bluuebunny/crossref_metadata_2025 huggingface dataset:
Adult Spinal Deformity in the Elderly. Preliminary Clinical and Radiological Results in 22 Patients Treated by a Two Times Minimally Invasive Spine Surgery
Authors: Cimatti Marco , Forcato Stefano , Miscusi Massimo , Frati Alessandro , Polli Filippo Maria , Raco Antonino
Published: April 2016

Introduction

The adult spinal deformity (ASD) seems, in the last years, in a progressive increment. It should be in relation to the aging of the population. This trend leads to a progression of the disability and the reduction of the quality of life of these patients. The surgical correction of the ASD obtained by a traditional “open” surgery can often be incompatible with the co-morbidities of these patients. The minimally invasive surgery for correction of the deformities (MISDEF) can offer technical nuances, such as reduce of intraoperative blood loss and quickly recovery, which can lead the opportunities for these patients to approach the surgery. We present the preliminary results of our observational study on the radiological correction and clinical results of old patients affected by ASD treated by MISDEF.

Methods

Observational study with 20 months of follow-up. Twelve patients affected by low-back pain, sciatalgia and/cruralgia, neurological claudication were enrolled in this study. All the patients underwent to a MISDEF based on a percutaneous transpedicular stabilization plus a lateral or transforaminal interbody fusion. We collected all the radiological datas, such as sagittal vertical axis (SVA), sacral slope (SS), pervic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL) and coronal cob (CC) and the clinical status, oswestry disability index (ODI) and SF-36.

Results

The mean age was 70 years (65 – 78 years), 3 men and 9 women. 7 patients presented a lumbar left side convex scoliosis, while 5 patients presented a right side one. All the patients underwent to a 2 times surgery: the first time was a lateral access, the second time was the posterior access. The side for the lateral interbody fusion was the concave side of the scoliosis. L4L5 segment was always been approached for a transforaminal interbody fusion. The proximal strumental vertebra was T10. The mean intraoperative blood loss was 500 cc. All the patients were mobilized within 2 days. The ODI and SF36 evidenced a statistically improvement ( p < 0,05). No evidence of infections, neurological deficit, failure of the implant and/or loosening of correction were documented in the follow up.

Conclusions

The MISDEF offers, even for elderly patients with co-morbidities, a valid and secure surgical solution for the correction of the ASD. From the results of our study appeared a good compliance of these techniques for all the patients, with a good result even at 20 months of follow-up. We considered that the opportunity to separate the surgical correction of the deformity in 2 times surgery seems to be a better and secure solution especially for elderly patients.
Pelvic Incidence is Not Constant
Authors: Tammam Hamdy , Mostafa Amer , Gad Wael , Koptan Wael , El-Sharkawi Mohammad
Published: April 2016

Introduction

The pelvis is a very important component in the overall balance. It changes its orientation in space aiming at compensation for any sagittal imbalance. Three pelvic parameters were recognized as descriptive tools for pelvic status. Pelvic incidence (PI) is considered as a constant value after maturity which changes only in pelvic trauma. This work aims to evaluate if the surgical correction of the fixed sagittal imbalance has any effect on the pelvic incidence.

Patients and Methods

Twenty seven cases with fixed sagittal imbalance were corrected surgically by posterior spinal osteotomies and prospectively followed for at least one year. Pelvic Incidence (PI), Sacral Slope (SS), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK) and Sagittal Vertical Axis (SVA) were compared between preoperative, postoperative and last follow up long standing lateral whole spine radiographs. Measurements were taken by three experienced spine surgeons independently.

Results

Twenty four cases were included, half of them were males, and the mean age was 16.3 (5–46) years. PI was fixed or changed by five degrees or less in seventeen cases (70%). PI increased in four patients (16%) by more than five degrees and decreased by more than five degrees in three cases (12,5%). The mean increase in the PI was 11.75° (6–20°) and 11.2° (7–23°) postoperatively and at last follow up respectively.

Conclusions

Despite that the PI is fixed or minimally changes (five degrees or less) in most of the cases of surgically corrected fixed sagittal imbalance, it is increased in some patients and decreased in others. The long term effect of this observation and its implication on surgical planning is yet to be determined.
A Radiological Evaluation of Effect of a Single Level Trans-Foraminal Lumbar Interbody Fusion (TLIF) on Lumbar Sagittal Parameters
Authors: Salem Khalid , Fisher Charles , Dvorak Marcel
Published: April 2016

Aim

To investigate the effect of a primary single level TLIF on the lumbar sagittal profile (segmental lordosis and total lumbar lordosis) comparing pre-operative, intra-operative and post-operative radiographs in patients with lumbar spine degenerative disease.

Methods

Patients over the age of 16 who underwent a single-level interbody fusion for degenerative stenosis and/or spondylolisthesis without scoliosis between March 2008 and March 2014 were reviewed. Age, gender, surgical level, surgical approach, facetectomy (unilateral vs bilateral) were recorded. Standardized pre and early and 6 month postoperative upright radiographs as well as an intra-operative lateral radiographs were analyzed for the pelvic incidence (PI), segmental lordosis (SL) at the TILF level and total lumbar lordosis (TL). Data analysis was performed after confirming normality using a paired t-test and is presented as mean (SD). p-value < 0.05 was considered significant.

Results

69 patients were reviewed. The mean age was 58.6 (13.6) years, 39 males (56.5%), a Wiltse approach was used in 30 (43.5%) while 39 had a midline posterior approach. Segments operated were L2/L3 (1 case), L3/L4 (6), L4/L5 (43), L5/S1 (19) and bilateral facetectomy was performed in 13 (18.8%). SL changed from 15.2° (7.3) preoperatively to 20.4° (7.7) intraoperatively ( p-value < 0.0001) but measured 17.9° (7.2) ( p-value < 0.0001) on early postoperative images and 17.2° (7.3) at 6 months follow up ( p-value= 024). The total improvement in SL at 6 months was 2° (6.7), ( p-value= 0.001). TL change was insignificant on the early postoperative X-rays (48.5° (12.4) to 47.2° (11.3), p-value= 0.37) but significantly increased to 53.1° (11.5) at six months ( p-value < 0.0001) with a total improvement of 4.6° (10) ( p-value= 0.001). The mean pelvic incidence was 59.7° (11.2). The cage subsided in 11 (15.9%) cases and we had no metal work loosening.

Conclusion

At the level of the TLIF, much of the lordosis achieved intra-operatively is lost once the patient mobilizes. An improvement in the total lumbar lordosis at 6 months following surgery is likely to be due to the decompression component of the surgical intervention.
Thinning, Peeling and Carving Technique for the Treatment of Thoracic Myelopathy Caused by Ossification of Ligamentum Flavum
Authors: Wang Dechun
Published: April 2016

Introduction

To introduce a novel technique of thinning, peeling and carving to remove the ossification ligamentum flavum(OLF) nidus easily, safely and completely for the treatment of thoracic myelopathy caused by OLF. This surgical procedure avoids aggressive irritating the most seriously compressed spinal cord caused by OLF nidus especially. The epidural venous plexus bleeding and the bleeding from the pedicle can be seen clearly and controlled easily during the decompression.

Material and Methods

Thoracic myelopathy caused by OLF was diagnosed in 28 patients using plain radiography, 3D CT, and MRI from January 2009 to January 2012. The lamina, the lower and the upper facet joint of the involved segment were thinned with the bigger neuro drill(diameter 3.5mm) first, The shell was so thin that the feeding blood vessels of the dura can be seen clearly. Second, the thinned shell was peeled off with the curette piece by piece. The upper facet joint and the OLF nidus were carved by the smaller neuro drill (diameter 2.5mm)and the thinned bony nidus compressing the spinal cord was removed finally, Spinal cord monitoring (SEP and MEP)was performed intraoperatively in all cases. The operating time and blood loss were recorded during the operation. The Frankel scoring system was used to assess the neurological status before the operation and in the follow up. The S F-36 were also used to assess the general health status.

Results

Of the 28 cases of OLF,3 were single level, 10 were double level, and 15 were multilevel. Of the 71 ossified segments in this study, 16 (22.5%) were located in the upper thoracic spine (T1–4), 9 (12.7%) were located in the midthoracic spine (T5–8), and 46 (64.8%) were located in the lower thoracic spine (T9-L1). The mean operating time was 145 ±32min. The mean intraoperative blood loss was 280 ± 48.6 ml. The neurological status improved during follow-up (mean 46.1 months) from a preoperative mean mJOA score of 5.39 ± 1.52 to 8.97 ± 1.22 points (t = 18.39, p < 0.05). The neurological function recovery rate ranged from 28.6% to 100%.

Conclusion

Thinning, peeling and carving technique was effective, safe and may be a reasonable choice for the treatment of thoracic myelopath y caused by OLF
Preoperative Embolization in Spinal Tumour Surgery
Authors: Kumar Naresh , Zaw Aye Sandar , Gopinathan Anil , Tan Barry
Published: April 2016

Introduction

Preoperative embolization has been shown to be effective in reducing intraoperative blood loss during metastatic spinal tumor surgery. However, the majority of studies investigating preoperative embolization for spinal metastases have preferentially selectedsecondaries fromrenal and thyroid as these are highly vascularized tumors. There is paucity of literature describing utility of embolization in other tumors. We aimed to determine the effect of preoperative embolization on intraoperative blood loss indifferent spinal tumors by type of surgical approaches.

Materials and Methods

We retrospectively evaluated 221 patients undergoing surgery for primary or metastatic spine tumors. Patients were analyzed for the effect of embolization agents, extent, level of embolization and timing between embolization & surgery, on estimated blood loss. Estimated blood loss and transfusion requirements were compared between embolized and non-embolized cases for different types of spinal tumor (metastatic lung, breast, renal, hepatocellular, thyroid, other epithelial tumors, myeloma/lymphoma and primary spine tumors) and surgical approaches (Type I: Cervical spine surgery either anterior and/or posterior stabilization with or without corpectomy, Type II: Thoracolumbar posterior instrumentation and decompression, and Type III: Thoracolumbar corpectomy).

Results

Preoperative embolization was performed in 48 patients. Hypervascular angiographic appearance was found in 22 (46%) and capillary blush in 26 (54%) embolized patients. Total embolization (>80% reduction of tumor blush) was achievable in more than half of the embolized patients (61%), and less amount of blood loss was observed in these patients (median blood loss = 900ml) compared with those who achieved partial (<50%) and subtotal (50–90%) embolization (1600ml and 1350ml respectively). Blood loss was also lower in those who achieved proximal embolization and those who underwent surgery between 13–24 hours after embolization. When stratified by type of tumor and surgical approaches, blood loss and transfusion requirement were lower in embolized cases of spinal secondaries from HCC & thyroid; and primary spine tumors. In multivariate linear regression, after adjusting for tumor type, type of surgical procedure, invasiveness index, preoperative haemoglobin and operative time, there were no significant differences in the blood loss as well as blood transfusion units between embolized and non-embolized groups.

Conclusions

Success of embolization in reducing blood loss depends on the extent of embolization, which should be total; and time interval between embolization and index surgery, which should be within 13–24 hours. Preoperative embolization is a useful modality in decreasing intraoperative blood loss in cases of spinal metastases from HCC, thyroid and primary spine tumors.
Operative Management of Post-tumor Spinal Deformity
Authors: Zaborovskii Nikita , Ptashnikov Dmitry , Mikhaylov Dmitry , Smekalenkov Oleg , Masevnin Sergei , Lapaeva Olga
Published: April 2016

Introduction

The purpose of our research is evaluation of the outcome after surgery and health-related quality of life (HRQOL) parameters in patients with post-tumor spinal deformity.

Material and Methods

Retrospective clinical and radiographic data were collected for 33 patients (15 male and 18 female, average age of 61.4 years) with spinopelvic malalignments (SRS-Schwab sagittal modifiers: 2 grade and more) who underwent spinal deformity surgery. Patients were divided into two groups. The first group included 13 patients ( n = 12 after chemotherapy of plasmacytoma, n = 1 patient after radiotherapy of cervix uteri cancer metastasis) with confirmed spinal oncology diagnosis by biopsy. All patients have had oncology remission with a 3-year minimum follow-up. Spinal deformity was developed in the period between 1 and 6 years after conservative treatment. Repeated biopsy did not show tumor cells, this was evaluated as local control of tumor. Low scores of HRQOL and unsuccessful nonoperative approach were indications for surgical intervention. The second comparative group consisted of 20 patients with “de novo” degenerative or posttraumatic spinal deformity. The aim of surgical management was to achieve sagittal balance, using osteotomies and transpedicular instrumentalization. Groups were evaluated with HRQOL-scales including VAS, ODI, SF36 and SRS-24. Radiographical assessment included Cobb coronal angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), sagittal vertical axis (SVA). Radiographical, HRQOL-parameters and complications were analyzed and compared between two groups. The comparisons were done by using independent sample Student t-test. A p-value of less than 0.05 was accepted as significant.

Results

Both groups showed a restoration of global spinal alignments without significant differences in TK, LL, PI, PT, SS, SVA parameters (p > 0.05). In addition, HRQOL-scores (VAS, ODI, SF36, SRS-24) of the patients were increased after operation. The HRQOL-scores after 2 years are slightly higher in the first group, but we did not get significant difference between groups (p > 0.05). The number of complications in the form of implant instability, proximal and distal junctional disorders was comparable (p > 0.05). However, general medical complications in the first group was significantly higher than in the second one ( p < 0.05). It is important that no patients had local recurrence or metastasis of tumor during follow-up in the first group.

Conclusion

Spinal tumor under local control is not contraindication for spinal deformity surgery. Realigning of the sagittal plane is paramount, especially because of the sagittal balance impact on quality of life.
Prognostic Factors for Survival in Surgical Series of Symptomatic Metastatic Epidural Spinal Cord Compression: A Prospective North American Multi-Centre Study in 142 Patients
Authors: Nater Anick , Fehlings Michael , Tetreault Lindsay , Kopjar Branko , Arnold Paul , Dekutoski Mark , Finkelstein Joel , Fisher Charles , France John , Gokaslan Ziya , Rhines Laurence , Rose Peter , Schuster James , Vaccaro Alexander R. , Sahgal Arjun , Massicotte Eric
Published: April 2016

Introduction

Symptomatic Metastatic Epidural Spinal Cord Compression (MESCC) afflicts up to 10% of all cancer patients and is associated with shortened survival and worsened quality of life. This study aims to identify the key survival prognostic factors in MESCC patients who were surgically treated for a single symptomatic lesion.

Material and Methods

142 MESCC patients were enrolled in a prospective North American multi-center study and followed postoperatively for 12 months. Using univariate analyses, Kaplan-Meier methods, and log-rank tests the prognostic value of various clinical predictors were assessed. Non-collinear predictors with p < 0.05 in univariate analyses were included in the final Cox proportional hazards model.

Results

The overall median survival was 7.7 months (range: 3 days – 35.6 months); breast cancer had the longest median survival (12.1 months). Ten patients (7%), whose primary cancer were lung (3), kidney (3), sarcoma (2), prostate (1), and breast (1), died within 30-days postoperatively and 88 had died at 12 months (62%). Univariate analyses yielded eight significant predictors for survival: the growth of primary tumor (Tomita Grade 1 vs Grade 2 and 3), BMI, gender, preoperative SF-36 physical component, EQ-5D, and ODI scores as well as the presence of either visceral or extraspinal bony metastasis. The multiple regression analysis revealed that the Tomita grade (Grade 1 vs Grade 2 and 3; HR: 2.81, p = 0.007), the absence of visceral metastasis (HR: 2.01; p = 0.0044), and higher score on SF-36 physical component (HR: 0.95, p < 0.0001) were independent predictors for longer survival regardless of the selection method used (backward, forward, or stepwise).

Conclusion

Slow growing tumor (Tomita Grade 1), absence of visceral metastasis, and lower degree of preoperative physical disability, as reflected by a higher score on the SF-36 physical component questionnaire, are good prognostic factors for survival in selected patients who underwent surgical treatment for a focal symptomatic MESCC lesion.
Morphology and TGF-beta1 Concentration's Analysis of Ligamentum Flavum of Patients with Lumbar Canal Stenosis and Lumbar Disc Herniation
Authors: Carletti Sandro , Ciampini Alessandro , Di Muro Licia , Delfinis Catia Pompea , Tinella Elettra , Caputo Nevia , Rispoli Rossella
Published: April 2016

Introduction

The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain, and paresis. The etiology of degenerative changes occurring in lumbar stenosis still remain unclear: some authors hypothesize the hyperplasia and others the hypertrophy of Ligamentum flavum (LF). The change of LF is known to be related to degenerative changes that are secondary to the aging process or mechanical instability. The study's objective is to analyze the LF of patients with lumbar canal stenosis and lumbar disc herniation to evaluate the morphology and the concentration of the Transforming Growth Factor-β 1 (TGF-β 1). Material and Method:The study is characterized by three phases: (A) Measurement of the thickness of the LF of patients with lumbar stenosis and/or herniated lumbar disc through the axial, T1 weighted images of the lumbo-sacral magnetic resonance imaging (MRI); (B) Removal of LF in patients undergoing intervention for lumbar stenosis and lumbar disc herniation (control group); (C) Optical microscopy study of the morphology of degenerated ligamentum and immunohistochemical analysis to assess the concentration of TGF-β 1 in the same. The analysis of the morphology of the ligamentum (meant as the increase of the fibers number or distension and relaxation of the same as a result of degenerative processes) and the presence or absence of a high concentration of TGF-β1 (then more fibroblasts involved in the degenerative process) can be important to clarify if there is an hypertrophy or hyperplasy of ligamentum flavum in lumbar canal stenosis.

Results

In the current study we have showed that decreased elasticity of LF in the elderly is due to the loss of elastic fibers that are degenerated and a concomitant increase of collagenous fibers (hypertrophy); the concentrations of TGF-β1 of the LF measured in both lumbar spinal stenosis and disc herniations was higher than that of the latter.

Conclusion

The current results suggest that LF of lumbar canal stenosis is hypertrophic: LF hypertrophy could be due to the thickening of the normal elastic layer as well as of the abnormal collagenous layer and to higher expression of TGF-β 1 by fibroblasts
An Analysis of the Spinal Nerve Roots in Relation to the Adjacent Vertebral Bodies with Respect to a Posterolateral Vertebral Body Replacement Procedure
Authors: Awwad Waleed
Published: April 2016

Introduction

This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help to improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement via either a transpedicular or costo-transversectomy approach, The major challenge to a total posterior approach vertebrectomy and vertebral body replacement in the thoracolumbar spine lies in the preservation of important neural structures.

Materials and Methods

Retrospective analysis of 100 normal MRI spinal studies (T1-L5) on sagittal T2 weighted MRI images were studied to quantify: 1) mid-sagittal vertebral body (VB) dimensions (anterior, midline and posterior vertebral body height); 2) midline VB and associated intervertebral discs height; 3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE) and 4) posterior approach expansion ratio (PAER).

Results

1) The mean anterior VB height gradually increased cranio-caudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. 2) Midline VB and intervertebral disc height gradually increased from T1 to L4. 3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. 5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level.

Conclusions

The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VB replacement from a posterior approach should take into account the specifications at each spinal level.
Which Factors Influence the Surgery vs. Non-surgery Decision for Adult Idiopathic Scoliosis Patients with Gray Zone (40-55°) Main Thoracic Curves?
Authors: Yilgor Caglar , Enercan Meric , Hamzaoglu Azmi , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Acaroglu Emre , Obeid Ibrahim , Kleinstuck Frank , Alanay Ahmet ,   ESSG European Spine Study Group
Published: April 2016

Introduction

To analyze the factors that may influence surgical vs non-surgical treatment for AdIS patients within gray zone (40–55°) main thoracic (MT) curves.

Material and Methods

A retrospective analysis of a multicenter, prospective, consecutive patient series. Inclusion criteria were: AdIS, ≥18 years of age, major curve to be MT, Cobb between 40 and 55°. Ninety-one patients (69 Non-surgical and 22 Surgical) were included. Non-surgery group had 57F and 12M; mean age: 28.3 (18–47), mean Cobb: 46.8° (40- 55). Surgery group had 19 F and 3M; mean age: 31.1 (18–71), mean Cobb: 49.2°(42–55). All patients completed SF-36, SRS-22 and ODI when they were first seen in the clinic. AP and lateral Cobb measurements and sagittal plane parameters were measured. Independent samples t-test was used to compare groups. Variable importance analysis was done using classification and regression tree algorithm to predict factors that influence surgical decision.

Results

ODI, SF-36 PCS and SRS-22 subtotal, function, pain, self-image scores were significantly different between the groups ( p < 0.05). Age, MT curve Cobb, Lumbar curve Cobb, trunk shift, SVA, coronal balance, SF-36 MCS and SRS22 mental health were not statistically different (p > 0.05). Most important variable that created a tendency toward surgery was SRS-22 functional status followed by ODI, SRS-22 pain score, SF-36 PCS and SRS-22 self image score ( Fig. 1 ).

Conclusion

AdIS patients having a curve magnitude in the gray zone (40–55°) with decreased SRS-22 function, pain, self-image and SF-36 PCS and increased ODI scores had a predilection toward surgery. Most important variable was SRS-22 function score. [Figure: see text]
Increased Apoptosis, Expression of Matrix Degrading Enzymes and Inflammatory Cytokines of Annulus Fibrosus Cells in Genetically Engineered Diabetic Rats: Implication for Intervertebral Disc Degeneration
Authors: Park Jong-Beom , Park Eun-Young
Published: April 2016

Introduction

Diabetes mellitus is thought to be an important etiologic factor in intervertebral disc degeneration. However, what is little known is whether diabetes has an effect on annulus fibrosus (AF) cells. The purpose of our study was to investigate the effect of diabetes mellitus on apoptosis, expression of matrix degrading enzymes and inflammatory cytokines of AF cells in age-matched genetically engineered OLETF (diabetic) and LETO (control) rats.

Material and Methods

Lumbar disc tissues (L1–2 through L5–6) were obtained from 6-month old OLETF and LETO rats (10 each). We examined the AF cells and tissues using Masson trichrome stain, TUNEL, Western blotting, and reverse transcription polymerase chain reaction. The apoptosis index and the degree of expression of matrix degrading enzymes and inflammatory cytokines of AF cells were evaluated by semiquantitative method.

Results

OLETF rats showed increased body weight and abnormal 2-hour glucose tolerance tests compared with LETO rats. The apoptosis index and the degree of expression of Fas of AF cells were statistically higher in the OLETF rats. The degree of expression of matrix metalloproteinase-1, -2, -3 and -13 and tissue inhibitor of metalloproteinase-1 and -2 was statistically higher in the OLETF rats. The expression of interleukin-1 and -6 and tumor necrosis factor-α was statistically higher in the OLETF rats. Finally, histological analysis showed more severe fibrosis and loss of lamellar pattern in AF tissues of OLETF rats.

Conclusion

Our results suggest that diabetes mellitus is associated with increased apoptosis and expression of matrix degrading enzymes and inflammatory cytokines in AF cells. This results in more severe fibrosis and loss of lamellar pattern of AF, which leads to intervertebral disc degeneration. Strict DM control might be important to delay or prevent early intervertebral disc degeneration in patients with DM.
Surgical Management of Spinal Dural Arteriovenous Fistulae with Intraoperative Indocyanine Green Angiography: Single Institute Experience
Authors: El-Maghraby Hussien , Bletechi Radu
Published: April 2016

Introduction

Spinal dural arteriovenous fistula (DAVF) is the most common vascular malformation of the spinal cord. We performed an observational study of patients with spinal DAVF who were treated by microsurgical obliteration with intraoperative indocyanine green (ICG) angiograph with the aim of complete obliteration of the fistulae.

Material and Methods

10 patients were included from May 2012 to May 2015. They were treated surgically with intraoperative intravenous administration of ICG. Direct microsurgical exploration was employed to identify the intradural fistulous connection and intravenous ICG was then injected to verify the identification of the lesion. Repeat ICG angiography was performed after the fistula had been obliterated using bipolar electrocautery.

Results

In all patients, ICG angiography correlated reliably with preoperative catheter angiography and intraoperative direct visualization and the fistulous connection was identified and successfully treated surgically.

Conclusion

ICG angiography in the setting of surgical management of spinal DAVF is a simple and effective technique for intraoperative confirmation of the relevant lesion. Post resection ICG angiography reliably demonstrated technical success and may replace formal postoperative catheter angiography.
The Effect of Post Operative Sand Bag Pressure on CSF Leak after Spinal Surgery
Authors: Mousa Hussein
Published: April 2016

Introduction

Dural tears are most common complications of lumbar spine surgery and have been successfully managed using several techniques. These include primary repair, closed subarachnoid drainage, tissue grafting, fibrin-adhesive sealant, and bed rest. In this study a new method with post operative sand bag pressure to prevent Cerebrospinal fluid (CSF) leak is used.

Methods

A prospective study of 96 patients admitted to the Department of Neurosurgery at the Alsadr Teaching Hospital in Basrah/Iraq had CSF leak following different lumbar spine surgeries. Fifty two patients between March 2006 and March 2010 treated with the classical methods and 44 consecutive patients who had a post operative CSF leak between March 2010 and March 2013 treated with sand bag pressure.

Results

Classically treated group (13.5%) patients stopped CSF leak as compared with post operative sand bag pressure group (68.2%) patients stopped CSF leak in the first day. Regarding post operative complications, classically treated group had headache (55.8%), Photophobia (25.0%), nausea (32.7%), vomiting (15.4%), meningitis (5.8%) and revision surgery (9.6%) while post operative sand bag pressure group had headache (20.5%), Photophobia (9.1%), nausea (11.4%), vomiting (2.3%), meningitis (2.3%) and revision surgery (0%).

Conclusions

and bag pressure is an excellent method to decrease duration and complications of CSF leak.
Prevalence of Unsuspected Malignancy in Patients with Vertebral Compression Fracture undergoing Percutaneous Vertebroplasty
Authors: Hansen Emil Jesper , Simony Ane , Rousing Rikke , Carreon Leah Y. , Tropp Hans , Andersen Mikkel Ø.
Published: April 2016

Introduction

Osteoporotic vertebral compression fractures (VCF) affect ~20% of postmenopausal women and can lead to long-term disability. Percutaneous Vertebroplasty (PVP) is a minimally invasive procedure, primarily used in patients with severe pain after VCF. Even with a thorough clinical examination, MRI scans and blood samples, some fractures maybe caused by an underlying malignant disease. Objectives were to determine the prevalence of malignancy and histology in bone biopsies obtained during PVP for osteoporotic VCF.

Material and Methods

Study design - Retrospective study of a prospective collected cohort. 144 consecutive patients underwent PVP for painful VCF, at the Center for Spine Surgery and Research, Middelfart Hospital. All patients had bone biopsies obtained during the PVP, and these biopsies were sent to the Department for Pathology at Vejle Sygehus for histologic diagnosis.

Results

144 patients were included in this study. The majority of the biopsy specimens (137, 95,1%) were acceptable for histological diagnosis. 129 (89.6%) of the biopsies showed no signs of malignancy. Seven (4,9%) were positive for malignancy. 1 biopsy was positive for MGUS. Seven (4.9%) of the biopsies were unsuitable for histologic diagnosis.

Conclusion

Our study shows a prevalence of unsuspected malignancy in biopsies during PVP of 4.9%. Conservative treatment with analgesics and brace can potentially delay diagnosis and treatment of underlying malignant disease. We recommend biopsy during PVP as a standard-procedure, to insure not to overlook any underlying malignancy despite the MRI-scan, blood analysis and clinical examination being inconspicuous.
Upright, Prone, and Supine Spinal Morphology in Adolescent Idiopathic Scoliosis
Authors: Brink Rob , Schlösser Tom , Colo Dino , Vincken Koen , van Stralen Marijn , Hui Steve , Chu Winnie , Cheng Jack , Castelein René
Published: April 2016

Introduction

Adolescent idiopathic scoliosis patients are exposed to ten times more radiation as compared with healthy adolescents, this leads to increased risk of developing malignancies. To minimize the radiation exposure, non-ionizing imaging modalities, such as MRI, can be used, but this is acquired in supine positioning, unlike the standing X-rays that are the gold standard. As far as we know, this is the first study to compare the 2-D morphology of the spine on conventional radiographs with the 3-D morphology on supine MRI and prone CT images. The objective is to evaluate the correlation between the morphology of the spine on conventional radiographs in the upright position and 3-D supine and prone imaging modalities in patients with adolescent idiopathic scoliosis.

Material and Methods

62 adolescent idiopathic scoliosis patients planned for scoliosis surgery and had undergone standard pre-operative work-up (upright radiographs, supine MRI for exclusion of neural axis abnormalities and prone CT for navigation surgery for posterior pedicle screw fixation) were included. In all three positions, Cobb angles, thoracic kyphosis, lumbar lordosis and apical vertebral rotation (2-D X-rays: method of Perdriolle, 3-D scans: semi-automatic software) were determined. In addition, on reconstructed 3-D MR and CT images, the true sagittal and coronal morphology were measured semi-automatically (previously validated technique). Chi-square tests were used for correlation analysis between the positions.

Results

In the thoracic and (thoraco)lumbar curves, Cobb angles correlated significantly between conventional radiographs (68 ± 15° and 44 ± 17°), supine MRI (57 ± 14° and 35 ± 16°) and prone CT (54 ± 15° and 33 ± 15°; r ≥ 0.89; p < 0.001). In the axial plane, the apical vertebral rotation showed a good correlation between the positions (upright, 22 ± 12°; prone, 20 ± 9° and supine, 16 ± 11°; r ≥ 0.56; p < 0.001). The thoracic kyphosis and lumbar lordosis on the conventional upright X-rays did not correlate with the true sagittal morphology on MRI or CT. The relation of the thoracic Cobb angle between the standing X-rays and the lying down images of moderate to severe patients is expressed by the formula: upright radiograph (°) = 10.81 + 1.01*supine MRI(°) and prone CT(°) = −3.02 + 1.00*supine MRI(°).

Conclusion

Although there is slight underestimation of the morphology of the 3-D spinal curvature in the supine position as compared with upright, there is a significant correlation of the deformation in all three dimensions between the different body positions and imaging modalities. Therefore, accurate estimation of the upright morphology of adolescent idiopathic scoliosis is possible, using non-ionizing supine MRI or prone CT scans.
Larger Curve Magnitudes (> 70 Degrees) in Adolescent Idiopathic Scoliosis are Associated with Significantly Higher Cost of Surgical Treatment and a Delayed Return to Function
Authors: Tarrant Roslyn , Kiely Patrick
Published: April 2016

Introduction

Surgical procedures to correct larger curve magnitudes >70°in patients with adolescent idiopathic scoliosis (AIS) are still common globally. Despite the increased complexity associated with surgical correction of these curves, there is limited evidence available assessing the effect of preoperative curve severity on clinical or economical outcomes. This study aimed to examine the impact of preoperative curves >70° versus those ≤ 70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF).

Material and Methods

Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to postoperative function was reported. Preoperative curves > 70° versus ≤ 70°, were analyzed in relation to surgical duration, estimated blood loss, perioperative complications, length of hospitalisation, return to function and cost of surgical treatment per patient.

Results

Severe preoperative curves greater than 70°, identified in 21 patients (27.3%), were associated with significantly longer surgical duration (median 6.5 hour versus 5 hour, p = 0.001) and increased blood loss (median 1,250ml versus 1,000ml, p = 0.005) – these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, Confidence Interval 1.4–2.7, p = 0.004). Curves greater than 70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 versus €28,620, P < 0.0001).

Conclusion

Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70°versus those ≤ 70°. Surgical correction for curves > 70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.
Is There a Difference in Outcome between Top and Side Loading Instrumentation System Used for the Surgical Treatment of Adolescent Idiopathic Scoliosis (AIS)
Authors: Fallatah Salah
Published: April 2016

Introduction

Different Instrumentation systems has been developed for the surgical correction of Adolescent idiopathic Scoliosis (AIS) with different deformity correction techniques. Material and Method: The purpose of this retrospective study was to compare top loading to side-loading instrumentation systems used in the surgical treatment of AIS looking at the clinical, functional and radiological outcomes as well as the cost difference between different systems. Thirty matched surgically treated female patients were assigned to 2 groups, group one were treated using a top loading system and in group 2 a side-loading spinal instrumentation system was used. The groups were evaluated for curve magnitude, percent correction, functional outcome using the scoliosis research society questionnaire-30.

Results

both groups were similar in their demographic data, preoperative clinical and functional variables. The cost of instrumentation was significantly higher in group 2. At 2 years follow up: both groups have significant improvement in all domaines of Scoliosis Research Society score-30. Group 1 had a better (not significant) correction of the rib hump and both groups had similar percent correction of the main curve.

Conclusion

The surgical treatment of AIS with side loading systems was significantly more expensive but had statstically similar functional and radiographic results to the top loading system. The top loading system achieved better correction of the rib hump.
Surgical Technique for Cervical Pedicle Screw Insertion using O-Arm
Authors: Shimokawa Nobuyuki
Published: April 2016

Introduction

Posterior cervical fixation using lateral mass screw and cervical pedicle screw (CPS) is getting available for various disorders such as trauma and degenerative disease and so on. The purpose is to report our detail surgical technique for CPS insertion using O-Arm, about cannulated CPS particularly.

Material and Methods

Consecutive one hundred twenty patients underwent posterior cervical fixation using CPSs since January 2007. Preoperatively we made further evaluation of the each patient's radiological condition including collateral circulation using MRI and MR angiography and CT angiography. We evaluated local instability with dynamic cervical radiography at each. During making pilot hole of CPS, usually we have felt resistant strong force which cervical back muscles and subcutaneous tissues have produced. So if we made short midline skin incision in particular, CPS underwent through the bilateral another skin incision which we made at the paramedian area. Using O-arm, CPSs were inserted slowly and intermittently taking care not to produce axial rotation or sagittal bending of the cervical spine, which related to the screw malposition including VA injury. And recently we used to use the cannulated screw.

Results

We inserted 668 CPS and classified their position with Neo's classification using postoperative CT scan, grade 0 (635 screws, 95.0%), grade 1 (27 screws, 4.0%), grade 2 (6 screws, 0.9%), grade 3 (0 screws). No neurovascular complications associated with surgery were encountered.

Conclusion

We believe what is the most important for safe CPS insertion is preoperative detail further evaluation including the indication of CPS. We think our procedure and techniques for CPS insertion are useful and safe.
The Comparison between O-Arm Navigation System and C-Arm Fluoroscopy Navigation System for the Amount of Radiation Exposure in Balloon Kyphoplasty
Authors: Maruo Yohei , Maruo Yohei
Published: April 2016

Introduction

Recently, balloon kyphoplasty(BKP) is widely used for osteoporptic vertebral fracture. In this study, we compare the amount of the radiation exposure between O-arm navigation system and C-arm fluoroscopy navigation system in BKP. We consider further review for the radiation exposure in BKP from here on.

Material and Methods

63 patients with vertebral fracture is recruited from Kansai Erectronic Power Hospital between March 2011 and June 2014. In all cases, we monitored the amount of radiation exposure by each device. In 63 cases,10 is O-arm navigation system and 53 is C-arm fluoroscopy navigation system.

Results

The average amount of the radiation exposure is 35.994mGry (range 0.52–97.27) in O-arm and 17.284mGry (range 2.69–86.6) in C-arm. The average radiation time is 35.227 second (range 1.9–57.71) in O-arm and 94.886 second (range 25–319) in C-arm.

Conclusion

O-arm navigation system use is shorter in radiation time and larger in radiation exposure than C-arm fluoroscopy navigation system. However, the amount of the radiation exposure per unit time in O-arm navigation system is larger than in C-arm fluoroscopy navigation system. We should consider the way to reduce the radiation exposure by stepping down the output power in O-arm.
O-arm Imaging and Naviation Systems for Transvertebral Anterior Cervical Foraminotomy
Authors: Umebayashi Daisuke , Yamamoto Yu , Nakajima Yasuhiro , Hara Masahito
Published: April 2016

Introduction

Anterior cervical discectomy and fusion (ACDF) results in excellent initial clinical results for herniated cervical disc and an osteophyte. On the other hand, the development of adjacent segment disease after ACDF is well recognized. However, most patients do not require total discectomy and vertebral fusion because most radiculopathies are caused by focal lesions of the intervertebral foramen. Especially, in patients who have unilateral radiculopathy with physiological alignment, we should avoid removal of healthy discs. Transvertebral anterior cervical foraminotomy (TVACF), nonfusion and nondiscectomy technique, can preserve intervertebral disc and reduce adjacent intervertebral degeneration compared with intervertebral fusion. Therefore, we have reported the advantages and usefulness of TVACF. However, TVACF requires skillfulness, especially for the appropriate drilling direction control for the keyhole. Recently, O-arm imaging and navigation systems were progressed. This navigation systems help to make the correct direction of the keyhole.

Material and Methods

We have performed TVACF under O-arm imaging and naviation systems. The patient was placed in the supine position. A lateral radiograph was used to identify the skin incision level. A 3.5cm transverse skin incision was made at half a level higher than the affected disc level. We approached the anterior surface of the vertebra from the affected side. After then, O-arm imaging and navigation systems were applied. We determined the appropriate keyhole position under the navigation. The lateral and caudal side trajectory of the tunnel was also decided under the navigation. The tunnel was ~6 mm in diameter.

Results

Under O-arm imaging and navigation systems, we were able to easily determine the appropriate keyhole position and the lateral and caudal side trajectory of the tunnel. Intraoperative findings and postoperative computed tomography imaging showed the accuracy of keyhole position.

Conclusion

Successful surgery is possible with using O-arm imaging and navigation systems. This navigation facilitate TVACF. As a result, TVACF is able to be more widely used among spinal surgeons in safe.
Neurological Recovery after Traumatic Cervical Spinal Cord Injury is Superior if Surgical Decompression and Instrumented Fusion are Performed within 8 h versus 8–24 h after Injury: A Single Centre Experience
Authors: Jug Marko , Kejžar Nataša , Vesel Miloš , Al Mawed Said , Dobravec Marko , Herman Simon , Bajrovic Fajko
Published: April 2016

Introduction

Traumatic spinal cord injury (tSCI) is a catastrophic event with enormous personal, social and economic impact. Despite recent progress in understanding the pathophysiology of acute tSCI and the positive effects of acute spinal cord decompression on neurological recovery reported in standardized preclinical studies, neurological benefits of early surgical decompression (SD) remain elusive in the clinical setting.

Material and Methods

A prospective study was performed to evaluate the impact of SD and instrumented fusion within 8 hour versus 8–24 hour after injury on neurological recovery after cervical tSCI in patients operated on in the UMC Ljubljana, Slovenia. Only patients with the ASIA Impairment Scale (AIS) grades of A through C and with MRI-confirmed spinal cord compression were enrolled. The primary outcome was the change in AIS grade at the six-month follow-up.

Results

Of the 48 enrolled patients, 22 patients who underwent surgery within 8h (Group-8h) and 20 patients who underwent surgery between 8 and 24h (Group-8–24h) after injury concluded the study. At admission, there was no statistically significant difference in AIS grade between the study groups. At the six-month follow-up, an improvement of at least two AIS grades was found in 45.5% of patients in Group-8h and in 10% of patients in Group-8–24h ( p = 0.017). In a multivariate analysis, adjusted for the preoperative AIS grade and the degree of spinal canal compromise, the odds of an at least two-grade AIS improvement were at least 106% higher for patients in Group-8h than for patients in Group-8–24h (OR = 11.08, p = 0.004). No statistically significant difference was found in the rate of pneumonia, the number of ventilator-dependent days or the mortality between the groups.

Conclusion

Our results suggest that the patients with tSCI who undergo SD within 8h after injury have superior neurological outcomes than patients who undergo SD 8 to 24h after injury, without any increase in the rate of adverse effects.