bluuebunny/crossref_metadata_2025 huggingface dataset:
Pedicular Screw Placement Accuracy with O-Arm Based Navigation in Patients with Scoliosis
Authors: Urbanski Wiktor , Jurasz Wojciech , Wolanczyk Michal , Dragan Szymon
Published: April 2016

Introduction

Application of transpedicular screws to obtain posterior spinal fusion in thoraco-lumbar spine has become standard in spinal surgery. However technique of screws insertion is demanding and not free of complications. Positioning is particularly challenging in pediatric patients with spinal deformity. Navigation systems based on intraoperatively obtained 3D image seem to be very promising solution to prevent or at least minimize screw misplacements. Although still lack of data confirming superiority of navigation above other techniques. The study was designed to assess the accuracy of transpedicular screws placement with O-arm and navigation in patients who underwent surgery for idiopathic scoliosis.

Material and Methods

451 screws in 27 patients were evaluated. All the screws were positioned by two surgeons (WU, WJ) with aid of navigation (Stealth Station, Medtronic) based on 3D image obtained during surgery (O-ARM, Medtronic). The accuracy was described separately for each screw based on postoperatively obtained CT scans. The assessment was made according to widely accepted grading system: grade 0 – no pedicle wall violation, grade 1 =< 2 mm perforation, grade 2 – wall perforation with half of the diameter of the screw outside of the pedicle (=< 4 mm), grade 3 complete perforation of the pedicle (>5 mm). The comparison of accuracy was made between adults (13 patients) and adolescents (14 patients).

Results

In the study authors reported overall accuracy of 96% correctly positioned pedicle screws (83% grade 0 and 13% grade 1). No grade 3 screws were reported. Statistical analysis confirmed decreased accuracy in upper thoracic level (82% of grade 0 and 1). No statistically significant differences in implant accuracy were observed between adults (96.2% of grade 0 and 1) and adolescents (95.3% of grade 0 and 1).

Conclusion

The application of navigation system is a safe method of pedicle screws introduction either in adults or adolescents. However the technique does not eliminate misplacement. Significant misplacement rate is still observed in upper thoracic spine.
Study of Functional Outcome of Anterior Cervical Decompression and Fusion Using Tricortical Iliac Bone Graft for Degenerative Cervical Spondylotic Myelopathy with Modified Japanese Orthopedic Association Score
Authors: Sharma Ayush , Singh Vijay
Published: April 2016

Objective

To determine functional outcome of anterior cervical decompression and fusion using tricortical iliac bone graft (ACDF) for degenerative cervical spondylotic myelopathy with modified Japanese orthopedic association score (MJOA).

Materials and Methods

60 diagnosed cases of one and two levels cervical myelopathy were prospectively analyzed preoperatively and at 3 months, 6 months, 1 year using MJOA.

Results

46 patients underwent Single level ACDF with C5-C6 the commonest level to be affected. The correlation between Duration of Symptoms to Preoperative and postoperative MJOA was statistically significant. We noted statistically significant improvement in symptoms of axial neck pain, radicular arm pain, clumsy hand, and gait disturbances post operatively at one year. Statically significant difference was noted while comparison MJOA of Pre-operative to 6 months and 1 year, and 3 months to 6 months and 1 year. Statistically significant difference in blood loss and anesthesia time for one level fusion compared with two level fusions was also noted. The fusion rate for single level ACDF was 95.65% compared 71.42% for two levels.

Conclusion

Functional outcomes in operated patients at 1-year follow up are better if ACDF surgery is done early. Symptoms of axial neck pain; radicular arm pain, clumsy hand and gait disturbances show significant improvement at one year follow up. While bladder and bowel involvement showed the least recovery. Significant improvement in function occurs postoperatively between 3 and 6 months, and then it plateaus from 6 months to 1 year. Fusion rates for single level ACDF are better than two levels ACDF.
Transpedicular Wedge Opening (TWO) Osteotomy for Post-Traumatic Kyphosis (PTK): Own Technique and Preliminary Results
Authors: El-Meshtawy Mohamed
Published: April 2016

Introduction

Management for symptomatic post-traumatic kyphosis always has presented a challenge to orthopedic surgeons. The management for post-traumatic kyphosis remains controversial: Anterior, posterior, or combined anterior and posterior procedures have been advocated by different authors and show various degrees of success. All of these techniques end in abnormal morphology of the affected vertebra, so in this technique we try to restore the normal sagittal balance by restoring the normal morphology of the affected vertebra (natural kyphoplasty).

Material and Methods

Between May 2010 and Jun 2014 30 patients with symptomatic kyphotic deformity were treated with TWO osteotomy. Twenty-two are males and eight are females. The mean age of patients was 37 years (range 18- 62 years). All patients had history of old trauma with time lag till surgerical interferance was 10 months in average (3m- 12y.). They underwent TWO osteotomy of the wedged VB bisegmental TPSF through posterior-alone approach The clinical evaluation throughout the study entailed visual analogue scale (VAS) and Oswestry disability index. The local kyphotic angel (LKA), sagittal balance (SB) and sagittal index (SI) were measured preoperatively, postoperatively and during the follow up visits. Radiographic bony healing of the v-shaped VB defect which left after the TWO osteotomy is confirmed by MSCT.

Results

The mean follow up period was 26.5 months (range12- 48 m.). TWO osteotomy was done for wedged VB between D10 and L2. The mean operative time was 110 minutes (range 70- 180 minute.) and the mean intraoperative blood loss was 625 cc (range 400- 1700 cc). The mean preoperative LKA was 28.7° (range 20- 56°) that had been improved to -2° (range 8°- (−10°)) postoperatively. Lordotic correction of 30.8° (range 22–48°) was achieved with minimum loss of correction (range 0- 8°) through the period of follow up. The mean period required for radiographic bony healing of the osteotomy was 7 months (range 3–15m.). The VAS &ODI had been improved significantly (p.005) in comparison to preoperative values. Excellent clinical and radiographic outcomes were achieved in 92% of cases with no major complications.

Conclusion

Spontaneous bony healing after TWO of wedged VB occurs without doubt. This study evoked the concept of “Natural Kyphoplasty” for treatment of certain cases of PTK. Although it is a newly described technique, it was proved to be safe and effective method for treatment of symptomatic thoracolumbar PTK.
Interbody Fusion in Low Grade Lumbar Spondylolsithesis: Clinical Outcome Do Not Correalte with Slip Reduction and Neural Foraminal Dimension
Authors: Debnath Ujjwal K. , McConnell Jeffrey R. , Goel Vivek
Published: April 2016

Introduction

There is no consensus in literature whether a beneficial effect of reduction on outcome can be expected following reduction and surgical fusion for low grade lumbar spondylolisthesis. This prospective study was designed to find a possible correlation between the clinical outcome and extent of lumbar spondylolisthesis reduction.

Material and Methods

52 patients (age 17–48 years) with isthmic spondylolisthesis underwent interbody fusion with cages with posterior instrumentation (TLIF or PLIF). Clinical outcome was measured using Visual Analogue Scores (VAS) and Oswestry Disability Index (ODI). Foraminal dimensions and disc heights were measured in standard digital radiographs. These were analyzed at baseline and at 1 year after surgery and changes were compared. Radiographic fusion judged with CT scans at 1 year.

Results

90 percent of the patients in the study had good or very good clinical results with fusion and instrumentation. The baseline and at one year postoperative, the mean VAS scores were 6.39 (range 5–8) and 0.81 (range 0–3) respectively ( p = 0.004). The baseline and at one year postoperative, the mean ODI scores were 48 (range 34–58) and 9.8 (range 4–22) respectively ( p < 0.001). A mean spondylolisthesis slip of 33.2% was reduced to 6.7% at 1 year. Average anterior disc height, posterior disc height, C distance, F diameter improved from 9.4mm to 11.7mm ( p = 0.005),from 4.3mm to 5.8mm( p = 0.004),from11.2mm to 12.0mm( p = 0.002), from 18.5mm to 19.4mm respectively( p < 0.001). The fusion rate was 66% with PLIF and 75% with TLIF. There is no significant correlation between the improvements of ODI scores and the extent of slip reduction.

Conclusion

Neural decompression and interbody fusion significantly improved pain and disability but the clinical outcome does not correlate with radiological improvement in neural foraminal dimension.
Comparison of NPY Y1 Receptors in the Spines of Ovariectomized and Ovary Intact Rats
Authors: McGuire Robert , Tucci Michelle , Benghuzzi Hamed
Published: April 2016

Introduction

Neuropeptide Y (NPY) is a 36-amino acid neuropeptide that acts as a neurotransmitter in the brain and in the autonomic nervous system of humans. In the autonomic system it is produced mainly by neurons of the sympathetic nervous system and serves as a strong vasoconstrictor. Recently, NPY has been shown to increase during stress and in patients with chronic back pain. NPY has the potential to innervate 5 subtypes of receptors Y1-Y5. The Y1 receptor has been shown to play a role in cell survival and contribute to pain hypersensitivity. In addition, Y1 receptors are also thought to contribute to bone loss leading to disc degeneration in osteoporosis. The goal of our study was identify the location of the Y1 receptor in the disc of osteoporotic animals and to compare those to ovary intact control.

Methods

Eight OVX animals and eight ovary intact control animals were followed weekly for 8 weeks. Four animals in each group were sacrificed at 4 and 8 weeks and blood and spines were harvested. Spines were decalcified and processed for histological analysis. Routine hematoxylin and eosin staining along with immunhistochemical analysis of the spine Y1 receptors.

Results

The results showed the intervertebral discs in the control group appeared normal. The nucleus pulposus contained abundant notochordal cells, surrounded by large zones of extracellular matrix, and the cartilage endplates were hyaline cartilage composed of chondrocytes. In the OVX animals, the discs showed degenerative changes, where the nucleus pulposus appeared reduced in size and comprised relatively few, chondrocyte-like cells. Mucoid degeneration could also be seen. An increased number of small chondrocytes appeared in the inner layer of the annulus. Bony tissues that contained bone marrow, hematopoietic lineage cells and mineralized bone, became more obvious in the deep zone of middle cartilage endplate. Immunohistochemical analysis for Y1 receptors showed positive staining in the outer annulus in the control with defined staining of chondrocyte cells. Y1 receptor staining was diminished in the OVX animals. Higher levels of circulating NPY was found in the plasma of OVX animals and may contribute to internalization of the Y1 receptor as a compensatory mechanism.

Conclusions

Y1 receptors are located in the outer portion of the annulus of rats. The portion of cellular staining differed between the OVX and intact ovary control animals. More experiments are needed to clarify the role of NPY in the normal and osteoporotic spine.
Reoperation Rates following Single-Level Discectomy
Authors: Heindel Patrick , Tuchman Alexader , Hsieh Patrick , Pham Martin , Patel Neil , Jakoi Andre , Liu John , Buser Zorica , Wang Jeffrey C.
Published: April 2016

Introduction

Lumbar discectomy is the most commonly performed procedure for treatment of radiculopathy due to lumbar disc herniation. Randomized trials have demonstrated the advantage of surgical removal of herniated disc material over non-surgical treatment options, allowing for a more rapid reduction in symptoms and return of function. Many small-size studies suggest that long-term outcomes for patients treated with discectomy and non-operative management are similar. Additionally, treatment of recurrent lumbar disc herniation is not standardized. Population-level data regarding reoperation following single level hemilaminotomy and discectomy is limited.

Material and Methods

Data was collected and analyzed for 13,654 patients undergoing single-level lumbar discectomy between January 2007 and December 2010 using the commercially available PearlDiver software (PearlDiver, Inc., Fort Wayne, IN, USA). The nationwide Humana private insurance database was queried for patients billed with the Current Procedural Terminology (CPT) code for our index procedure, hemilaminotomy and removal of disc material (CPT-63030). Patients receiving concurrent lumbar surgeries were excluded from the index group. The index group was then followed in retrospective cohorts for 3 months, 6 months, 1 year, 2 years, and 4 years for recurrent lumbar surgery, including spinal fusion, laminectomy, and additional discectomy.

Results

Patients received additional lumbar surgeries following single-level discectomy at a rate of 3.95% (539/13654) within 3 months and 12.2% (766/6274) within 4 years of the index procedure. Lumbar spinal fusion was performed on 5.90% (370/6274) of patients within 4 years, with interbody fusion in 75.4% (279/370) of cases and multi-level fusion in 47.0% (174/370) of cases. Reoperation for re-exploration discectomy at the same level as the index procedure with no subsequent surgeries occurred in 2.71% (170/6274) of patients followed out to 4 years. Patients who received a re-exploration discectomy at the same intervertebral level within 2 years of the index procedure went on to receive lumbar fusion at a rate of 38.4% (48/125) within the 4 years following the re-exploration discectomy.

Conclusion

Data in our study demonstrated a reoperation rate of 12.2% after single level discectomy, a routinely performed procedure for the treatment of symptomatic lumbar disk herniation. Moreover, we show that the rate of progression to lumbar fusion after a re-exploration discectomy was 38.4% within 4 years of reoperation. These data should help surgeons in their operative decision-making and counseling recommendations to patients. To our knowledge, this is the largest population study delineating reoperation rates across the US after single-level lumbar discectomy. Further studies are needed regarding the best treatment algorithm in patients with re-herniation or iatrogenic instability following lumbar discectomy.
Morphometric Measurement of the Lumbosacral Spine for Minimally-Invasive Cortical Bone Trajectory Implant Using Computed-Tomography
Authors: Zhang Hua
Published: April 2016

Introduction

The cortical bone trajectory (CBT) is a novel lumbar pedicle screw trajectory. There is a dearth of literature on CBT screw insertion techniques. The aim of this study was to conduct a detailed morphometric measurement of the lumbosacral spine for CBT pedicle screw starting point, trajectory, length and diameter, using the inferior facet of the cephalad level as a bony landmark.

Methods

The 3-dimensional reconstruction computed tomography (CT) scans of 86 adults who underwent examination of the lumbosacral spine were studied. The junction of the inferior and medial border of the smallest coronal section of the lumbar pedicle was traced in lumbar segments while the junction of the medial border of the sacral 1 (S1) pedicle and the inferior border of the L5 inferior facet was traced in S1 segments. The starting point was defined to be the projective point on the vertebral plate by this junction. The distances from the starting point to the inferior, lateral and medial border of the inferior facet of the cephalad level, and the inferior border of the transverse process were measured. The trajectory of pedicle screws for the lumbar and S1 segments was determined in the axial and sagittal planes. The angle formed between this trajectory and a line from the vertebral midline was defined as the transverse angle (TA). The angle formed between this trajectory and a line from superior margin of the vertebral body was defined as the cephalad angle 1 (CA1). Cephalad angle 2 (CA2) was defined as the angle formed between the same trajectory on the sagittal plane and a line from the posterior margin of the pars interarticularis. The maximum pedicle screw diameter, as well as the maximum pedicle screw length of the lumbosacral segments was measured on axial and sagittal CT scans, respectively.

Results

The distances from the inferior border of inferior facet to the starting point from L1 to S1 were 8.9, 6.3, 4.1, 2.9, 1.4 and 0 mm, respectively. The distances from the medial border of the inferior facet to the starting point from L1 to S1 were between 3 to 4mm. The percentages of the distance from the starting point to the medial border of the inferior facet from L1 to S1 were 80.5, 70.1, 61.6, 48.6, 40.8 and 29.3%, respectively. TA from L1 to S1 were 9.0, 9.6, 11.3, 13.5, 15.5, and 8.2 degrees, respectively. CA1/CA2 from L1 to S1 were 26.7/38.7, 26.0/38.7, 26.9/38.0, 24.4/37.2, 22.9/35.1 and 18.4/47.8 degrees, respectively. The maximum diameters of the trajectory from L1 to S1 were 4.8, 5.1, 6.1, 6.8, 7.8, and 6.1mm, respectively. Twenty-five mm was a safe border as the maximum length of the pedicle screw from L1 to S1.

Conclusions

The inferior facet of the cephalad level is an attractive bony landmark for establishing a starting point of CBT for minimally-invasive spine surgery.
Better Height Restoration and Kyphosis Correction of Osteoporotic Vertebral Compression Fractures Using Intravertebral Reduction Devices (SpineJack): One Year Follow Up
Authors: Lin Jiann-Her , Wang Sheng-Hao , Chiang Yung-Hsiao , Lin En Yuan
Published: April 2016

Background

Transpedicular cement augmentation has became a significant treatment for osteoporotic vertebral compression fractures with the evident effect of pain-relief. However, height restoration and kyphosis correction of the spinal column following transpedicular cement augmentation are not satisfying. SpineJack, one of intravertebral reduction devices, has been proved to has better height restoration and kyphosis correction in a cadaveric study. It also has been reported to has good outcomes for treating spine trauma. However, for treating osteoporotic vertebral compression in the elderly, the role of SpineJack is still unknown. This clinical study was conducted to compare the radiological and clinical outcomes between transpedicular cement augmentation with/without SpineJack for osteoporotic vertebral compression fracture in the elderly.

Materials and Methods

75 patients with osteoporotic vertebral compression were included and treated with transpedicular cement augmentation with/without SpineJack during Sep. 2013- May. 2015. The radiological outcomes, including the anterior, central, posterior body height, and kyphotic angle, were measured on flexion/extension lateral lumbar X-ray at the time points of pre-operatively, post-operatively 1 week, 3 month, 6 month, and 1 year. The clinical outcomes, including VAS for pain, SF-36, complications were recorded by reviewing the charts retrospectively. The incidences of adjacent and non-adjacent fracture in both groups were also recorded.

Results

36 patients was treated with SpineJack and 39 without SpineJack (Vertebroplasty group). The age, bone marrow density, body mass index, sex ratio, fracture level, the use of steroid and anti-osteoporosis medication were comparable in two groups (p > 0.05). The pre/post- VAS for pain, SF-36, or complication was similar in two groups(p > 0.05). The incidences of adjacent and non-adjacent fracture were also comparable in both group (p > 0.05). The restoration of anterior/middle body height and kyphotic angle in SpineJack group were significantly better than that in Vertebroplaty group at post-op 1 week, 3m, 6m, and one year (p > 0.05). The restorations maintained at least for 1 year in SpineJack group (p > 0.05), while the restorations in Vertebroplasty groups only maintained for 3 months.

Conclusion

Based on this study, height restoration and kyphosis correction were significantly better in the SpineJack group at least for one year for treating osteoporotic compression fractures in the elderly.
Minimally Invasive Spine Surgery for Intracanal Tumor Resection. Clinical Study and Surgical Results
Authors: Diaz Roberto , Berbeo Miguel , Quintero Tatiana
Published: April 2016

Introduction

Neuroimaging technology, micro-surgical instruments and minimally invasive techniques have allowed the development of new approaches that maintain favorable neurological outcome obtained by conventional techniques in resection of spinal neoplasm. Our work describes a new surgical technique for patients with spinal intra-canal neoplasms in order preserve muscle tension band posterior ligamentous and assessed the results.

Material and Methods

Our surgical technique proposes a para-median posterior minimally invasive approach from linear incision of 2.5 cm ipsilateral to the site of the lesion trough an expandable tubular retractor. Patients were followed prospectively with visits at one, three, six and twelve months after surgery. Surgical time, blood loss, intra-operative and post-operative complications, hospital length of stay, pre and post-operative neurological status were assessed.

Results

We describe the surgical treatment technique in twenty one patients diagnosed with spinal intra-canal compressive lesions, which underwent surgical resection between January 2010 and July 2015. The Meningioma was the most frequent neoplasm. The means surgical time was 148 minute. The average intraoperative bleeding was 217 ml. Patients experienced minimal postoperative pain and they were discharged in average 31 hours after surgery. There were no intraoperative complications; though two patients developed complications in the late postoperative period. A patient had cerebrospinal fluid leak and other patient developed myelopathy secondary to non-infectious arachnoiditis.

Conclusion

This type of approach technique provides adequate visualization and microsurgical resection of the intra-canal tumor lesions, with reduced muscle denervation and devascularization by preserving the tension of the ligament complex. These results correlate with previous studies of minimally invasive techniques for spinal neoplasms.
Perioperative Morbidity in Overweight or Obese Patients after Minimally Invasive Lumbar Spine Surgery
Authors: Diaz Roberto , Berbeo Miguel , Uribe Rafael
Published: April 2016

Introduction

Obesity is a known risk factor for many medical complications. Spinal surgery in overweight or obese patients poses specific challenges related to technical difficulties and risks of complications. Minimally invasive spinal (MIS) surgery has been developed with the purpose of decreasing post operative pain, operative blood loss and to promote early ambulation while offering the same outcomes of traditional open techniques. Nonetheless, there is a paucity of information as to whether these techniques are safe and their results reproducible in overweight or obese patients. We report perioperative outcomes in a retrospective cohort of overweight or obese patients after minimally invasive lumbar spine surgery.

Material and Methods

Retrospective chart analysis of patients treated with minimally invasive techniques for lumbar spinal pathology was performed, starting from January 2007 to December 2011. Fifty – seven patients with a body mass index (BMI) greater than or equal to 25 kg/m2 were included for analysis. 40 patients with a BMI lower than 25 kg/m2 were included for comparison. Multivariate logistic regression analysis was performed.

Results

Out of the 97 patients included in the study, 9 presented complications. These were distributed by BMI groups as follows: Two patients in the group below BMI 25 kg/m2; five patients in the group between 25 and 29.9 kg/m2, and two patients in the group above BMI 30. There were no reported mortality cases. After multivariate logistic regression analysis, none of the variables observed (BMI, age, gender, type of fusion) demonstrated a statistically significant increase in morbidity.

Conclusion

MIS surgery doesn't appear to have a higher risk of perioperative complications in overweight or obese patients with lumbar spine pathology.
Frailty and Postoperative Outcomes in Patients Undergoing Surgery for Degenerative Spine Disease
Authors: Charest-Morin Raphaële , Flexman Alana , Ryerson Chris , Stobart Liam , Street John
Published: April 2016

Introduction

Frailty is defined as a state of decreased reserve and susceptibility to stressors. The relationship between frailty and outcomes after degenerative spine surgery has not been studied.

Objectives

(1) Determine prevalence of frailty in the degenerative spine population; (2) Describe patient characteristics associated with frailty; (3) Determine the ability of frailty to predict postoperative outcomes.

Material and Methods

We analyzed 52,671 patients in the National Surgical Quality Improvement Program who underwent degenerative spine surgery. A modified frailty index (mFI) was used to determine the prevalence and severity of frailty as previously described. The association of frailty with postoperative outcomes was determined using multivariate logistic regression.

Results

Frailty was present in 2,041 patients within the total population (4%), and 8% of patients older than 65 years. Frailty severity increased with increasing age, male sex, African-American race, higher body mass index, recent weight loss, paraplegia or quadriplegia, ASA score, and pre-admission residence in a care facility. Frailty severity was an independent predictor of major complication (OR 1.15 for every 0.10 increase in mFI, 95%CI 1.09–1.22, p < 0.0005), and specifically predicted re-operation for post-surgical infection (OR 1.3, 95%CI 1.16–1.46, p < 0.0005). Prolonged length of stay and discharge to a new facility were also independently predicted by frailty severity ( p < 0.0005). Frailty severity predicted 30-day mortality on unadjusted (OR 2.05, 95%CI 1.69–2.47, p < 0.0005) and adjusted analysis (OR 1.44, 95%CI 1.15–1.81, p < 0.005).

Conclusions

Frailty is an important predictor of postoperative outcomes following degenerative spine surgery. Preoperative recognition of frailty may be useful for perioperative optimization, risk stratification and patient counseling.
Assessing Transverse Ligament Integrity Throught a New CT Based Alternative
Authors: Pérez-Orribo Luis , Brage Liberto , Kalb Samuel , Roldán-Delgado Héctor , Crawford Neil Robert , Newcomb Anna Sawa
Published: April 2016

Objectives

The Rule of Spence for assessing integrity of the transverse atlantal ligament (TAL) suffers from poor specificity and sensitivity, frequently incorrectly reflecting the condition of the TAL. Since CT scans are quickly and easily obtained in trauma centers, we propose using a special sequence of two CT scans for more accurate diagnosis of injury to the TAL. We sought to assess the sensitivity of the CT method for TAL injury diagnosis in a laboratory setting.

Materials and Methods

Ten human cadaveric specimens were mounted horizontally in a supine posture with wooden inserts attached to the back of the skull to maintain neutral or slightly flexed (10°) postures. Specimens were scanned in neutral and flexed postures in four conditions: intact ( N = 10), after simulated Jefferson fracture with TAL intact ( N = 5), after TAL disruption without fracture ( N = 5), and after TAL disruption with simulated fracture ( N = 10). Atlanto-dens interval (ADI) from sagittal slices of the CT image was measured to assess anteroposterior instability of C1-C2; cross-sectional canal area was measured to assess canal encroachment caused by the flexed posture.

Results

In going from neutral to slight flexion, ADI increased by 0.02 mm (2.5%) in intact spines, 0.08 mm (6.25%) after Jefferson fracture without TAL disruption, 0.4 mm (34%) after TAL disruption without fracture, and 0.42mm (25%) after TAL disruption with fracture (Fig. 1). ADI increases from neutral to flexed were not significant (p > 0.33, paired Student's t-test) in normal condition or with fracture.without TAL disruption. However, ADI increases were significant with TAL disruption or TAL disruption+fracture ( p < 0.035). Increases in canal area were < 0.8% and were not significant (p > 0.74).

Conclusions

This study explores the possibility of utilizing two CT scans to evaluate TAL integrity. The change in ADI between these two postures was very sensitive in distinguishing TAL injury from atlas fracture. The results of this study indicate that this method should be more sensitive than the Rule of Spence for evaluating TAL integrity. By the conclusion of this session, participants should be able to identify tranverse ligament injury with a new proposed CT based method.
Surgical Management of Spinal Osteoblastomas
Authors: Versteeg Anne , Boriani Stefano , Varga Péter Pál , Luzzatti Alessandro , Fehlings Michael , Bilsky Mark , Rhines Laurence , Reynolds Jeremy , Dekutoski Mark , Gokaslan Ziya , Germscheid Niccole , Dea Nicolas , Fisher Charles
Published: April 2016

Introduction

Primary spinal osteoblastomas are rare benign neoplasms which often behave more aggressively than other benign tumors and can present as malignant transformations. Optimal surgical treatment strategies and risk factors for local recurrence and mortality of spinal osteoblastomas remain unclear. The aim of this multicenter cohort study was to assess rates of local recurrence and mortality following surgical intervention for spinal osteoblastomas and to evaluate whether the application of the Enneking classification in the management of these tumors influences local recurrence and mortality.

Methods

The AOSpine Knowledge Forum Tumor developed a multicenter ambispective database of patients who underwent surgical intervention for spinal osteoblastoma. Patient demographic, diagnosis, treatment, cross-sectional survival, and local recurrence data were collected. Patients were analyzed in two cohorts based on the Enneking classification of the tumor: Enneking appropriate (EA) and Enneking inappropriate (EI). EA was defined by the final pathology margin matching the Enneking recommended surgical margin, if otherwise, it was defined as EI.

Results

Between November 1991 and June 2012, a total of 102 patients diagnosed with a spinal osteoblastoma were identified. Twenty-eight patients were omitted from the analysis due to insufficient follow-up (<12 months) or incomplete survival data, leaving 74 patients for final analysis. The mean follow-up was 4.3 ± 2.8 years in the EI and 4.5 ± 3.3 years in the EA group. Thirteen (18%) patients suffered a local recurrence and six (8%) patients died during the study period. Local recurrence was strongly associated with mortality with a relative risk of 9.4 ( p = 0.007). When adjusting for Enneking appropriateness, the result was not significantly altered. Significant differences were not found between the EA and EI groups for local recurrence and mortality.

Conclusion

Upon evaluating the largest multicenter cohort of spinal osteoblastomas to date, the application of the Enneking classification as treatment guide for spinal osteoblastomas could not be confirmed. Considering the consequences of a local recurrence and the strong association of local recurrence with mortality even after adjusting for Enneking appropriateness, en bloc or marginal resection is nevertheless the recommended surgical treatment strategy for spinal osteoblastoma.
The Prevalence of Vitamin D deficiency in Elective Spine Surgery: A Study in Three Orthopaedic Centers
Authors: Diaremes Panagiotis , Christodoulou Evangelos , Maier Gerrit Stephen , Maus Uwe Martin , Matzaroglou Charalampos , Drees Philipp , Kafchitsas Konstantinos
Published: April 2016

Introduction

Decreased bone mineral density due to osteoporosis and osteomalacia pose a significant risk for instrumentation failure and adjacent fractures in elective spinal surgery. The purpose of this study was to evaluate serum levels of 25hydroxyvitamin D (25OH D) in patients presenting for elective spine surgery and to determine whether patients with degenerative spinal disease and spinal instability need a perioperative treatment with Vitamin D substitution.

Material and Methods

Serum 25-OH vitamin D levels were evaluated postoperatively (<72 hours) in patients undergoing elective spinal fusion in three orthopaedic centers, in Germany and in Greece. Patients with diagnosis of spinal instability as well as with degenerative spine disease were treated with spinal fusion.

Results

369 consecutive patients (mean, 68.3 ± 15.4 years) were admitted for elective spine surgery. Mean 25-OH vitamin D level was 19,44 ± 11,52 ng/mL (range, 4–71,8 ng/ mL). 228 (62.0%) patients were diagnosed with vitamin D deficiency and 87 (38.9%) were diagnosed with vitamin D insufficiency (20–30 ng/mL). There was no statistically significant difference between men and women. There was also no significant difference between the patients of the three centers.

Conclusion

Vitamin D deficiency is very common in patients with spinal instability as well as with degenerative spine disease. Therefore an algorithm of treatment as well as a preoperative control of the Vitamin D values is required before spine fusion surgery is performed, to enhance bone mineral density and thus better pedicle screw fixation.
Spondyloptosis Reduction and Fixation in 25-Year-Old Male
Authors: Refai Omar
Published: April 2016

Introduction

Spodyloptosis is a quite difficult situation to be confronted with. All it is solutions are very challenging ranging from non-anatomical insitu fusion to hard and hazardous anatomical reorientation.

Material and Methods

Male patient 25 years old with spodyloptosis of L5 vertebral body was treated all from posterior by disc exaction, nerve release, reduction and fixed with transpedicular screws augmented by S2 iliac screws.

Results

Reasonable reduction of L5 over S1 was achieved from the posterior aspect and realignment of the spine with good fixation.

Conclusion

Still reduction of spodyloptosis from posterior is ideal option in treatment with attention for the neural tissues and good release and fixation.
Uncommon Intradural-Extramedullary Lesions Removed by Direct Uniportal Minimally Invasive Technique: Clinical and Radiological Results. A Study with 24 Months of Follow-up
Authors: Pesantez Carlos Fernando Arias , Peña Pablo
Published: April 2016

Introduction

Intradural extramedullary cervical lesions usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes standard fashion cut incision, open laminectomy and some cases fusión with a delayed recovery and return to daily activities.

Material and Methods

We present seven patients (four woman and tree man) with symptoms include radicular pain and/ or neurological deficit, due intradural-extramedullary cervical lesion. All the patients underwent total resection with minimally invasive uniportal technique using a tree blade MAXCESS retractor system (Nuvasive, Inc) and surgical microscope. We measured a VAS, Nurick scales preop and with follow up of 6 weeks, 3,6, 12 and 24 months of follow up. Surgical time, blood loss and time to discharge. All the patients was underwent control MRI postoperatively.

Results

Histologically report: Two patients neurenteric cyst, four patients: neurocisticercosis and the last: epidermoid cyst. The VAS and Nurick scales was decreased over the time line. The surgical time was 140 minutes mean, blood loss 30cc mean, All the patients was discharged 47hours mean and return to daily activities 10 days mean.

Conclusion

Intradural-extramedullary lesions can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization, disruption to local tissues and return to daily activities suggest that, this technique may present an alternative to traditional open resection with excellent follow up.
A Study of the Modified Quebec Task Force Classification of Chronic Low Back Pain with Regards to Activity Limitation, Global Percieved Effect, Sick Leave, and its Prognostic Implications
Authors: Varma Kalyan
Published: April 2016

Introduction

The Quebec Task Force(QTF) on activity related spinal disorders was a group of experts in various fields brought together by the Quebec Worker's Health and Safety Commission. It formally recognized that clinicians couldnot reliably differentiate between different patho anatomic causes of low back pain(LBP). Classifying patients as described by the QTF has shown associated differences on several characteristics which showed increasing severity from category 1(local LBP) across the categories of LBP+radiation above knee (category 2), LBP+radiation below knee (category 3) to LBP+neurological signs (category 4). The objective of the study is to determine the prognostic significance of the QTF classification in patients with chronic LBP and to compare the efficacy of the chronic LBP rehabilitation protocol among various categories of QTF.

Material and Methods

Routine data was collected at the time of presentation to an outpatient department of a tertiary care center in India. After taking a detailed history and clinical examination, the pain severity is assessed by Low Back Pain Rating scale (LBPRS) and the activity limitation is assessed by Roland Morris Disability Questionnaire (RMDQ). The patients were advised treatment according to the common standard rehabilitation protocol. The patients were followed up every 6 weeks to check for the progression of symptoms clinically and for the compliance with the rehabilitation protocol. The patients were evaluated at 3 months and again at 6 months for Global Perceived Effect (GPE), activity limitation (RMDQ questionnaire) and sick leave status along with LBPRS.

Results

A total of 188 patients were included with 75% 3 month and 70% 6 month follow up.category 1 had the least and category 4 had the most severe activity limitation at all time points.Patients in category 4 improved the most at the end of 6 months with the common rahabilitation protocol.Patients in category 4 landed up more frequently in surgery compared with others. There were no significant differences in comparisions between category 2 and category 3

Conclusion

Categorizing patients based on QTF classification has shown significant association with activity limitation. Prognosis of the patient's condition based on the symptoms at presentation can be roughly estimated using the QTF classification. However, differentiating patients based on radiating pain above or below the knee has no significant prognostic implications. It was found difficult to establish a diagnosis based on symptoms alone. Hence, targeted treatment based on the QTF classification may have a potential role in better management of patients with chronic LBP.
The Choice of Upper Instrumented Vertebra in AIS and Shoulder Balance
Authors: Kharrat Khalil , Khouri Georges , Kreichati Gaby
Published: April 2016

Background

The choice of the upper instrumented vertebra has long been debated. With little proof regarding the best fusion level, scarce information about the final outcome and lack of consensus, four criteria were used to study each AP and lateral films to choose the most optimal level. The author's used criteria were (1) the positive shoulder sign defined as the contralateral shoulder to the main curve being the highest, (2) a proximal curve that is stiff on reduction maneuvers only to be corrected less than 30% a junctional kyphosis on lateral view between the main, (3) the proximal curve and finally a long proximal curve accounting for 5 and more vertebrae and (4) the final outcome being shoulder balance. The objective of this study is to study the concordance between these criteria used by our surgeons and those defined by Lenke in 2001 to select the most conservative posterior fusion possible to achieve coronal and shoulder balance in AIS.

Methods

Thirty Lenke type I AIS deformity patients, with a minimum postoperative follow up of 2 years, were divided according to the proximal fusion level with group 1+ being all patients who have a fused proximal thoracic curve and group 1- being all patient whose proximal thoracic curve wasn't included in spinal arthrodesis. Then a comparative study between the two groups was made, accounting for shoulder balance as the main outcome by measuring coracoid height, T1 tilt and clavicle angle between the two groups and comparing the results whether the proximal thoracic curve was included or not.

Results

The two groups were initially similar (p > 0.05) and remained equivalent having an appropriate shoulder balance in the immediate post-operative period and at last follow up without a significant difference in shoulder balance (p > 0.05) (coracoids difference, T1 tilt and clavicle angle). The study showed an average correction of 60% in the proximal thoracic curve and 70% in the main thoracic curve whether PT was included or not. A similarity study between Lenke criteria and the authors' criteria showed no difference between the two with the exception of a PT bigger than 5 vertebrae. Having a PT bigger than 5 vertebrae did not influence shoulder balance in AIS type I. The study showed a concordance of 74% between Lenke criteria and the authors'.

Conclusion

There is a high level of concordance between the authors' criteria and those defined by Lenke showing that whether to include the proximal curve or not depends on establishing whether the proximal curve is stiff i.e structural or not.
Preliminary Results of Treatment of Early Onset Scoliosis using Magnetic Growing Rods
Authors: Siam Ahmed Ezzat , Shaheen Elsayed , Mohamad-Ali Niazi , Pfandlsteiner Thomas , Wimmer Cornelius
Published: April 2016

Introduction

One of the major disadvantages of traditional growing rod systems is the requirement for multiple surgical procedures to lengthen the rods as the patient grows. This has been avoided by introduction of magnetically controlled growing rod (MCGR).

Materials and Methods

A prospective uncontrolled, single-center, single-surgeon, clinical and radiological study. Between November 2012 and August 2015, 16 children with EOS were treated using MCGR. Preoperative, postoperative and final follow-up (FFU) whole spine radiographs were reviewed to determine the degree of spinal deformity and correction, measured using Cobb angle. T1–S1 length was calculated. Clinical notes to determine number of rod lengthening procedures using remote control device and to record any complications during surgery or FU period. Mean age was 11.6 years, 3 boys and 13 girls; 11 children had primary correction by MCGR; 7 of them had neuromuscular, three infantile and one congenital scoliosis. All had a dual MCGR implanted. The remaining five patients had previously undergone other growing rod operation before converting to MCGR implant.

Results

Mean pre-operative Cobb angle of the primary group was 63.2°, postoperative 35.6° (40.5% correction), FFU 39°. Mean initial percentage of the lengthening was 14.8%. Thoracic kyphosis changed from preoperative mean of 49.1° to 34.1° postoperatively. One patient had wound infection, three had pull-out of proximal screws/hooks, one sustained a breakage of a single-rod construct 6 months after surgery and was replaced by a double magnetic-rod construct. A total of 40 distractions have been performed. Mean FU was 15.5 months.

Conclusions

In our consecutive series of patients treated with MCGR we found that scoliosis was well controlled. Cobb angle was significantly reduced following surgery in patients who had MCGR performed as a primary procedure. Generally, the correction was maintained at FFU. Despite the relatively high complication rate, comparing our results for MCGR and other growing rod techniques, they are comparable, without need to repeated surgery.
Conversion of Implant Failure in Early Onset Scoliosis to Magnetic Growing Rod. A Series of Five Cases
Authors: Siam Ahmed Ezzat , Shaheen Elsayed , Pfandlsteiner Thomas , Wimmer Cornelius
Published: April 2016

Introduction

Conventional growing systems allow spinal growth to continue and prevent curve progression but need multiple interventions that increase the risk of infection, complications of anesthesia. A more advanced, less invasive method is the remotely distractible, magnetically controlled growing rod (MCGR) system which has been developed to allow frequent non-invasive distractions. This is the first series focusing on the conversion of failed growing implant to MCGR.

Materials and Methods

A prospective single center study from 11/2012 to 8/2015 with consecutive patients with progressive deformity and implant failure. Five children have been converted to MCGR; one boy and 4 girls; mean age 11.9 years. The scoliosis was infantile in two and neuromuscular in 3 cases. Four patients had VEPTR and one had a conventional growing rod.

Results

Mean preoperative Cobb angle was 56.6°, thoracic kyphosis 59.6° and spinal length (T1-S1) 339mm. The upper fixation level was T3-T5 with a lower fixation to T11 and L2 in the infantile scoliosis and L3 in two neuromuscular cases. One neuromuscular scoliosis was fixed with hooks to the iliac crest. Mean operative time was 135 minutes and blood loss 217 ml. Mean postoperative Cobb angle was 48.1°, thoracic kyphosis of 49.8% and spinal length 379mm. During this study a total of 15 distractions have been performed to all children. At final FU (mean of 21.8m), mean Cobb angle was 48° (total additional correction of 2.5°), thoracic kyphosis of 51.5° (total additional correction of 3.2°) and spinal length of 387 mm (total spinal growth of 33 mm). One case reached to final fusion after 2 distractions. Double rods have been the rule with exception of one neuromuscular case. This single rod was broken after 6 months and replaced by a double rod system. The other complication was a proximal junctional kyphosis (PJK) that occurred primarily after VEPTR and again after magnetic rod.

Conclusion

Although conversion of implant failure from VEPTR and growing rod systems to MCGR is a good option to allow growth of the instrumented segment, this gives limited results when performed at a relatively older age. The postoperative correction in these cases is relatively limited due to prior correction by the older systems. One complication related to the implant occurred with single rod construct. Correction by MCGR will face the same challenge to prevent PJK, like other growing rod systems. The new technique provided a non-surgical repeated (sometimes outpatient) distractions.