bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Decompression (<8h) versus Delayed Surgical Management Improves Functional Outcome after Traumatic Cervical Spinal Cord Injury
Authors: Grassner Lukas , Wutte Christof , Klein Barbara , Mach Orpheus , Riesner Silvie , Panzer Stefanie , Vogel Matthias , Högel Florian , Bühren Volker , Strowitzki Martin , Maier Doris , Vastmans Jan
Published: April 2016

Introduction

Traumatic cervical spinal cord injury affects the individual in a multi-faceted way. Early decompression of the spinal canal is recommended. The optimal time point for this intervention has been under debate for decades. This study compares a variety of neurologic, radiologic and functional outcome parameters between patients after early (<8 hour) versus delayed decompression.

Materials and Methods

We performed a retrospective analysis at the Center for Spinal Cord Injuries (Trauma Center Murnau, Germany), an over-regional level-I trauma center. Follow-up data was collected prospectively for one year after injury, according to institutional and international consensus criteria. We included data acquired over a 10-year period (2004 – 2014). We only analyzed patients over 18 years with traumatic cervical spinal cord injury without concomitant extremity injury, traumatic brain injury or central cord injuries.

Results

We identified 70 patients (59 males), who met in- and exclusion criteria. Out of this population, 35 patients were decompressed within the first 8 hour (average: 4.36 hour after the insult) (= early group). After one year, patients from the early group showed a significantly higher gain in total motor score (TMS) points and upper extremity motor score (UEMS) points. Additionally, this patient cohort showed significantly better grades on the American Spinal Injury Association Impairment Scale (AIS) and a significantly higher AIS conversion rate. Furthermore, they were more likely to experience a significant greater difference in the Spinal Cord Independence Measure (SCIM) within the follow-up period.

Conclusion

This study shows that an early surgical decompression not only leads to higher AIS conversion rates, but – most importantly – also to a better functional outcome (as indicated by the SCIM score).
New Surgical Attitude in Complete Acute Traumatic Spinal Cord Injury
Authors: Iencean Stefan Mircea , Iencean Andrei Stefan
Published: April 2016

Introduction

Studies have shown the values pattern of the phosphorylated form of the high-molecular-weight neurofilament subunit (pNF-H) in CSF is a predictive biomarker for acute traumatic spinal cord injury (SCI).

Materials and Methods

A previous study of pNF-H in CSF of patients with SCI showed it is a specific biomarker for SCI, it can distinguish the severity of SCI and it is a predictive biomarker because of its values pattern can show the reducing or stopping of the secondary lesion and a favorable result. At 22 subjects with acute traumatic SCI we correlated the pNF-H concentration in CSF with the MRI, with the diffusion tensor tractography on the SCI site and with the clinical evolution. All patients underwent surgery during the first 24 hours (decompression, stabilization). In two cases with unfavorable pattern of pNF-H after 4 and 7 days, MRI identified the SCI site with an extensive spinal cord edema and a necrotic cavity. A second microneurosurgery was done: opening the dura 5 levels, duraplasty and opening the spinal cord in the midline and debridement of the necrotic tissue.

Results

Complete SCI cases had a specific pattern of values of pNF-H correlated with the MRI and the clinical evolution. A second microneurosurgery solved the cord edema and the spinal cord laceration. One case has improved progressively after 6 months and the other case - no neurological improvement after one year of rehabilitation.

Conclusions

Patients must undergo surgery during the first 24 hours: a large decompression on 5 – 7 levels with duraplasty and stabilization. After these we can use the predictive unfavorable pattern of pNF-H correlated with MRI and a second microneurosurgery in SCI site must be done: opening the spinal cord in the midline and microsurgical debridement of the necrotic tissue. This surgical attitude can create favorable conditions for functional recovery of the remaining spinal cord.
Efficacy and Safety of Riluzole in Acute Spinal Cord Injury (SCI). Rationale and Design of AOSpine Phase III Multi-center Double Blinded Randomized Controlled Trial. (RISCIS)
Authors: Fehlings Michael , Kopjar Branko , Grossman Robert
Published: April 2016

Introduction

There is convincing evidence from the preclinical realm that the pharmacologic agent riluzole attenuates certain aspects of the secondary injury cascade leading to diminished neurological tissue destruction in animal SCI models. The safety and pharmacokinetic profile of riluzole have been studied in a multicenter pilot study in 36 patients. Efficacy of riluzole in acute human SCI has not been established

Material and Methods

This ongoing multi-center, international double-blinded phase III RCT will enroll 351 patients with acute C4—C8 SCI and ASIA Impairment Grade A, B or C randomized 1:1 to riluzole and placebo. Primary outcome is the change in ASIA Motor Score (AMS) between baseline and 180 days. Other outcomes include ASIA Upper and Lower Extremity MS; ASIA Sensory Score; ASIA grade; SCIM); SF-36v2; EQ-5D and GRASSP. Two-stage sequential adaptive trial statistical design has 90% power to detect 9 points difference in the ASIA Motor Score at one-sided α = 0.025.

Results

A matched cohort analysis performed in the Phase I study showed that riluzole treated cervical SCI patients experienced an additional 15.5 points in AMS recovery at 90 days post injury. Although the phase I study was underpowered to investigate efficacy the current phase III study is poised to definitive address this question. Subject enrollment for this trial began on October 1, 2013 in 11 international centers. To date, 31 subjects have been enrolled. Average age of the enrolled subjects is 49 years (SD 16.9); 83.9% males. ASIA at arrival and Pre-Injury status, ASIA Grade A (45%), B (29%), C (26%). GRASSP 54.1 (SD 12.8), SF35v2 PCS 52.6 (SD 9.0) SF36v2 MCS 55.6 (SD 12.8).

Conclusion

This is a Phase III study of riluzole in acute SCI.
Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Stand-alone Polyetheretherketone (PEEK) Cages
Authors: Shiban Ehab , Meyer Bernhard , Lehmberg Jens , Nies Moritz , Kogler Johann
Published: April 2016

Aim

To evaluate long-term results after one- and two-level anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK) cages.

Methods

We performed a retrospective review of a consecutive patient cohort with degenerative disc disease that underwent ACDF with stand-alone PEEK cages between 2007 and 2013 with a minimum follow-up of 12 months. Radiographic follow-up included static and flexion/extension radiographs. Changes in the operated segments were measured and compared with radiographs directly after surgery. Clinical outcome was evaluated by a physical examination, pain visual analog scale (VAS) and health-related quality of life (HRQL) using the EuroQOL questionnaire (EQ-5D).

Results

Of 667 consecutive cases, 554 met all inclusion criteria. Follow-up data were obtained from 439 (79.2%) cases. The mean age at presentation was 55 years and 237 patients were male (54%). 220 and 219 patients had one- and two- level surgeries, respectively; 220 (50%) presented with spondylotic cervical myelopathy and 219 (50%) with cervical radiculopathy. Fusion was achieved in 85.9% and 86.3% of segments in one- and two-level surgeries, respectively. Cervical alignment was better in 37% and 40%, same 32% and 43%, worse in 30% and 17% in one- and two- level surgeries, respectively. Subsidence was observed in 27.7% and 26.5% of segments in one- and two-level surgeries, respectively. Follow-up operations for symptomatic adjacent disc disease and implant failure at index level were needed in 34 (7.7%) and 22 (5%) cases, respectively. Mean VAS declined from 5.3 ± 3.5 to 2.6 ± 2.3 ( p < 0.001) and 4.5 ± 3.7 to 2 ± 2.5 ( p < 0.001) for neck and arm pain, respectively. Health-related quality of life (HRQL) as measured by the EuroQOL questionnaire (EQ-5D) improved most cases.

Conclusions

One and two level ACDF with stand-alone PEEK cages achieved very high fusion rates and a low rate of follow-up operations. The rate of good clinical outcome is highly satisfactory.
Dysphagia Due to Ossification of the Cervical Anterior Longitudinal Ligament. Report of Three Cases
Authors: Valacco Marcelo , Imposti Felix , Servidio Mariano
Published: April 2016

Introduction

Symptomatic ossification of the anterior longitudinal ligament is rarely pathology. Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition in the aging spine. DISH, also called with the eponym Forestier's disease, is a clinical syndrome characterized by the abnormal formation of osteopytes involving the spine. These are largely asymptomatic, however are recognized as an unusual cause of dysphagia, which may occur secondary to the mechanical compression with partial obstruction or perioesophageal inflammation caused by pharyngo- esophageal motion over the osteophytes. Dysphagia is reported in up to 28% of patients. Surgical treatment is advocated only after failure of conservative therapies. Conversely, in absence of relevant clinical signs due to the presence of DISH, surgery is not considered mandatory. However, surgical resection of the osteophyte has been reported to be an effective treatment for severe cases. Therefore, from 1995, we started to observe long-term postoperative courses of DISH patients with recalcitrant dysphagia who underwent surgical resection of osteophytes. The purpose of this study was to examine these surgical outcomes and literature review.

Material and Methods

Case 1. A 70-year-old man referred to our clinic because of progressive dysphagia for solids and liquids and cervical pain. A lateral cervical spinal X-ray and cervical MRI revealed giant cervical osteophytes at the ventral portion of the C 2/3/4 vertebral bodies and contiguous calcification of the anterolateral cervical vertebral bodies. Case 2. A 57-year-old man presented with a 1.5-year history of increased difficulty swallowing. A plain lateral radiograph revealed OALL ventral to the C3–5 vertebral bodies. Three- dimensional computerized tomography studies further demonstrated extensive C3–5 OALL. Case 3. A 75-year-old white man was seen at Hospital with the main complain of increased difficulty in swallowing solid food over the past two years. Routine cervical spine films revealed prodigious osteophytes of the cervical spine involving the bodies of C-2, C-3, C-4, C-5 and C-6 consistent with DISH. A magnetic resonance imaging (MRI) scan of the cervical spine revealed an elongated ossification of the frontal planes of the vertebral bodies, with spurs projecting into the soft tissues of the neck.

Results

The three patients underwent uneventful operative excision of the anterior cervical osteophytes. Surgery was performed with an anterolateral approach. They had marked improvement in swallowing function and were able to resume a normal diet after one to two months.

Conclusion

Diffuse idiopathic skeletal hyperostosis or Forestier's disease is an uncommon etiology of progressive dysphagia. This unrecognized condition may provide a new challenge for spine surgeons who are not as familiar with DISH as rheumatologists. Surgical decompression through osteophytectomy is effective for patients who fail conservative treatment
Role of Spinal Diffusion Tensor Imaging in Predicting Post-operative Outcome in Cervical Degenerative Pathologies
Authors: Ahmad Faiz , Rindler Rima , Eshraghi Sheila , Chokshi Falgun , Mossa-Basha Mahmud , Buster Bryan , Chu Jason , Pradilla Gustavo
Published: April 2016

Introduction

Predicting post-operative recovery after surgery for cervical spondylotic myelopathy (CSM) is challenging. The authors performed a systematic review of the literature evaluating the diagnostic ability of DTI in CSM, and its ability to predict post-operative outcome.

Material and Methods

A systematic PubMED search adherent to PRISMA guidelines included relevant clinical studies reporting use of DTI in adult humans undergoing operative management for CSM from 1980 onwards. Available data on pre-operative clinical status and imaging and post-operative clinical outcomes were abstracted.

Results

Six of 562 studies were eligible for detailed review. There were 112 patients with CSM and 45 healthy controls. Seventy-three (59.8%) underwent operative management with mean follow-up time 90–730 days. Fractional anisotropy (FA) was significantly lower in patients compared with controls across multiple studies, and correlated with pre-operative assessment (modified Japanese Outcome Assessment). FA and fiber tractography ratio (FTR) correlated with post-operative clinical assessments, with FA independently predicted surgical need and good outcome post-operatively.

Conclusion

DTI may be a valuable tool in identifying patients in need of surgical decompression and predicting post-operative outcome. Future prospective studies are required for choosing optimal DTI parameters, anatomic levels and acquisition techniques.
Successful Treatment of Severe Occipitocervical Pain from C1-C2 Osteoarthritis Using a Modified Harms Technique
Authors: Deukmedjian Ara , Cianciabella Augusto , Patel Bharat , Deukmedjian Arias
Published: April 2016

Introduction

C1-C2 fusion with instrumentation is an established treatment for C1-C2 instability due to trauma or inflammatory disease. C1-C2 fusion for debilitating occipitocervical pain secondary to C1-C2 osteoarthritis has been reported in a small number of patients. Here we report the successful treatment of three patients that underwent C1-C2 instrumented fusion using a modified Harm's technique for medically refractory occipitocervical pain.

Materials and Methods

Between August 2012 and July 2015, three consecutive patients with debilitating, unilateral occipitocervical pain and radiographic C1–2 osteoarthritis, underwent posterior instrumented C1-C2 arthrodesis using bilateral polyaxial C1 lateral mass and C2 pedicle screw and rod constructs (modified Harms technique). All three patients failed preoperative conservative treatment including therapy, medical management and interventional pain management including facet joint injections. In all three patients, the source of occipitocervical pain was confirmed preoperatively with direct C1-C2 joint injection using 0.5ml of a mixture of 2% lidocaine/0.5% Marcaine/10mg kenalog. All three patients had immediate but temporary relief of their occipitocervical pain from the diagnostic C1-C2 joint injection. Preoperative CT scan confirmed the presence of C1-C2 osteoarthritis on the symptomatic side. Outcome measures include pre and postoperative VAS, patient reported resolution of pain, hospital LOS, EBL and complications.

Results

Each of the three patients surgically treated had complete resolution (100%) of their preoperative occipitocervical pain beginning immediately after instrumented posterior fusion of C1–2. Average VAS improved from 8.3 preoperatively to 0.0 postoperative for the cohort. Average follow up is 33 months. Average age for the group at the time of surgery was 75 years old and the M:F ratio is 1:2. Hospital LOS was 1 day for each patient. EBL was 45ml on average with a range of 15ml - 75ml. There were no postoperative complications.

Conclusions

Instrumented posterior C1-C2 fusion, using a modified Harms technique, is a safe and effective treatment for refractory occipitocervical pain secondary to C1-C2 osteoarthritis. The source of pain should be confirmed preoperatively with both CT scan and diagnostic joint injection.
The Quantitative Observation of Interbody Fusion with Local Autogenous Bone Harvested from Single Interlaminar Fenestration in PLIF
Authors: Wang Qing , Yang Yong
Published: April 2016

Introduction

Local autogenous bone (LABORATORY) harvested from interlaminar fenestration or total facetectomy has been widely applied in interbody fusion of lumbar disc degenerative diseases (DDD) with satisfactory clinical results. However, there was lack of weight and volume observation of LABORATORY harvested from single interlaminar fenestration(SIF). The aim of this study was to quantitative observe the interbody fusion feasibility with LABORATORY harvested from SIF in PLIF.

Materials and Methods

107 patients were undergone PLIF only by LABORATORY+one cage at L4/5 and/or L5S1 due to DDD. The weight and volume of LABORATORY from SIF were measured by analytical balance and 5ml disposal sterile syringe. The height of cages used intraoperative were recorded. The area of endplate (Se) and the contact area (Sc) between the cartilaginous endplate and LABORATORY +cage at every intervertebral space was measured and calculated by PACS of CT workstation. The clinical results and fusion status were estimated by JOA score and 3D-CT at 12, 18 and 24 months postoperative.

Results

113 segments of 107 patients were successfully fused only by LABORATORY harvested from SIF. The weight and volume of LABORATORY from SIF showed no significant differences at different ages, genders, segments and type of DDD, and the same result exists about Se and the height of interbody space in L4/5 or L5S1 segments. The mean volume and weight of LABORATORY were 3.1ml and 3.7 g from SIF. The packing ratio (PR) of LABORATORY+one cage was 38.1%. The volume and weight to reach 30% PR needed ~2.5ml and 3.0 g LABORATORY. 94 cases (98 segments) were followed up for average 24 months postoperative. The improvement rate of JOA score was 82.5%, and the fusion rate was 92.9%.

Conclusion

SIF can provide enough LABORATORY for one interbody fusion in PLIF. The average volume and weight of LABORATORY from SIF were 3.1ml and 3.7 g respectively. 38% PR, including one cage, is achievable at fusion segment in present study. 2.5 ml (3.0 g) LABORATORY+one cage can perform ~30% PR.
Early Adjacent Segment Degeneration after Short Lumbar Fusion
Authors: Masevnin Sergei , Ptashnikov Dmitry , Mikhaylov Dmitry , Smekalenkov Oleg , Zaborovskii Nikita , Lapaeva Olga
Published: April 2016

Introduction

Today in a review of the world literature there is no consensus about the main risk factor for the symptomatic adjacent segment disease, as well as the terms and conditions of its occurrence. Furthermore there are more and more questions about the reasons for the early development of ASD in the event of a short fixation, which according to some authors, should be associated with the wrong tactics of treatment and regarded as a complication of surgery.

Material and Methods

This study evaluated 146 patients who underwent one level 360° fusion lumbar surgery from 2005 to 2012 for the treatment degenerative conditions of the lumbar spine. It should also be noted, that patients with L5-S1 fusion were excluded from the study due to the peculiarities of the biomechanics of the segment. So we compare 2 groups according to the presence and extent of initial degenerative changes in the adjacent upper segment. These groups were similar of major risk factors for ASD, such as obesity, age, smoking, menopause, global balance disturbance. Patients in both groups had no significant differences in sex and age composition, the level of quality of life and daily physical activity. First group include 86 patients with no pre-existing or 1 to 3 stage degenerative changes by Pfirrmann modified, second group include 60 patients with initial adjacent disk degenerative changes of stage 4 and above according Pfirrmann modified classification. The average follow-up period was 42.2 months (range, 28–112 months).

Results

In the I group symptomatic ASD was found in 14 (16,3%) cases and ASD average development time was 35 (8–56) months. In the II group during the follow-up period 24 (40%) patients had ASD with average development time 21,5 (3–46) months. Symptomatic adjacent segment pathology was significantly more frequent in the II group ( p < 0.05). The timing analysis of the symptomatic ASD showed statistically significant data on the earlier development of this disease in the second group ( p < 0.05).

Conclusion

Patients with pre-existing degenerative changes in adjacent levels above stage 3 by Pfirrmann must be assigned to a high risk group for early ASD development even in the short lumbar fusion.
Postoperative Complications in Patients Undergoing Minimally Invasive Sacroiliac Fusion
Authors: Schoell Kyle , Buser Zorica , Jakoi Andre , Pham Martin , Patel Neil , Liu John , Hsieh Patrick , Wang Jeffrey C.
Published: April 2016

Introduction

Minimally invasive sacroiliac (SI) fusion has become increasingly popular as a treatment for non-traumatic sacroiliac joint pain in recent years. This has created significant need for reliable data addressing risks associated with the procedure. Initial investigations have focused primarily on efficacy and patient satisfaction with small sample size. Furthermore, the majority of past studies have been primarily single center or case series investigations and as such their findings were limited to their sample populations. The aim of this study was to analyze complications associated with minimally invasive SI fusion using a large medical record database that more closely and accurately models the American population as a whole.

Material and Methods

Patients undergoing minimally invasive SI fusion from 2007–2014 were selected from records of the nationwide private insurance provider Humana. Using the Pearl Diver patient records database (Pearl Diver Technologies, West Conshohocken, PA, USA), patient data on age, procedure date, and medical diagnoses before and after the procedure was acquired. ICD-9 diagnosis codes (International Classification of Diseases 9th edition) were used to reveal incidence of post-operative complications including infection, pain, osteomyelitis, joint derangement, uterine tract infection (UTI), and nerve pathology. Cases of pre-existing conditions were excluded from the analysis. The data was also examined for incidence of patients with diagnoses of new lumbar pathology following the procedure. Patients undergoing SI fusion for surgical revision, neoplasia, or pelvic ring trauma were excluded from the study.

Results

Data from 469 patients (305 female; 164 male) showed a substantial increase in the number of minimally invasive sacroiliac fusion procedures performed from 2007–2014 [ p < .05]. Among these patients, an overall complication rate of 13.2% was seen at 90 days and 16.4% at 6 months post-op. Rates of individual complications were as follow. Infection: 30 days = 3.0%, 90 days = 3.6%, 6 months = 4.1%. Pain: 90 days = 2.6%, 6 months = 4.1%. UTI: 90 days = 3.8%, 6 months = 4.9%. Nerve pathology: 90 days = 4.3%, 6 months = 6.2%. Incidence of novel lumbar pathology was 3.6% at 90 days post-op and 5.3% at 6 months. Males experienced diagnoses of novel lumbar pathology at higher rates than females at both 90 days (M=6.7%; F≤3.3%) and 6 months (M=9.1%; F≤3.3%) [ p < .01].

Conclusion

The results of this study show that minimally invasive SI joint fusion may carry higher risks of complications than previously stated, including a possible association with the development of lumbar pathology. These finding are critical for physicians and patients considering minimally invasive SI fusion as a treatment for chronic SI joint pain, and should be taken under careful consideration when deciding if surgical treatment is warranted.
Lumbar Spinal Stenosis Associated with Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-analysis of Secondary Fusion Rates following Open vs. Minimally Invasive Decompression
Authors: Schöller Karsten , Alimi Marjan , Cong Guang-Ting , Christos Paul , Navarro-Ramirez Rodrigo , Härtl Roger
Published: April 2016

Introduction

Decompression surgery plus instrumented fusion is the gold standard in patients with lumbar spinal stenosis (LSS) associated with degenerative spondylolisthesis (DS) when conservative treatment has failed. Open laminectomy (OL) alone is an option in patients with stable low-grade DS, but progressive instability contributes to significant secondary fusion rates and compromises patient outcome. A minimally invasive unilateral laminotomy (MIL) for “over the top” decompression is a potentially less destabilizing alternative. The aim of our systematic review and meta-analysis was to analyze secondary fusion rates after open laminectomy and minimally invasive laminotomy in patients with LSS associated with DS.

Material and Methods

We performed a systematic literature search in the National Center for Biotechnology Information Database (Pubmed/MEDLINE) using the keywords “lumbar spondylolisthesis” and “decompression surgery.” All studies that separately reported the outcome of patients with LSS associated with DS that were treated by decompression surgery only were included. The accepted decompression techniques were 1.) open laminectomy and 2.) microsurgical transmuscular or subperiosteal unilateral laminotomy with “over the top” decompression. The primary end point was secondary fusion rate. Secondary end points were total reoperation, complications, postoperative progression of listhetic slip, and patient satisfaction.

Results

We identified 37 studies with a total number of 1156 patients that were published between 1983 and 2015. 19 studies reported the outcome after OL, and 18 after MIL. There were two randomized controlled trials, 8 prospective, and 24 retrospective cohort studies or case series. In two trials the study design was unclear. None of the trials compared OL to MIL. The pooled secondary fusion rates were 12.8% in the OL cohort, and 3.3% in the MIL cohort; the pooled total reoperation rates were 16.3% after OL, and 5.8% after MIL. The complication rate ranged from 0–5.4% in the OL cohort, and from 0–8.1% in the MIL cohort. Surgery-related deaths, major permanent complications, or medical complications were not reported by the studies. In the OL cohort 72% of the studies displayed a slip progression compared with 0% in the MIL cohort, respectively. After OL the pooled analysis of satisfactory outcome was 62.7% compared with 76% after MIL.

Conclusion

In patients with LSS associated with DS a minimally invasive laminotomy is associated with lower reoperation and fusion rates, less slip progression and greater patient satisfaction than open surgery. Better quality studies are needed to corroborate these results. These results also indicate that routine fusion may not be necessary in all patients with LSS and DS.
Short Percutaneous Posterior Instrumentation: a Reliable Option in the Treatment of Thoraco-lumbar post-traumatic Spinal Fracture
Authors: Caruso Giuseppina , Turiano Francesco , Tramacere Martino , Campello Mauro
Published: April 2016

Introduction

There are several options to treat instable thoraco-lumbar spinal fractures without spinal cord involvement. A short percutaneous posterior instrumentation [SPPI] (i.e., involving only one level up and one level below the lesioned level) is a fast choice, safer than other more invasive options at the cost of an apparent less efficacy in restoring proper alignment or in the ability to maintain good results in the long term. Aim of our present contribution is to report the incidence of worsening during time of spinal alignment features in patients treated with SPPI.

Material and Methods

Between September 2010 and August 2015, among 230 consecutive operations for instable post-traumatic thoraco-lumbar spinal fractures, we performed 47 SPPI and 130 other percutaneous instrumentations (4 levels or more). Fractures were defined according to the AO classification; vertebral body index [VBI], vertebral body angle [VBA] and Cobb's angle [CA] were measured before, immediately after operation (i.e., in the first two post-op days) at 1 month- and at 12 month-follow-up. All data were drawn from multi-slice high-definition CT-scans. Local ethical committee approved the study design. Results were also stratified according to the class of fracture and number of blocked levels (3, 4 or more).

Results

In the SPPI-cases we found preop the following mean values: VBI 0,67, VBA -16,5, CA -9,5; at 12 months follow-up (26 patients out of 35) mean values were: VBI 0,84,VBA -14,8 and CA -5,4 with changes statistically non significant between immediate post-op and 1 year follow-up.

Conclusion

In our hands SPPI proved to be an effective therapeutic option. No significant kyphotic worsening was observed during the first year post-op. Parallel sections of the present study and prolongement of the observational time will allow us to compare SPPI with longer posterior instrumentations in non spinal cord-lesioned thoraco-lumbar fractured patients.
How to Minimize Complications of Classic Decompression and Fusion in Lumbar Spinal Stenosis: is a Complemental Interspinous Fusion an Alternative?
Authors: Slawomir Moszko
Published: April 2016

Introduction

Lumbar spinal stenosis (LSS) is the most common reason for back surgery in patients over 50 years. LSS decompression may cause an instability or deteriorate it. A classic fusion with pedicle screws enhances the hazard of the surgery in geriatric patients. The goal of the study was to find out, if the additional interspinous fusion (partly combined with interbody fusion) with a rigid intespinous device can minimize the risk of classic procedure.

Material and Methods

94 patients (44 men and 46 women) in age of 49- 88 years (mean 69) underwent LSS decompression with interspinous fusion, some of them additionally with intervertebral cages. Interspinous rigid fusion device were used to provide fusion. Demographic data, indications, operated levels, results in terms of approval of ODI, VAS back and legs, walking distance and satisfaction were analyzed. Blood loss, OP-, fluoroscopy time and complications were registered. Fusion was determined by CT performed at least 6 months post OP and X- rays.

Results

78 patients (83%) were operated with stand alone interspinous fusion device and 16 (17%) received additionally an intervertebralcCage. The follow- up was 6 to 36 months (mean 20). Indications: LSS with instability 41, LSS 28, LSS with disc herniation 19, deformity 3 and adjacent segment disease 3. The Op time ranged from 35 to 209 minutes (mean 82). The blood loss was between 10 to 450 ml (mean100ml). The fluoroscopy time reached from 2 to 18 seconds (mean 6). Mean values for ODI and VAS are presented in Table 1. [Table: see text] 2 years post OP the improvement of ODI was 54%. VAS back 50% and VES legs 72% respectively. The walking distance increased at least at 50% in 86 patients (91,5%). Concerning the satisfaction 90 patients (96%) would undergo the surgery once more, 4 of them (4%) not. Following complications were observed: cage subsidence (3), cage dislocation (1), epidural hematoma (2), wound infection (1), deep infection (1), dural tears (7), seroma (4). It means all in all 19 adverse events (20%). Only in 10 patients (11%) they had a consequence with revision surgery. Radiological criteria of the fusion had 59% of the patients with 6 months follow up, in 94% patients with 12, 98% with 24 and 100% with 36.

Conclusion

The results of the study show, that the LSS decompression can be supplemented using an interspineous rigid device to provide a fusion without significant extending the Op time. More extended surgeries with pedicle screw fixation can be avoided and thus the complication rate reduced. 11% of complications, which require a repeat surgery are acceptable in population of aged patients with comorbidities. The advantage is the less invasive technique with less blood loss and only 0,1 minutes fluoroscopy time. We found no real liminations in decision making for the surgery. There were 22 drop outs.
Neurological Outcomes following Iatrogenic Vascular Injury during Posterior Atlanto-axial Instrumented Fusion
Authors: Ahmad Faiz , Akinduro Oluwaseun , Baum Griffin , Howard Brian , Pradilla Gustavo , Grossberg Jonathan , Rodts Gerald
Published: April 2016

Introduction

Iatrogenic vascular injury is a feared complication of posterior atlanto-axial instrumented fusion. A better understanding of clinical course following this injury will allow surgeons to better care for these patients. The object of the study was to systematically review the neurologic outcomes after iatrogenic vascular injury during atlanto-axial posterior instrumented fusion.

Methods

A systematic review of the PubMed database was performed, following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The extracted data was recorded in an excel spreadsheet. To be included, the patients must have undergone fusion of the C1/C2 joint using posterior instrumentation with injury to an arterial vessel directly attributable to the surgical procedure.

Results

86 incidences of vascular injury were found in 41 articles with 11200 patients. The average age of included patients was 46.4 +/− 24.1 for the screw rod construct (SRC) group and 36.2 +/− 28.2 for the transarticular screw (TAS) group. Vascular injury in SRC cases resulted in ipsilateral stroke in 15.9% ( n = 7/44) of patients and neurologic deficit in 22.7% ( n = 10/44) of patients with a permanent neurologic deficit occurring in 11.4% ( n = 5/44) of patients. Vascular injury following TAS fixation resulted in ipsilateral stroke in 11.9% of cases ( n = 5/42) and neurologic deficit in 23.8% of cases with the deficit being permanent in 9.5% ( n = 4/42) of cases. Death was the result of injury in 9.1% ( n = 4/44) of SRC cases and 7.1% ( n = 3/42) of TAS cases.

Conclusions

Neurological morbidity after iatrogenic vascular injury during posterior C1/2 fixation is higher than previously reported in literature. There has been no large-volume studies aimed at identifying a rate of neurologic complications after iatrogenic injury. Surgeons should be aware of the normal and anomalous vertebral artery anatomy to avoid this potentially catastrophic injury.
Frequency of Post-Operative Hematoma in Lumbar Disc Excision through Fenestration without Closed-Suction Drainage
Authors: Umair Muhammad , Bashir Muhammad Farrukh Bashir , Aziz Amer , Akram Rizwan , Ahmad Saeed
Published: April 2016

Introduction

Spinal epidural hematoma is a well-known complication of spinal surgery. To prevent hematoma formation its routine that suction drain is placed for 24 to 48 hours after laminectomy. But Clinically insignificant small epidural hematomas develop after Lumbar disc excision through interlaminar fenestration. The aim of this study is to find out Frequency of Post-Operative Hematoma in Lumbar Disc Excision through Fenestration without closed-suction drainage.

Materials and Methods

This was a descriptive case series done at Ghurki trust teaching hospital Lahore from from January 2009 to January 2014. Total 423 cases who underwent Lumbar Disc Excision through Fenestration were included in the study. All the patients were followed for 7 days for postoperative Spinal Hematoma Formation which was considered positive in patients who either develop a new postoperative neurological deficit or pain and on mri shows Spinal Epidural Hematoma at the site of surgery.

Results

Frequency of post-operative hematoma after lumbar disc excision through fenestration without using closed-suction drainage reveals 2.13%( n = 9) while 97.87%( n = 414) had no findings of hematoma.

Conclusion

We concluded that frequency of post-operative hematoma after lumbar disc excision through fenestration without using closed-suction drainage is determined as insignificant.
Should we Remove Bullets from the Spinal Cord?
Authors: Grandidge Lisa , Michael Antony , Athanassacopoulos Michael , Chiverton Neil , Breakwell Lee , Cole Ashley
Published: April 2016

Introduction

To discuss a case and review evidence for and against intra-dural bullet removal.

Materials and Methods

A 45 year-old gentleman presented with gunshot wound, with a loss of sensation below his chest and loss of power in his lower limbs. On examination there was a single 1cmx0.5cm bullet entry wound on the anterolateral aspect of the left shoulder, with a T3 motor and sensory level. PR revealed reduced tone and no squeeze. A full body CT showed a bullet within the spinal canal adjacent to the T3 vertebral body. The spinal injuries team diagnosed a T3 complete ASIA A paraplegia. He underwent a posterior decompression of T3 and intra-dural bullet removal with dura repair on the same day. Surgery revealed a dural tear and an intra-dural bullet with obvious cord damage. This was removed with rubberised forceps and handed to police for ballistics. He was given flucloxacillin and transferred to the spinal injuries unit for rehabilitation. He made no neurological recovery but did not develop any further complications.

Results

A thorough literature search revealed the role of surgery in gaining lost neurological function remains ambiguous. Indications for bullet removal include acute neurological deterioration and CSF fistulas. Epidural haematoma/abscesses, radiological compression or a destabilized spine are also considerations. Removals of bullets below T12 have had an effect on motor recovery. However similar neurological recoveries have been reported in both surgical and conservative management of incomplete deficits. Compete deficits are unlikely to improve neurologically regardless of surgical intervention, however cervical injuries with early detection of compressive pathology should be considered. Complication rates are reported to be higher if operated. Prophylactic antibiotics should be started immediately on admission. Surgery does not reduce the incidence of infection. Pain may be intensified when caused by a gunshot injury, but there is no evidence of improvement with bullet removal. One indication for surgery in this case was to prevent post traumatic syringomyelia (PTS). The incidence is 0.3–3.2%, however radiological/autopsy studies suggest up to 22%. There has been one prior reported case where a patient developed symptoms 14 months following initial gunshot injury. However due to lack of data it is uncertain if initial surgical management reduces development of future syrinxes.

Conclusions

This appears to be the first reported case of an intra-dural bullet in the UK. Treatment should be focused on ensuring spine stability, enhancing potential for neurological recovery and preventing complications. The role of surgery versus non-surgical treatment is still debate.
Factors Influencing Outcomes during and Post Hospitalization in Geriatric Cervical Spine Injuries- do the Young and Old Elderly Differ?
Authors: Dsouza Areena , Chhabra Harvinder , Mittal Vivek
Published: April 2016

Introduction

Geriatric patients with cervical spine injuries are known to have high morbidity and mortality. Our aim was to evaluate the acute outcomes of geriatric cervical spine injuries in terms of morbidity, mortality, and factors influencing it during hospitalization and after discharge, and the differences between young and old elderly patients.

Material and Methods

Hospital records of 62 geriatric patients with cervical spine injuries from 2003–2014 were retrospectively reviewed and telephonic interview after discharge were done. Patients were divided into young (65- 74yrs) and old (>74yrs) elderly groups. Demographics, mechanism and level of injury, duration of stay (ward/ICU), radiographic findings, neurological deficits, comorbidities, type of management, mortality, factors influencing mortality and complications rates were studied.

Results

45 patients were young elderly and 17 old elderly. Mean age was 70.46 years. 39 sustained high velocity injury and 23 low velocity. C4–5 was the most common injured level. 34 patients had preexisting co-morbid conditions, cardiac was most common. 34 patients underwent surgery. Mean ICU stay was 16.93 days and ward stay 43.94 days. Pulmonary complications were most common in old elderly. Tracheostomy was required in 20 patients and ventilator support in 24 patients. 28 patients had complete deficit, 27 had incomplete neurology and 7 had normal neurology. Mean duration of follow up was 3.2 years. 14 patients died in our series. 10 patients had returned to preinjury functional level. Mortality was more common in old elderly patients with conservative treatment, patients with higher level of neurological deficit, multiple comorbidities, and ventilator dependancy.

Conclusion

Differences exist between young and old elderly with cervical spine injuries, and there are high morbidity, mortality rates. Efforts should be made to reduce pulmonary complications in this age group of patients. Surgical management can be performed reasonably safely when indicated.
Traumatic Atlantoaxial Rotatory Fixation (AARF) with Odontoid Fracture, Case report
Authors: Shaker Ahmed
Published: April 2016

Introduction

Atlantoaxial rotatory fixation (AARF) is also known as rotatory subluxation, rotatory displacement, rotary deformity, rotational subluxation, and is characterized by incomplete dislocation of the inferior atlantal and superior axial articular facets.1 AARF in combination with odontoid fracture is an extremely rare injury.2–6 Atlantoaxial injuries can be classified according to Fielding 1 or White and Panjabi7 classification. The management of this combination is a matter of debate. 1,8,9

Material and Methods

We present a case of a 78 years old woman who sustained a fall on the ground from a couch directly on her forehead, resulting in atlantoaxial dislocation with type II odontoid fracture accompanied with left sided hemiparesis ASIA type C.

Results

After failure of closed reduction, the treatment plane was to achieve reduction under anesthesia and C1–2 fusion, but again reduction was not possible. Occipitocervical fusion to C3 was done to have better stability in osteoporotic bone. Successful reduction was achieved during rod reduction from the occiput to C2 pedicle screw and C3 lateral mass screw. Cervical collar was advised for 3 months, and good fusion and improvement of the neurological status to ASIA type D was achieved after 6 month.

Conclusion

AARF with Odontoid Fracture is a rare combination and reduction may be impossible. Occipitocervical fusion is a good option in such case as C1–2 reduction is a prerequisite for transarticular screw. C2 pedicle screw offers good purchase even in osteoporotic bone which enabled reduction after rod repositioning. References Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 1977;59(1):37–44 Born CT, Mure AJ, Iannacone WM, DeLong WG Jr. Three-dimensional computerized tomographic demonstration of bilateral atlantoaxial rotatory dislocation in an adult: report of a case and review of the literature. J Orthop Trauma 1994;8(1):67–72 Jones RN. Rotatory dislocation of both atlanto-axial joints. J Bone Joint Surg Br 1984;66(1):6–7 Moore KR, Frank EH. Traumatic atlantoaxial rotatory subluxation and dislocation. Spine 1995;20(17):1928–1930 Robertson PA, Swan HA. Traumatic bilateral rotatory facet dislocation of the atlas on the axis. Spine 1992;17(10):1252–1254 Wise JJ, Cheney R, Fischgrund J. Traumatic bilateral rotatory dislocation of the atlanto-axial joints: a case report and review of the literature. J Spinal Disord 1997;10(5):451–453 White AA III, Panjabi MM. The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am 1978;9(4):867–878 Schmidek HH, Smith DA, Sofferman RA, Gomes FB. Transoral unilateral facetectomy in the management of unilateral anterior rotatory atlantoaxial fracture/dislocation: a case report. Neurosurgery 1986;18(5):645–652 Crockard HA, Rogers MA. Open reduction of traumatic atlanto-axial rotatory dislocation with use of the extreme lateral approach. A report of two cases. J Bone Joint Surg Am 1996;78(3):431–436
Lumbo-iliac Reconstruction after Total Sacrectomy
Authors: Saavedra Javier M. , Buritica Jose L. , Madrinan-Navia Humberto , Riveros Mauricio , Garcia Marco
Published: April 2016

Introduction

Giant sacral tumors often require a radical and extensive surgical approach. En bloc–sacrectomy implies a surgical challenge for the anatomical stability of the spino-pelvic joint. Different fusion approaches have been used to address this situation. We describe the surgical technique and summarize the clinical outcome after a total resection of giant sacral tumors and a transpedicular lumbo-iliac fusion.

Material and Methods

Case report of three patients who underwent an En-bloc sacrectomy between february of 2013 and February 2015. A combined extraperitoneal and posterior approach was used headed by a multidisciplinary surgical group of neurosurgeons, colorectal and plastic surgeons.We used a transperitoneal approach for anterior and lateral tumor isolation and for sacral dissection from ligaments and muscle insertion sites. Subsequently a posterior approach was used through which an L5-S1 diskectomy was performed followed by lateral osteotomies for sacral wing separation and bilateral S1 pedicle and laminae osteotomies with intact preservation of S1 nerve roots. Then the dural sac was ligated and the sacrum was amputated. For reconstruction of tumor site, a lumbo-iliac arthodesis was performed using polyaxial bilateral pedicle screws in L3, L4, L5 and two bilateral Transiliac Monoaxial screws. Vertical rods placed alongside the spine bylaterally maintaining lorditic axis, Cross links to connect the two vertical rods and Heterologous bone grafts were used.

Results

The three patients underwent a successful en bloc sacrectomy and lumbo-Iliac reconstruction without perioperative mortality and significant morbidity. Total tumor resection was performed in the three patients. None of the patients had gait disturbances after surgery. Patients were followed 6 to 30 months after surgery and at the final checkup there were no local recurrence reported and no instrumentation failure were noted.

Conclusion

Lumbo-iliac reconstruction through screw assisted transpedicular L3, L4, L5 and transiliac stabilization system after total oncologic sacrectomy provided spino-pelvic stability maintaining functional gait.