bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior Column Reconstruction with Bundled Autologous Rib Graft after Thoracic Spinal Tuberculosis Debridement
Authors: Wang Qing , Xu Shuang , Wang Gaoju
Published: April 2016

Introduction

Vertebral defects are created after radical debridement for spinal tuberculosis, which often require anterior spinal column reconstruction with a strut graft. Autologous rib can be harvested through the same skin incision and can be exploited to reconstruct anterior column defect for thoracic spinal tuberculosis. The purpose of this study was to assess the clinical efficacy of bundled autogenous rib graft for anterior column reconstruction after thoracic spinal tuberculosis debridement.

Material and Methods

Fifty-eight patients with a confirmed diagnosis of thoracic vertebral tuberculosis (T4-T11) between January 2008 and December 2013 were analyzed retrospectively. All patients underwent anterior radical debridement and immediate reconstruction using bundled autologous rib with anterior instrumentation. We retrospectively analyze the clinical and radiographic data.

Results

All patients were followed 24–42 months and achieved solid bony fusions. There was no slide, subsidence, migration and breakage of bundled autogenous rib and screw-rod system. No significant loss of deformity correction was noted. Spinal cord function was effectively improved in all patients who had incomplete paralysis before surgery. There was no recurrence of tuberculosis. Pleural damage occurred in 10 ases while the rib was harvested. They were treated successfully with repair and closed drainage after operation. Two patients suffered from intercostal neuralgia postoperative and were relieved using non-steroidal anti-inflammatory (NSAID). The length of the rib harvested intraoperative was 15–22 cm with an average of 17.1 cm. Length of bundled autologous rib was 1.5–4.6 cm with an average of 3.7 cm. Cross-sectional area of bundled autologous rib accounted for an average of 35% of the endplate area adjacently.

Conclusions

This case series demonstrates anterior radical debridement, graft and instrumentation are safe and effective methods for thoracic tuberculosis. The bundled autogenous rib graft and anterior instrumentation could work effectively to provide immediate stabilization for reconstruction of anterior column defect created by radical debridement for thoracic spine.
Comparison of Surgical Outcomes by the Age at the Time of Surgery in the Treatment of Congenital Scoliosis: More than 10-year Follow-up
Authors: Chang Dong-Gune , Kim Jin-Hyok , Na Ki-Ho , Lee Jung-Hee , Suk Se-Il
Published: April 2016

Introducion

There is little information reported about the long term follow-up of surgical outcomes that pertain to the timing of surgery for congenital scoliosis in children under age 20 years. This study is to compare the surgical outcomes of posterior vertebral column resection (PVCR) for congenital scoliosis in children less than 20 years of age.

Materials and Methods

Forty-five congenital scoliosis patients ( N = 45) under age 20 at the time of surgery were treated by PVCR and fusion with PSF. These cases were retrospectively studied and had a minimum 10-year follow-up. We assigned patients into two groups: Group 1 ( N = 19) patients who had surgery before 10 years of age, Group 2 ( N = 26) those who had surgery after 10 years of age.

Results

In Group 1, the mean Cobb angle of the main curve was 44° before surgery, 10.2° after surgery, and 14.2° at last follow-up. In Group 2, the mean Cobb angle of the main curve was 48.7° before surgery, 17.2° after surgery, and 20.4° at last follow-up. The mean operative time was 189 minute (range: 70 to 405 minute) in Group 1 and 245 minute (range: 80 to 395 minute) in Group 2. The mean estimated blood loss (EBL) was 1285 mL (range: 270 to 3000 mL) in Group 1 and 2376 mL (range: 600 to 6000 mL) in Group 2. The mean fused segments were 3.3 in Group 1 and 4.6 in Group 2.

Conclusions

In congenital scoliosis patients, PVCR is an effective procedure for the management of congenital scoliosis under age 20. PVCR and fusion with PSF for congenital scoliosis before the age of 10 years had significantly better deformity correction compared with the group after the age of 10 years and did not cause crankshaft phenomenon. The mean operative time and EBL in children under age 10 were both significantly less compared with children between 10 and 20 years of age.
Effect of Posterior Dynamic Instrumentation on High-Intensity Zone in Lumbar Degenerative Disc Disease
Authors: Canbay Suat , Ataker Yaprak , Canbolat Nazan , Kabaoglu Zeynep Unal , Oktenoglu Tunc , Sasani Mehdi , Ozer Ali Fahir
Published: April 2016

Introduction

To investigate high-intensity zone (HIZ) changes after lumbar posterior dynamic instrumentation.

Material and Methods

Our study included 53 patients: 27 patients in group 1, 26 patients in group 2. All patients had one or two levels of degenerative disc disease with an HIZ confirmed by magnetic resonance imaging (MRI). Group 1 underwent one- or two-level dynamic lumbar posterior instrumentation. Group 2 was treated conservatively with an exercise program. Patients were evaluated using MRI, a numerical visual analog pain scale (VAS), and the Oswestry Disability Index (ODI) at baseline, at 1 year after surgery, and at final follow-up evaluation.

Results

The mean duration of follow-up was 49.3 months in group 1 and 47.19 months in group 2. The baseline VAS and ODI scores were similar for both groups. The mean VAS score of group 1 was significantly improved at 1 year after surgery and at final follow-up. The mean ODI value was lower in group 1 than in group 2 at 1 year and at final follow-up. Pfirrmann grades in group 1 significantly differed at 1 year and at final follow-up but did not change in group 2. The number of HIZs significantly decreased in from baseline to 1 year and from baseline to final follow-up in group 1 but did not differ in group 2.

Conclusion

Dynamic lumbar stabilization systems are promising. Observations such as Pfirrmann grade improvements and disappearance of HIZs are concordant with improvements in VAS and ODI scores demonstrate that dynamic stabilization systems may provide an environment for regeneration.
Adipose-derived Stem Cells as a Potential Additive Therapy in Chronic Compression Neuropathy in Rodents: a Diffusion Tensor Imaging Study
Authors: Sottaz Lima , Schären Stefan , Madduri Srinivas , Schäfer Dirk , Kalbermatten Daniel
Published: April 2016

Introduction

Compression neuropathy and nerve root compression are a leading cause of morbidity as well as a major cause of work impairment. Surgical and conservative treatments are widely used but there is still a lack of long-lasting effects. We seek to provide an additive therapy consisting of injected adipose-derived stem cells (ASCs) in the epineurium of a chronic nerve compression rodent model. In animal studies, evaluation of peripheral nerve injury and therapy monitoring is commonly performed using clinical scoring and histopathological workup. Recent developments in magnetic resonance imaging allow for the direct evaluation of nerve fiber integrity. Here we present the evaluation of this imaging method, diffusion tensor imaging (DTI) in the context of chronic sciatic nerve compression.

Material and Methods

We created a compressive lesion with a polymer clip on the left sciatic nerve of Sprague-Dawley rats. 0.5 million ASCs were injected in the epineurium under ultrasound guidance two weeks after the crush injury in a first group. The second group was injected with culture medium as control. The clips were removed in a third group who benefited from an intraoperative injection of ASCs and a fourth group underwent the same procedure but received the sham injection. Gait analyses with calculation of the Sciatic-Function-Index using a computed track were performed before the cells or sham injections as well as after two and four weeks. Two weeks post injection, respectively four weeks, post-mortem imaging was acquired on a 3-Tesla scanner. The Fractional Anisotropy (FA), a measure of fiber integrity, was measured for the proximal and distal part of the lesion and for the contralateral nerve. Afterwards, histomorphometry of cross sections of the nerve, histochemistry for muscle fiber typing and calculation of the gastrocnemius muscle weight ratio were undertaken.

Results

The FA showed no differences between the injured and uninjured side at the proximal site. Distally, the FA was clearly reduced on the injured side. The FA in the group treated with ASCs who underwent clip removal was significantly higher as well as the FA ratio (distal value/ proximal value). These findings could be correlated with clinical and histological analyses that showed faster regeneration and faster clinical recuperation in this group associated with reduced muscle atrophy.

Conclusion

ASCs alone seem to be insufficient to provide a clinically relevant treatment in this context of severe crush injury. Nonetheless, regenerative cells could be an interesting additive therapy after surgical decompression. Furthermore, our results indicate that DTI may be used to quantitatively assess sciatic nerve injury after treatment using ASCs in a rat model.
Safety and Efficacy of Local Bone with PEEK Cage versus Iliac Bone Graft in Anterior Cervical Discectomy and Fusion: A Prospective Study
Authors: Liu Zhili , Liu Jiaming , Xiong Xu , Xu Risheng
Published: April 2016

Introduction

A prospective study was performed to compare the clinical and radiological results between the use of local bone graft with a PEEK cage versus an iliac bone graft in anterior cervical discectomy and fusion (ACDF).

Materials and Methods

A total of 60 consecutive patients who underwent ACDF were evaluated from January 2010 to January 2013. 29 patients received an ACDF with a PEEK cage combined with local bone graft (local bone cohort) and 31patients received an ACDF with tricortical iliac bone graft (iliac bone cohort). The intraoperative and perioperative complications of both cohorts were recorded. Preoperative and postoperative radiographs were taken to calculate the ratio of interbody height to the disc height and the interbody bony fusion rate. The Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) were used to estimate postoperative clinical outcomes.

Results

The mean follow-up time was 25.0 ± 3.8 months in the local bone cohort and 24.4 ± 3.4 months in the iliac bone cohort ( p = 0.56). Although there was no statistically significant difference between the two cohorts in terms of blood loss ( p = 0.17), the length of surgery was significantly less in the local bone cohort compared with that of the iliac bone cohort ( p = 0.01). Postoperatively, VAS scores were significantly decreased, and JOA scores were improved in both cohorts. However, no statistically significant difference was found between the two cohorts at final follow up ( p = 0.45, p = 0.93). The disc space height and segmental interbody angle at the surgical segment were greater in local bone cohort than those in the iliac bone cohort ( P < 0.001 and P < 0.001). The fusion rates were 93.1% (27/29) in local bone cohort and 90.3% (28/31) in the iliac bone cohort at last follow up ( p = 0.70). Perioperative complication rates in local bone cohort and iliac bone cohorts were 6.8% and 29%, respectively ( p = 0.04).

Conclusions

In a prospective study of 60 patients receiving ACDF with either local bone graft with a PEEK cage or an iliac bone graft alone, the former had a statistically shorter operation time, lower perioperative complications rate, and better radiological results. Although further long-term studies will delineate whether these improved radiographic findings will translate into better clinical outcomes, the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft during the perioperative period.
Anterior Cervical Discectomy and Fusion Using an “Oversized” PEEK Cage: Radiological and Clinical Outcome
Authors: El-Sharkawi Mohammad , Gad Wael
Published: April 2016

Introduction

There has been controversial data about the effect of cage size on radiological and clinical outcome of anterior cervical discectomy and fusion (ACDF). Oversized cages have been linked to higher incidence of non-union, adjacent segment disease, and unfavorable clinical outcomes. The aim of this work is to evaluate the effect of an oversized PEEK cage on the radiological and clinical outcomes in ACDF.

Patients and Methods

Between January 2012 to July 2014, 57 patients (29 single level, 15 double levels, 8 three levels, 5 four levels) underwent ACDF using a stand-alone oversized PEEK cages. They were 35 males and 22 females with mean age 56 ± 13.5 years. The minimum follow up period is one year. The following parameters were measured preoperatively, postoperatively and at final follow up: cervical lordosis (in degrees), disc height (in mm), motion at operated level (in degrees), radiological ASD (present or not) and VAS for neck pain, VAS for arm pain. All complications were as well recorded.

Results

The mean cervical lordosis changed from 25°±5.5 postoperative to 7°±4.5 at final follow up. The mean disc height was 5± 2 mm preop, 7 ± 1.5 mm postop and 6 ± 1 mm at final follow up. Residual motion at operated level was observed at 1 year follow up X-rays in 2 patients (one double level and one 3-level) with average 5°. None of them had neck pain and no revision was required. In the postoperative X-rays, the suprajacent level was always observed to be slightly narrowed; this narrowing gradually diminished during the follow up. Radiological ASD developed in 9 patients (16%), all of them remained to date asymptomatic. The average improvement in VAS for neck pain was 27%±8.5 and the average improvement in VAS for arm pain was 33%±9.5. At the final follow up, fusion was achieved in 55 patients (96%) and clinical outcome was excellent. Radiological loss of the postoperative disc height and cervical lordosis and development of radiological ASD did not correlate to poor clinical outcome. No single case of cage dislodgement was observed in this series.

Conclusion

The use of a stand-alone oversized PEEK cage in ACDF seems to minimize the incidence of cage dislodgment even in multiple levels ACDF. Despite some radiological settlement and loss of cervical lordosis, an excellent clinical outcome was maintained.
Identifying the Best Treatment in Adult Spinal Deformity: A Decision Analysis Approach
Authors: Acaroglu Emre , Yavuz Aysun Çetinyürek , Güler Ümit Özgür , Yuksel Selcem , Yavus Yasemin , Ayhan Selim , Sabat Montse Domingo , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Alanay Ahmet , Obeid Ibrahim , Kleinstuck Frank ,   European Spine Study Group (ESSG)
Published: April 2016

Introduction

Adult spinal deformity (ASD) is a major public health problem. There are pros and cons of the available treatment alternatives (surgical or non-surgical) and it had been difficult to identify the best treatment modality. Aim of this study is to construct a statistical decision analysis (DA) model to identify the optimum overall treatment in ASD.

Material and Methods

From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical –NS), 164 surgical –S), constitute the population of this study. DA was structured in two main steps of: 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference –utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis.

Results

432 patients (309 NS, 123 S) had baseline and 1 year follow-up ODI measurements. Overall, 104 (24.1%) were found to be improved (a decrease in ODI > 8 points), 225 (52.1%) unchanged (−8 > ODI > 8) and 65 deteriorated. Surgery presented with a higher chance of improvement (54.2%) versus NS (9.7%) (Table 1a). The overall QALE ranged from 56 to 69 (of 100 years) and demonstrated better final outcomes in the NS group, although this group had also started with higher QALE. There were improvements in overall QALE in both groups but this was significant only in the surgical group (Table 1b). In addition, in the subgroup of patients with significant baseline disability (ODI > 25) surgery appeared to yield marginally better final QALE (Table 1c).

Conclusion

This study demonstrated that a single best treatment modality for ASD may not exist. Conservative treatment appears to yield higher (up to 6%) QALE compared with surgery, probably secondary to a higher baseline QALE; except in patients with significant disability at baseline. On the other hand, surgery provides a significantly higher increase in QALE and chances of improvement at 1st year are significantly lower with NS treatment.
A Multicenter Prospective Randomized Controlled Clinical Trial to Evaluate the Effectiveness and Safety of a Standalone Percutaneous Interspinous Spacer versus Decompressive Surgery in Degenerative Lumbar Spinal Stenosis with Neurogenic Intermittent Claudication
Authors: Meyer Bernhard , Le Huec Jean Charles
Published: April 2016

Introduction

The objective of this study is to show that a minimally invasive percutaneous IPD is safe and non-inferior to SDS with regards to clinical outcomes in patients suffering from Degenerative Lumbar Spinal Stenosis with NIC (Neurogenic Intermittent Claudication), relieved by flexion. (Design: Multicenter international randomized controlled trial)

Methods

One hundred and sixty three patients enrolled by 19 sites across 10 countries (mean age 65 ± 11 years, 51% female, mean duration of leg symptoms 2.5 years) were randomly assigned to IPD or SDS group and are followed until 24 months. Physical function, symptom severity and patient satisfaction were assessed by Zurich Claudication Questionnaire (ZCQ) at baseline, 14days, 6 weeks, 6 months and 12 months follow-ups. Leg, buttock/groin and back pain were assessed by VAS scores. SF-36v2 questionnaire was used to assess quality of life. In addition, physical examination data was collected at all-time points. Percentage of re-operations at index level at follow-up was determined. (Trial registration NTC00905359)

Results

ZCQ physical function mean percentage change from baseline to 12 months (primary outcome variable) decreased equally and without statistically significant difference over all points in time for IPD and SDS group (respectively, −32 ± 32%, −37 ± 23%, p = 0.158, CI −5, +15). As for secondary outcomes the IPD group showed lower mean surgical time and mean blood loss (respectively, 24 ± 11 minutes and 6 ± 10 ml, p < 0.001) compared with the SDS group (70 ± 39 minutes and 157 ± 145 ml, p < 0.001). Symptom severity improved in both groups equally (−31 ± 27%, −36 ± 25%, p = 0.140, CI −4, +14). No differences in patient satisfaction were observed. VAS leg pain score improved with 59% for the IPD and 66% for the SDS group from baseline to 12 months follow-up. SF-36 v2 physical and mental aggregated score improved equally over time for both treatment groups. At 12 months, 47 SAEs were reported, in 36 patients. Re-operations at index level occurred in 9% of the patients in the IPD group and in 7% in the SDS group. In 6 patients the IPD was explanted.

Conclusions

This study confirms two prior recent RCTs. Implantation of an IPD as well as open decompression achieve both equally satisfying results in patients with NIC. Both seem to be appropriate procedures with an advantage in some secondary outcomes for IPDs. So far the significantly higher reoperation rate for IPDs could not be confirmed in this study, which opens a window of indication in a subset of patients with NIC, i.e., those with cardiac or other comorbidities.
The Surgical Management of Low Grade Single Level Adult Degenerative Spondylolisthesis: Posterolateral Fusion versus Posterior Lumbar Interbody
Authors: ElAbed Khaldoun
Published: April 2016

Introduction

Posterolateral Fusion (PLF) and Posterior Lumbar Interbody Fusion (PLIF) are procedures that can be undertaken for the surgical management of degenerative low grade spondylolisthesis. Although there is tentative evidence in the literature that PLIF provides an increased fusion rate and therefore an improvement in symptomology, PLIF surgery does carry an increased peri- and post-operative complication rate. The aim of this study was to establish which surgical intervention has the better outcomes.

Materials and Method

A prospective cohort study was undertaken of patients who underwent a single level instrumented fusion for low grade degenerative lumbosacral spondylolisthesis between 2008 and 2010. There were 56 patients in total, with 36 patients in the PLF group (group1), and 20 patients in the PLIF group (group 2). Follow-up was at 3 month, 1 year and 3 year post operatively. Visual analogue leg pain score (VAS), Oswestry Disability Index (ODI) for back pain, and SF 12 Health Survey were measured pre and 3 year post operatively. All patients were assessed by MRI scans preoperatively. Standardized lumbosacral radiographs were taken preoperatively, and at 3 month, 1 year and 3 year postoperatively, to assess radiological union.

Results

In the PLF group, the VAS score improved from 8 to 2, the SF 12 score from 25 to 76, and the ODI score from 36 to 8. In the PLIF group, the VAS score improved from 8 to 4, the SF 12 score from 27 to 72, and the ODI score from 38 to 12. All improvements were statistically significant. There was a statistically larger improvement margin in all scores in the PLF group than in the PLIF group. Radiological union was demonstrated in 91% of all patients, with 95% of patients in each group demonstrating at least, unilateral lateral mass bone graft incorporation.

Conclusion

We conclude that PLF surgery is superior to PLIF surgery for the surgical management of low grade single level degenerative spondylolisthesis
A Novel, Objective, Quantitative Method of Evaluation of the Pain Component and Paresthesia Coverage using Comparative Computerized Multiparametric Tactile Mapping and Database Analysis: The “Neuro-Mapping-Tools” Software (N3MT)
Authors: Roulaud Manuel , Guetarni Farid , Nivole Kévin , Monlezun Olivier , Lorgeoux Bertille , Rigoard Philippe
Published: April 2016

Introduction

One of the major challenges of neurostimulation is actually to address the back pain component in patients suffering from refractory chronic back and leg pain. Facing a tremendous expansion of neurostimulation techniques and available devices, implanters, patients and even industrial companies can still remain confused as they need to select the right tool for the right indication. To be able to evaluate and compare objectively patient outcomes, depending on therapeutical strategies, it appears essential to develop a rational and quantitative approach to pain assessement and neurostimulation outcomes for those who undergo neurostimulation implantation.

Material and Methods

Our neuroinformatics laboratory (N3Laboratory) located in Poitiers University Hospital, Department of Neurosurgery, enabled us to develop the Neuro-Mapping Tools software (N3MT) (Inter Deposit Digital Number: IDDN FR 001–1600002–000-R-P-2013–000–31230; Patent Applications n°PCT/EP2014/067231, n°PCT/FR 14/000 186 and n°PCT/FR 14/000 187). This tool consists of touch screen mapping, allowing the patient and/or the physician to interact by means of a tablet computer to delineate painful zones and paraesthesia coverage in the thoracolumbar region and legs.

Results

The Neuro-Mapping Tools software (N3MT) (Neuro-Pain'T, the Neuro-Mapping Locator and the Neuro-Data-Base) have been put together and used in more than 190 patients since 2012, leading us to describe new measurement parameters, divided into two categories: (1) Technical parameters, evaluating the implanted device itself, as “Device Performance, XP,” “Device Specificity, XS” and “Persistence of the Paresthesia Perception” on the long term (XP3). (2) Clinical parameters, evaluating patient response to the therapy: (a) pain surface reduction. This parameter is called YS. (b) pain intensity reduction. This parameter is called YI. (c) pain characteristics redistribution after implantation. This parameter is called YPC.

Conclusion

The N3MT software could help to guide tomorrow's treatment options by transforming personal convictions into a more robust scientific rationale based on data collection and data mining techniques.
Survival and Clinical Outcomes in Patients with Metastatic Epidural Spinal Cord Compression: Results from the AOSpine Prospective Multi-Centre Study of 142 patients
Authors: Fehlings Michael , Nater Anick , Tetreault Lindsay , Kopjar Branko , Arnold Paul , Dekutoski Mark , Finkelstein Joel , Fisher Charles , France John , Gokaslan Ziya , Rhines Laurence , Rose Peter , Massicotte Eric , Sahgal Arjun , Schuster James , Vaccaro Alexander R.
Published: April 2016

Introduction

Although surgery is being increasingly used in patients with Metastatic Epidural Spinal Cord Compression (MESCC) as a complementary strategy to radiation and chemotherapy, the impact of surgery on quality of life (QoL) is not well established. This study aimed to prospectively evaluate survival, neurological, functional, and QoL outcomes in MESCC patients undergoing operative management.

Material and Methods

A total of 142 surgically treated patients with a single symptomatic MESCC lesion enrolled in a prospective North American multi-center study were followed for 12 months. Clinical data, such as Brief Pain Inventory (BPI), ASIA, SF-36, Oswestry Disability Index (ODI), and EQ-5D scores, were obtained both pre- and post-operatively.

Results

The median survival was 7.7 months. The 30-day and 12-month mortality rates were 9% and 62%, respectively. Six weeks post-operatively, ambulatory status ( p = 0.02) and bladder control ( p = 0.03) were significantly improved. Overall, 67.5% of ASIA B, C, or D patients gained at least 1 grade after surgery, 25% remained stable, and 7.5% deteriorated. ODI, EQ-5D, BPI scores were significantly improved at each follow-up (p ≤ 0.01). SF-36 scores were generally higher after surgery for mental and physical components, and for all domains except energy/fatigue. The incidence of wound complications was 10% and 2 patients required a second surgery (screw malposition and epidural hematoma).

Conclusion

Surgical intervention, as a complementary adjunct to radiation and chemotherapy, provides immediate and sustained improvement in pain, neurological, functional, and QoL outcomes with acceptable risks in patients with a focal symptomatic MESCC lesion.
Biomechanical Evaluation of the Transpedicular Nucleotomy with Intact Anulus Fibrosus
Authors: Russo Fabrizio , Vadalà Gianluca , Hartman Robert Allen , Bell Kevin M. , Sowa Gwendolyn A. , Vo Nam , Kang James D. , Denaro Vincenzo
Published: April 2016

Introduction

Mechanical loading represents a crucial part of intervertebral disc (IVD) homeostasis. However, traditional regenerative strategies require violation of the annulus fibrosus (AF) resulting in significant alteration of joint mechanics. The transpedicular nucleotomy represents a suitable method to create a cavity into the nucleus polposus (NP), as a model to study IVD regeneration with intact AF. The aim is to study how the transpedicular tunnel (TT) and the novel mechanical nucleotomy affects the biomechanics of the NP.

Material and Methods

60 ovine lumbar FSUs (L1-L6) randomly assigned to 5 groups: Control; TT; TT + polymethylmethacrylate (PMMA), to repair the bone tunnel; Nucleotomy; Nucleotomy + PMMA. The robotic spine testing system consists of a robotic manipulator (Staubli RX90) and a six-axis load cell (JR3 Inc.). Flexion/extension, lateral bending and axial rotation were evaluated under adaptive displacement control. Axial compression was applied for 15 cycles of preconditioning followed by 1 hour of constant compression. Viscoelastic properties were determined.

Results

TT has minimal effects on rotational biomechanics. The nucleotomy increases ROM and NZ displacement width while decreasing NZ stiffness. TT + PMMA has small effects in terms of ROM. Nucleotomy + PMMA brings ROM back to the control, increases NZ stiffness and decreases NZ displacement width. The nucleotomy tends to increase the rate of early creep. TT reduces early and late damping. The use of PMMA increased late elastic damping (S2) and reduced viscous damping (η2) culminating in faster resolution of creep.

Conclusion

Biomechanical properties of NP are crucial for IVD repair. TT does not affect rotational stability. Mechanical changes that occur with nucleotomy are similar to those characteristics of early degeneration. These findings confirm that the NP is crucial for segmental stability in physiologic rotations.
Review of Patient Transfers from Spinal Surgery to the Spinal Injuries Unit
Authors: Grandidge Lisa , Breakwell Lee , Athanassacopoulos Michael , Chiverton Neil , Cole Ashley , Michael Antony
Published: April 2016

Introduction

To review the length of time patients are awaiting spinal injury reviews on the spinal surgery ward and awaiting beds on the spinal injuries unit.

Materials and Methods

A list of all spinal surgery patients with a spinal injuries episode within the same spell during the period 01/04/12 to 26/11/14 were gained by coding ( n = 37). Three patients were excluded from the data (one under neurosurgery, two were transferred from the spinal injuries unit (SIU) and were both discharged from the spinal surgery ward) ( n = 34). Data was obtained via a case note review.

Results

The mean number of days patients were awaiting a SIU bed (calculated from spinal injuries review to transfer) was 19 (+/−14). The maximum time waiting on the spinal surgery ward was 39 days, and one patient waited 48 days for a ventilator bed. The later the admission the longer patients were waiting, with a positive correlation but this was not significant (r = 0.28, p = 0.18). The mean waiting time was 9 days in 2012, 17 days in 2013 and 24 days in 2014. There was a positive correlation between the length of time patients were awaiting a SIU bed and their length of spinal injuries stay (r = 0.105, p = 0.39). The mean time awaiting a spinal injuries review was 5.9 days. However often there was limited documentation regarding how patients were referred and so was not clear when referrals were received by the spinal injuries team. Two patients had no documented review before transfer. The most frequent type of injury which resulted in patients requiring transfer for rehabilitation was fracture (44%), followed by infection (29%). 47% of injuries were in the thoracic spine. 71% received surgery during their admission.

Conclusions

This review shows patients are waiting considerable amounts of time awaiting SIU beds and the delays are increasing each year. Delays cause significant implications for patients such as psychological issues and risk of complications including pressure sores, contractures and infections, all of which can impact on functional outcomes. Delays are a high cost to the NHS (the cost of a critical care bed is over £800 more than a ventilated SIU bed). Further work can be performed reviewing reasons for delays and to look at delays in SIU discharges. Patients could benefit from an increase in spinal injury reviews while beds are awaited. An audit on the management of SCI patients while they are on an orthopaedic ward could ensure care meets current recommendations.
Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-analysis
Authors: Evaniew Nathan , Belley-Côté Emilie P. , Fallah Nader , Noonan Vanessa K. , Rivers Carly S. , Dvorak Marcel F.
Published: April 2016

Introduction

Previous meta-analyses of methylprednisolone for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in pooled effect estimates and new primary studies have been recently published. We performed a systematic review and meta-analysis to determine whether methylprednisolone improves motor recovery and is associated with increased risks for adverse events.

Material and Methods

We searched MEDLINE, EMBASE, and The Cochrane Library for eligible randomized controlled trials (RCTs) and controlled observational studies. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. We pooled outcomes from RCTs and controlled observational studies separately using random effects models. We quantified heterogeneity using the chi-squared test and the I-squared statistic, and we pre-specified subgroup hypotheses to explain potential high heterogeneity. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to evaluate confidence.

Results

We included four RCTs and 17 observational studies. Methylprednisolone did not increase long-term motor score recovery (two RCTs: 335 participants, mean difference [MD] -1.11, 95% CI -4.75 to 2.53, p = 0.55, low certainty; two observational studies: 528 participants, MD 1.37, 95% CI -3.08 to 5.83, p = 0.55, very low certainty) or improvement by at least one motor grade (three observational studies: 383 participants, risk ratio [RR] 0.84, 95% CI 0.53 to 1.33, p = 0.46, very low certainty). Evidence from two RCTs demonstrated superior short-term motor score improvement if methylprednisolone was administered within eight hours of injury (two RCTs: 250 participants; MD 4.46, 95% CI 0.97 to 7.94, p = 0.01; low certainty), but risk of bias and imprecision limit confidence in these findings. Observational studies demonstrated a significantly increased risk for gastrointestinal bleeding (eight studies: 2727 participants, RR 2.53; 95% CI 1.48 to 4.32; p < 0.01, very low certainty), but RCTs did not. Risks for other adverse events were not significantly increased.

Conclusion

Methylprednisolone does not provide significant long-term benefit to patients with acute TSCIs and may be associated with increased gastrointestinal bleeding. These findings support current guidelines against routine use, but strong recommendations are not warranted because confidence in the effect estimates is limited. This meta-analysis advances current understanding because it includes recent studies not pooled previously and it is the first to consider confidence in the pooled effect estimates. Further research could increase confidence and clarify the influence of potential confounders or effect modifiers.
Intrathecal Baclofen Pumps do not Accelerate Progression of Scoliosis in Quadriplegic Spastic Cerebral Plasy
Authors: Rushton Paul , Nasto Luigi , Aujla Ranjit , Vloeberghs Michael , Grevitt Michael
Published: April 2016

Introduction

Intrathecal baclofen pumps are an effective treatment for spasticity in patients with cerebral palsy. Recently, concerns have been raised regarding the potential for intrathecal baclofen pumps to accelerate scoliosis progression and increase the need for spinal fusion surgery. To date the literature remains unclear, with studies often failing to account for the natural history of scoliosis progression in this population when assessing the influence of baclofen pumps. We aim to clarify matters by comparing progression of scoliosis in quadriplegic spastic cerebral palsy with and without intrathecal baclofen pumps. Material and Methods: Design: Retrospective matched cohort . Patients: Inclusion criteria: Quadripegic spastic cerebral palsy, GMFCS level 5, follow up > 1 year, adequate radiographic/clinical data . Methods: Suitable patients who underwent intrathecal baclofen pump insertion were matched to cases with the same diagnosis and function level with comparable age and baseline Cobb angle but without intrathecal baclofen pumps. Outcomes: Primary: Sequential radiographs measured to assess annual coronal curve progression and peak curve progression . Secondary: Need for spinal fusion for curve progression . Analysis: Between group comparisons made with paired t-tests and chi square tests.

Results

Baclofen group: 17 patients (7 female), mean age at insertion of pump 9.4 (3.6), 10 cases with a scoliosis > 10° at baseline. Initial Cobb angle 21° (21) and Risser grade 0.8. Twelve cases had hip subluxation/dislocation at baseline. Mean follow up 4.7 (1.3–8.8) years. Mean Cobb angle at final follow up was 77° (27). Non-baclofen group: 17 patients (10 female), mean age at baseline 9.5 (3.7), 12 cases with a scoliosis at baseline. Initial Cobb angle 25° (20) and Risser grade 0.9. Three cases had hip subluxation/dislocation at baseline. Mean follow up 3.6 (1–7.5) years. Mean Cobb angle at final follow up was 67° (30). The two groups were statistically similar in terms of age, initial Cobb angle, Risser grade and presence/absence of scoliosis at baseline. The baclofen group had a higher proportion of hip subluxation/dislocation at baseline ( p = 0.006). Mean annual curve progression was 13.4° (7.2) for the baclofen group vs 13.6° (9.1) for the non-baclofen group ( p = 0.8). Mean peak curve progression was 31.7 (34) for the baclofen group and 27.1 (18) for the non-baclofen group ( p = 0.95). 4 patients with baclofen pumps and 5 without required spinal fusion for curve progression during follow up. All patients, aside one non-baclofen case, had developed a scoliosis by follow up; mainly thoracolumbar/lumbar collapsing C curves.

Conclusion

Patients with quadriplegic spastic cerebral palsy with and without baclofen pumps showed significant curve progression over time. Intrathecal baclofen pumps do not appear to alter the natural history of curve progression in this population.
Three Dimensional Correction of Severe Rigid Neurofibromatosis Scoliosis
Authors: Koptan Wael , El-Sharkawi Mohammad , ElMiligui Yasser
Published: April 2016

Introduction

The surgical management of severe rigid dystrophic neurofibromatosis curves is a demanding procedure with uncertain results. Several difficulties are present in such patients including a poor bone stock, sharp angulation of these curves and the delicate nature of the dural sac. The aim of this work is to review the clinical and radiographic outcome of three-dimensional correction of severe rigid neurofibromatosis curves analyzing its efficacy, safety and possible complications.

Materials and Methods

The results of 32 patients with severe rigid neurofibromatosis deformities were retrospectively reviewed. Patients were followed-up for a minimum of 3 years; an average of 6.5y (range 3 – 9y). The average age was 14 years (range 11 – 19y). All patients had typical dystrophic curves and the apex of the deformity was dorsal (13 patients); dorsolumbar (14 patients) and lumbar (5 patients). All patients had a two staged procedure; an anterior release followed by posterior instrumentation augmented by sublaminar wires. The wires were placed immediately below the proximal anchor and several sublaminar wires at the apex of the deformity. There were a total of 142 wires with an average of 6.5 wires/ patient (range 5 – 8 wires).

Results

The mean Cobb angle of the main curve was 102° before surgery corrected to an average of 39° and the loss of correction had an average of 4°. Sagittal alignment improved from an average of 12° to an average of 47° and rotation was corrected by an average of 34%. There were no dural tears during passage of the sublaminar wires and no neurological or implant related complications.

Conclusions

The use of extensive and vigorous anterior release with posterior hybrid instrumentation has proved useful and effective in the treatment of these difficult cases; sublaminar wires allow safe gradual correction and even distribution of forces over multiple anchor points improving the correction achieved and decreasing implant related complications.
The Impact of Low Back and Neck Pain on Dentistry Students in Northern Greece
Authors: Stavridis Stavros I. , Samoladas Efthimios , Tsitas Konstantinos , Xanthopoulou Kassiani , Apostolidou Kleri , Hatzokos Ippokratis
Published: April 2016

Introduction

Dentistry students and dentists comprise a unique group of professionals, whose everyday professional activity requires long hours of standing and working in position considered “unhealthy” for low-bask and neck. The aim of this cross-sectional study was to explore the factors involved in the appearance of low-back and neck pain in dentistry students, as well as the impact of the pain on the students' professional and everyday activities.

Materials and Methods

A questionnaire was sent via e-mail to all dentistry students of the 7th, 8th, 9thand 10th semesters (years of clinical practice) of our university. The questionnaire included 43 questions regarding demographical data, history (spinal injury, other comorbidities), daily activities (exercise, smoking, alcohol and caffeine consumption, use of cell phone, etc), professional activities (length and type of dental work), pattern and intensity of pain and personal pain evaluation. A statistical analysis of the gathered data was performed.

Results

All students having suffered a spinal trauma or indicating any other comorbidities that could cause severe pain of the spine were excluded from the study. 55 students (21 male, 34 female) were included in the study. Our data showed that increased alcohol consumption and prolonged use of cell phone were connected to increased levels of pain. The students reported that the most frequent onset of pain was one hour after starting to work in standing position, while the majority believed that their working habits were involved in the appearance and the intensity of neck and low-back pain.

Conclusions

Our findings indicate that among dentists and dentistry students there appears to be a causative relation between their professional activities and the experienced spinal pain. These findings may be useful in a possible future restructuring of the educational program in dental schools, as well as in improving the ergonomics of dentistry working units.
Length of Stay and Post-operative Complications and Their Relation with the Glucose Level Preoperatively in Diabetic and Non-diabetic Patients Undergoing Spinal Surgeries
Authors: Almana Yousef , AlHammad Nouf , Almutair Abdulaziz , Awwad Waleed
Published: April 2016

Introduction

Hyperglycemia in diabetic patients is a well-known risk factor for many perioperative morbidity and mortality, as it alters the normal physiology of the patients responding to many stressors like surgery, it therefore tends to increase the patients’ costs and length of stay in the hospital. Other studies have showed the relation between glycemic instability with the adverse events following spinal surgeries, showing as high as 19% non-diabetic patients, had hyperglycemia and considering it as a risk factor for many adverse events like surgical site infections and sub-optimal wound healing and for the increasing rates of surgical revision, matching our hypothesis of the positive correlation between glycemic instability and the rate of adverse events. The purpose of this study was to expose the effect of glucose level preoperatively on the patient complications and length of stay in the hospital, and to compare between diabetics and non-diabetics with hyperglycemia preoperatively regarding complications and length of stay.

Material and Methods

Of the 129 patients who underwent spinal surgeries at King Saud University Medical City, Riyadh SA, during two years period (2013–2015) exclusion and inclusion criteria were applied including only the patients whom their preoperative glucose level was documented and a total number of 106 patients were enrolled in a retrospective analysis study design. Each of the patients' records underwent a comprehensive and complete review.

Results

34 (32.1%) of our patients were diabetic, 13 (12.2%) of all patients had hyperglycemia, 6 (46.2%) of the hyperglycemic patients had at least one post-operative complication, compared with 9 (10.5%) among the euglycemics ( P value 0.004), having most commonly infections and suboptimal wound healing (23.1%, n 3, P value 0.094, 0.192, respectively), with an increase in length of stay by an average of 4.37 days ( P value 0.256) and the incidence of complications among the hyperglucemic ptients seen in 5 (55.6%) of the diabetics and in 1 (25.0%) of the non-diabetics( P value 0.343).

Conclusion

Pre-operative hyperglycemia is associated with more adverse events post operatively (seen more in diabetics in this study), hence, along with other factors, increasing patients' length of stay in the hospital which adds to the financial costs as well as predisposing to more infections. However, the number of diabetic patients examined in this study was limited, demanding for more extensive researches addressing the same topic.
Differences between Manufacturers of CT-based Computer Assisted Surgery Systems Do Exist: A Systematic Literature Review
Authors: Nooh Anas , Lubov Joushua , Aoude Ahmed , Aldebeyan Sultan , Jarzem Peter , Ouellet Jean , Weber Michael H.
Published: April 2016

Summary of Background Data

Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CT-based navigation systems. Yet, there has been no systematic review directly comparing accuracy of pedicle screw placement between different CT-based navigation systems. The aim of this study was to review the results presented in the literature and compare CT-based navigation systems relative to screw placement accuracy.

Methods

A systematic review of the literature was preformed using CENTRAL, Medline, PubMed and Embase databases. Studies included were randomized clinical trials, case series, and case control reporting the accuracy of pedicle screws placement using CT-based navigation. Two independent reviewers extracted the data from the selected studies that met our inclusion criteria. Papers were grouped based on the CT-based navigation system used for pedicle screws placement.

Results

33 Papers met all of our inclusion criteria and were included in the final analysis, which showed a significant statistical difference ( P < 0.0001) in accuracy of pedicle screws placement between three different CT-based navigation systems. The mean (weighted) accuracy of pedicle screws placement based on the CT-based navigation system was found to be 96.8% ± 3.8% in StealthStation, 96.07% ± 3.8% in VectorVision and 97.7% ± 1.7% in SurgiGate. Post hoc analysis showed a significant statistical difference between StealthStation vs VictorVision ( p < 0.0001) and StealthStation vs SurgiGate ( p < 0.0001) as well.

Conclusion

This paper summarizes results presented in the literature and compares screw placement accuracy using different CT-based navigation systems. The differences in accuracy demonstrated in this review should be considered by spine surgeons, and need to be validated for effects on patients' outcome.

Level of Evidence

Level I.