of local recurrence and survival were dependent on negative surgical margins.

Methods

To assess our series of 36 sacral chordoma surgeries, emphasizing overall surgical and oncologic outcomes. Patients underwent sacral resections for chordoma at our institution between 1995 and 2011. Medical records of all patients were reviewed, including 36 patients who underwent primary en bloc sacral resections, either total and high sacrectomies by a combined anterior and posterior approach, or posterior-only en bloc midsacral resection.

Results

Sacral amputation was defined by the level: L5 (9 cases, 26%), S1 (8 cases, 23%), S2 (13 cases, 27%), and S3 (5 cases, 14%). Extent of resection was en bloc in 34 cases and intralesional in 2 cases. Flap reconstruction was performed in 29 cases (85%), with gluteal in 20 cases (69%) and VRAM in 9 cases (31%). All patients were followed-up 87 ± 54 months (range: 22–215 months) after surgery. Twenty-two patients have disease-free survival till date. Fourteen of the 34 patients who underwent en bloc resection had recurrence: 7 patients died 70 months after surgery and the other 7 survived 114 months after surgery. Among them, 5 cases had local sacral and iliac recurrence, while 10 cases had distal metastasis, such as liver, lung, and muscular skeleton.

Conclusion

En bloc sacral resections/reconstructions in patients with chordoma increase survival and decrease tumor recurrence.
Prognostic Variables for Local Recurrence and Overall Survival after Surgical Treatment of Sacral Chordoma: An Analysis from AOSpine Tumor Knowledge Forum Primary Spinal Tumor Retrospective Database
Authors: Varga Peter , Szövérfi Zsolt , Lazáry Aron , Gokaslan Ziya , Fisher Charles , Boriani Stefano , Dekutoski Mark , Chou Dean , Quraishi Nasir , Fehlings Michael , Rhines Laurence
Published: May 2015

Introduction

Sacral chordomas are rare, locally invasive, malignant neoplasms. Although, their surgical and oncological therapy has changed significantly over the last few decades, the prognosis is still poor. The objective of this study was to identify factors that have an impact on the overall and local recurrence-free survival of patients with sacral chordoma.

Materials and Methods

Utilizing the AOSpine Knowledge Forum Tumor multicenter ambispective database, surgically treated sacral chordoma cases were identified. Kaplan–Meier, log-rank test, and Cox regression modeling were used to assess the effect of several pre-, peri-, and postoperative variables on overall survival and local recurrence-free survival.

Results

A total of 167 patients with surgically treated sacral chordoma were identified. The male/female ratio was 98:69 with a mean age of 57 years (SD = 15) at the time of surgery (18–89 years). The local recurrence occurred in 35% ( n = 57) and death occurred in 30% of the patients ( n = 50) during the study period (5 days–16.2 years). The median overall survival was 6 years postsurgery and local recurrence-free survival was 4 years. In the univariate analysis, age ( p < 0.001) and preoperative motor deficit ( p = 0.003) were significantly associated with poor overall survival, and nerve root sacrifice showed a trend toward significance ( p = 0.088). Previous tumor surgery at the same site ( p = 0.002), intralesional resection ( p < 0.001), and tumor volume ( p = 0.030) were significantly associated with local recurrence. In the multivariate models, age and motor deficit were associated with poor survival, while previous surgery and intralesional resection were significantly related to local recurrence.

Conclusion

This study identifies two predictive variables for mortality (age and impaired motor function) and two for local recurrence (previous tumor surgery and intralesional surgery) in surgically treated sacral chordoma.
Outcomes following Surgical Intervention for Impending and Gross Instability (SINS criteria) Caused by Multiple Myeloma in the Spinal Column
Authors: Goodwin C. Rory , Sciubba Daniel , Sarabia-Estrada Rachel , Petteys Rory , Zadnik Patricia , Karami Kristophe , Mehta Ankit , Amin Anubhav , Groves Mari , Wolinsky Jean-Paul , Witham Timothy , Bydon Ali , Gokaslan Ziya
Published: May 2015

Introduction

Multiple myeloma is the most common primary tumor of the spine. Spinal multiple myeloma is classically a radiosensitive lesion; however, clinical or radiographic signs of instability merit surgical intervention. The authors present the epidemiology, surgical indications, and outcome data of the largest single series of 31 consecutive surgically treated patients with diagnoses of multiple myeloma and plasmacytoma of the spine.

Methods

The Spinal Instability Neoplastic Score (SINS) was utilized to make an assessment of surgical instability as the criteria for operative intervention. Patients were analyzed using lesion location, Frankel score, adjuvant therapy, outcome, and survival.

Results

All patients undergoing surgical intervention had either indeterminate or gross spinal column instability according to SINS criteria. Median survival was 78.9 months. No significant difference in survival was seen for patients with higher SINS scores or for older patients (> 55 years). There was a statistically significant difference in survival benefit observed in patients receiving chemotherapy and radiation versus radiation alone as an adjuvant to surgery ( p = 0.02).

Conclusion

The report demonstrates outcomes for patients with indeterminate stability and gross spinal instability because of multiple myeloma and plasmacytoma of the spine who underwent surgical intervention with improved neurological function following surgery and low rates of instrumentation failure.
Validation of the Spinal Instability Neoplastic Score: A Retrospective Analysis
Authors: Versteeg Anne , Fisher Charles , Oner Cumhur , Verlaan Jorrit-Jan
Published: May 2015

Introduction

With improved survival rates of cancer patients, the incidence of spinal metastases is increasing. Spinal metastases increase the risk for pathological fractures that subsequently increase the risk of spinal instability, spinal cord compression, and neurological compromise. The Spinal Instability Neoplastic Score (SINS) was developed by the Spinal Oncology Study Group (SOSG) to assess neoplastic-related spinal instability and to provide a tool to guide referrals between the appropriate oncology specialists. Considering the multidisciplinary aspect of care of metastatic cancer patients, reliability of the SINS was tested among radiation oncologists and radiologists. Yet, validation of the SINS score has only been done using selected cases by the developers of the SINS. Therefore, the purpose of this study was to retrospectively validate the SINS in the clinical setting.

Methods

A retrospective database review of patients who underwent palliative surgery or radiotherapy only for the treatment of painful spinal metastases has been conducted. All patients were ambulatory (ASIA E and D) and the two cohorts were matched at the time of follow-up to eliminate neurological compromise and prognosis as indications or exclusion for surgical intervention. Demographics and oncology data were extracted from the hospital charts. The SINS score was calculated based on pretreatment imaging.

Results

A total of 124 patients were included for analysis. Patients in the surgical cohort were significantly younger and presented more often with a combination of back and radicular pain. The median SINS score in the surgical cohort was 11 (range 7–16) and differed significantly (< 0.001) from the median SINS score of 7 (range 2–16) in the radiation therapy cohort. Sensitivity–specificity analysis showed an optimal cut-off point of a SINS score of 9 for surgical consultation with a sensitivity of 84% and a specificity of 72.6%. The set cut-off value of 7 of the SOSG demonstrated a sensitivity of 96% and a specificity of 41.9% in this analysis.

Conclusion

In retrospect, a high SINS score corresponded with the indication for surgical intervention for the treatment of neoplastic-related spinal instability.
Image-Guided Cervical Pedicle Screw Fixation: Implant Precision and Complications in 67 Consecutive Patients
Authors: Duff John Michael , Henchoz Yves , Levivier Marc , Bobinski Lukas
Published: May 2015

Introduction

Cervical pedicle screws (CPS) are an alternative technique to lateral mass fixation. We present our experience of 67 patients who underwent image-guided CPS instrumentation, either exclusively or as part of a construct. Implant precision, as measured by the orthogonal view evaluation method (OVEM), and complications are reported in all patients.

Materials and Methods

Retrospective chart review of a single institution experience of 67 consecutive patients, with 356 screws placed ( Table 1 ), including 232 subaxial pedicle screws. Implant precision was measured using OVEM (unpublished data). This allows multiple orthogonal views along the long axis of the screw through the bone target on CT multiplanar images. Grade I: no bone breach, GrIa: screw thread breach, GrII: internal screw diameter breach, and GrIII: neurovascular injury. Complications including those related to implant placement are presented in Table 2 .

Results

There were two implant-related complications. One, when a lateral mass screw was pulled out and replaced with a CPS. The other was because of a post CPS placement radiculopathy, which resolved on screw revision. There were three postoperative wound infections (4.5%) and five patients with postoperative pneumonia (7.5%). [Table: see text][Table: see text]

Conclusion

CPS is an alternative screw implantation technique which appears to be safe and effective with two screw revisions necessary (3% patients), with no neurovascular injury. There was a 23% navigational “failure” using OVEM criteria (GrII), which may be attributed to strict precision criteria. CPS may be useful when high biomechanical loads are anticipated, where there is poor bone quality or a pedicle fracture.
Spinal Navigation in Minimally Invasive Spinal Fixation Surgery: A Retrospective Study of Our 4-Year Experience
Authors: Nicassio Nicola , Trivedi Rikin , Patel Krunal
Published: May 2015

Introduction

Spinal navigation is considered a useful adjunct in minimally invasive spine surgery. Numerous reports suggesting lower radiation exposure have been described, but there have been concerns around increased operative times that navigation may attract.

Materials and Methods

Radiation exposure and surgical times were analyzed in all minimally invasive instrumented spine surgery cases performed between January 2010 and March 2014. A total of 141 cases were identified (degenerative, tumor, and trauma). These were divided into two groups: those performed with fluoroscopy guidance and those performed using intraoperative spinal navigation. These two groups were compared for cumulative radiation dose and operative times.

Results

Mann–Whitney nonparametric tests demonstrated a statistically significant lower radiation exposure in the navigated cases compared with the fluoroscopy cases (233.26 vs. 710.12 cGy/cm2; p < 0.05) without any significant difference in operative times (195 vs. 206 minutes; p = 0.52).

Conclusion

Evolving technologies are increasing our ability to improve spinal fixation. Our experience indicates that spinal navigation, in particular in longer spinal stabilization procedures, can be a powerful tool to reduce radiation exposure to both the patient and operating room personnel.
Combination of Elective Preoperative Vertebral Artery Stenting with O-Arm-Assisted Navigation in Cervical Spine Tumor Excision
Authors: Alfawareh Mohammad , Alotaibi Dawi
Published: May 2015

Introduction

The cervical spine is considered the most mobile segment of the spine, most of the movement occurs at the upper cervical. In addition to the flexion–extension movement, a rotational movement is added because of the orientation of lateral masses of C1 and C2 and the unique ligamentous structures which play an integral role in stabilization of the upper cervical spines. In general, primary spinal tumor is not as common as metastatic secondary tumors; the reported incidence is less than 10% of all spinal tumors. The management of cervical spine bony tumors is challenging and different from the rest of the spine, not only the rarity to be affected compared with other spines but also the anatomical regional difficulties that come with it, in addition to the challenge in approach, the proximity to the vertebral artery, and the spinal cord. The mainstay treatment of primary cervical spine tumor is surgical resection, although there have been reports of minimal invasive management with embolization. Vertebral artery injury is a rare complication of cervical spine tumor excision and the sequel of vertebral artery injury varies from arterio-venous fistula, pseudo aneurysm, thrombosis with embolic stroke, or even death.

Purpose

The purpose of this study is to report our new technique for the management of the cervical spine tumors by combining vertebral artery elective preoperative stenting with O-arm navigation-assisted tumor excision.

Materials and Methods

For the retrospective analysis of our patient's data for cervical spine tumors, between January 2010 and December 2013, inclusion criteria were: patients with primary cervical spine tumors underwent elective preoperative VA stenting, excision done under O-arm navigation with sufficient follow-up. Exclusion criteria were patients with secondary tumors, patients lost to follow-up, and if surgery was done without navigation.

Results

A total of 15 patients met our inclusion criteria, 5 were excluded: 2 lost to follow-up, in 1 stenting was not done, and the other 3 were done without navigation. Mean age was 16.4 years, average follow-up period was 16 months, 7 females and 6 males, neck pain was a presenting symptom in 8, neck swelling in 1, and one incidental finding in routine check-up. Diagnosis was aneurysmal bone cyst in 7, osteoblastoma in 2, and giant cell tumor in 1. The level was C2 in 5, C3 in 3, C4 in 1, and C6 in 1. Our results are of 10 case series with different primary bone tumors that were successfully managed by a combination of both techniques.

Conclusions

Combining both techniques provides successful tumor excision, with several advantages: keeping the patency of the VA, possibility of VA hand feeling during the procedure, and possibility of visualizing the VA at the time of surgery under O-arm navigation.