bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Lumbar Foramina Size Change in Patients with Lumbar Spondylolisthesis using Kinetic Magnetic Resonance Imaging
Authors: Huang Hsiang-Ming , Yang Jui-Jung , Patel Neil , Wang Justin , Hsieh Patrick , Liu John , Buser Zorica , Wang Jeffrey C.
Published: April 2016

Introduction

The pathology of lumbar spondylolisthesis contributes to lumbar instability and significant clinical symptoms. However, the effect on intervertebral foraminal area (FA) during motion change is not well understood.

Material and Methods

In this study we used 107 patients diagnosed with single or multiple level lumbar spondylolisthesis at L3–L4, L4–L5 or L5–S1. All patients were initially divided into two groups: group A (sliding percentage 0–3%) and group B (sliding percentage ≥4%). Sliding percentage and FA size in neutral, flexion and extension were measured using kMRI. The FA change in different sliding groups at L5-S1 level was further analyzed.

Results

The number of patients in the group A (sliding percentage 1–3%) was 68 at L3–4, 38 at L4–5 and 32 at L5-S1 spine levels. The number of patients in the group B (sliding percentage ≥4%) was the following: 39 at L3–L4, 69 at L4–L5 and 75 at L5–S1. The mean FA in both groups changed with different spine positions. When considering all levels, the average FA increased ~17% from neutral to flexion and decreased ~21% from neutral to extension. Similarly, there was a significant difference in FA in flexion at L5-S1 ( p < 0.004) between the groups. For L5/S1 patients, 104 patients were divided into three sub-groups according to the sliding percentage (group I (0–9%), group II (10–19%) and group III (20–29%)). The FA was significantly increased in the flexion position and decreased in the extension position in all three groups. In group III FA size was significantly decreased from neutral to flexion when compared with Group I ( p < 0.022). The FA size was significantly increased from neutral to extension when group III was compared with groups I and II ( p < 0.000 and p < 0.017, respectively).

Conclusion

Our kMRI study revealed position-dependent changes of the intervertebral foramen. In patients with severe sagittal subluxation the change in FA from neutral to extension position demonstrated the largest decrease. This change may also correlate with changes in neuroforaminal stenosis and nerve root compression and its associated symptoms and should be taken in consideration when choosing the treatment option.
Predicting High Surgical Treatment Costs at Primary Spinal Tumor Patients
Authors: Szövérfi Zsolt , Lazary Aron , Koszó Izabella , Papik Kornél , Varga Péter Pál
Published: April 2016

Introduction

Surgical treatment cost of primary spinal tumors -due to the complexity and magnitude of the surgery- can be high. From a healthcare provider perspective being aware of those factors that influence treatment cost is essential for the best hospital resource management. However the impact of the individual patient characteristics on direct medical costs is unknown. Our objective was to identify those preoperative factors that predict a high direct cost at patients with surgically treated primary spinal tumors.

Material and Methods

A retrospective micro-costing study was conducted from a healthcare provider perspective. Total cost per patient resulted from the aggregation of inpatient-days costs, ICU days costs, OR time costs (surgery and anesthesiology), medication costs, blood transfusion costs and other material costs, including appropriate allocation of overheads. Patients with primary spinal tumors operated in the National Center for Spinal Disorders between 2011 and 2014 were selected. The prognostic value of ten preoperative factors (dignity, previous surgery, pathological fracture, neurological dysfunction, age, spinal level, ASA score, Charlson Comorbidity Index, BMI, tumor volume) was investigated in linear regression modelling.

Results

72 surgically treated primary spinal tumor patients were included in the study. Median length of hospital stay was 12 days (3–115), the median ICU treatment was 1.4 days (0–21.7), the median OR time was 2.8 hour (0.4–20.4). Median cost per patient was 3,088.5 € (537.7 € to 21,860.6 €). In the univariate analysis only ASA score, Charlson Comorbidity Index and pathological fracture were not significantly associated with higher cost. The seven significant variables were further assessed in a multivariate model. Dignity, previous surgery, spinal level and tumor volume were associated with high cost and preoperative neurologic dysfunction showed only a trend toward significance (whole model: R=0,69, R2=0,44, df=5, F=12,34 p < 0,001).

Conclusion

The present study identifies four predictive variables for high hospital cost related to primary spinal tumor surgery. Malignant tumors, previous surgery, sacral involvement and large tumor volume significantly increase the cost of treatment. This method of cost analysis provides useful insights for resource management in the surgical treatment of spinal tumors.
Morphometric Analysis of Pedicle and Lateral Mass of C1 Vertebra in Indian population using 3D Reconstructed Computerized Tomographic Images, with Comparative Analysis of the Feasibility and Safety of two Proposed C1 Pedicle Screw Trajectories in Relation to Vertebral Artery and Internal Carotid Artery
Authors: Kanagaraju Vijayanth
Published: April 2016

Introduction

Lateral mass screw fixation has been considered the gold standard in the instrumentation of C1 vertebra since its introduction by Goel and Laheri. The morphometry of pedicle and pedicle screw fixation in C1 vertebra is poorly illustrated in literature. Further biomechanical studies have proved better pullout strength in C1 pedicle screws compared with C1 lateral mass screws. Here we analyze the morphometry of C1 pedicle and lateral mass in Indian population, with comparison of two proposed pedicle screw trajectories. Materials and Methods 3D CT reconstructed images of C1 vertebra of 100 adult Indian population(50 male and 50 female) were analyzed for 22 parameters(200 pedicles, 4400 measurements). The anatomic parameters include pedicle height(PH), pedicle sagittal angle(PSA), lateral mass height, length, width(LH,LL,LW). Two pedicle screw trajectories, straight(S) and medially angulated(M) were defined and comparative analysis were done using following parameters, entry point midline distance(SEMD,MEMD), axial length(SAL,MAL), pedicle length(SPL,MPL), distance from vertebral foramen(SVD,MVD), angle of freedom from vertebral foramen for screw trajectory(SVAF,MVAF), pedicle screw trajectory width(SPW,MPW), medially angulated pedicle screw transverse angle(PTA), shortest distance from internal carotid artery(ICA) to screw exit point in anterior cortex(SID,MID), angle of freedom from ICA for screw trajectory(SIAF,MIAF).

Results

All 22 parameters were analyzed using SPSS software with mean PH 3.4, PSA 19°, LH 11.3, LL 15.2, LW 13.1, SEMD 18.7, MEMD 21.7, SAL 24.9, MAL 25.4, SPL 9.6, MPL 6.6, SVD 3.3, MVD 4.1,SVAF 12.1°, MVAF 24.5°, SPW 6.6, MPW 8.3, PTA 22.3°, SID 5.8, MID 9.9, SIAF 5.2° and MIAF 20.3°(all linear measurements in mm). PW, PSA, LH, LL, LW, SEMD, MEMD, SAL, MAL, MVD, MVAF, MPW and SID were significantly dependant on sex. There was a statistically significant difference in values of measured parameters between both trajectory S and M. All parameters except MPL are quantitatively greater in trajectory M than S.

Conclusion

Out of 200 pedicles studied the PH of only 89 are ≥ 3.5mm, and 154 are ≥ 3mm. So ¾ of Indian C1 pedicles can accommodate only a 3mm screw. A preoperative CT analysis is necessary in all patients to evaluate the feasibility of C1 pedicle screw and for neurovascular safety. A medially angulated C1 pedicle screw with more lateral entry point is more accommodative and safer in respect to ICA and vertebral artery than the straight screw. Also a bicortical screw purchase is safer in a medially angulated screw than a straight screw, which is comparatively at a higher risk of injuring ICA. Still biomechanical studies have to be done comparing both screw trajectories.
The Relationship between Increased Signal Intensity on t2-weighted Magnetic Resonance Imaging and the Entropy of Gait Analysis in Cervical Spondylotic Myelopathy
Authors: Tsai Wan-Ling , Wu Chao-Cheng , Lin Jiann-Her , Chiang Yung-Hsiao , Chang Cheng-Kuei , Yang Chin-Wei , Chang Cheng-Kuei
Published: April 2016

Objective

To determine relationships between increased signal intensity (ISI) on T2-weighted cervical spine magnetic resonance imaging (MRI) and parameters of gait analysis in patients with cervical spondylotic myelopathy (CSM). Methods and Materials: Patients were evaluated by using the Nurick scale, cervical spine MRI, and gait analysis. The signals of 3-axis accelerometer was collected during the gait analysis, and then the entropy of frequency (EF)and amplitude (EA) of vertical axis was measured The increased signal intensity on the spinal cord was determined by two neurosurgeons.

Results

7 CSM patients with ISI on the spinal cord and 2 CSM patients without ISI were included. In addition, 7 health subjects were recruited as the control group. Relative to patients without ISI and the control group, those with ISI showed significantly higher EAs of vertical axis signal ( p < .05), but not EFs. Moreover, postoperative EAs significantly decreased compared with preoperative EAs. The Nurick scales significantly correlated with EA.

Conclusions

The gait analysis showed that EAs of vertical axis were significantly higher in CSM patients with ISI and in preoperative gait analysis of those patients. EA of vertical axis also correlated well with the Nurick grades. EA of vertical axis in gait analysis may be a useful tool for evaluating gait functions in cervical myelopathy.
Berry's Ligament and the Inferior Thyroid Artery as Reliable Anatomical Landmarks for the Recurrent Laryngeal Nerve (RLN) - A Fresh Cadaveric Study Relevant to the Cervical Spine
Authors: Rajabian Ali , Quraishi Nasir A.
Published: April 2016

Introduction

While most cadaveric studies of the Recurrent Laryngeal Nerve (RLN) have focused on course variations as a suitable guide for Right versus Left RLN, they have mostly been done on preserved (fixed) cadavers which renders the RLN immobile. Our aim was to perform anterior cervical exposures from C2 to T2/3 with particular attention to the course of the RLN on right and left sided exposures in fresh cadaveric specimens. In addition, we aimed to expose the entire course of the RLN. Finally, we wanted to show the position of the RLN in relation to the trachea-oesophageal groove, inferior thyroid artery and Berry's ligament.

Methods

Eight fresh cadavers had extensive layer by layer dissections performed by 2 surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). The RLNs were exposed in their entire length and relationship to different landmarks recorded. Photographs were taken at each stage of the exposure.

Results

In all specimens, we were able to demonstrate the entire course of both RLNs from origin to insertion. The RLNs were consistently associated with the inferior thyroid artery and Berry's ligament bilaterally with the RLNs passing at almost perpendicular to these structures.

Conclusion

The near horizontal direction of the Berry's Ligament in the cervical tissue planes exposed during anterior cervical exposures enables the surgeon to reliably identify the expected position of RLN at its medial end and hence avoid it prior to visual observation of the nerve on either side. We found that the most reliable anatomical landmark bilaterally for the RLN was the inferior thyroid artery and Berry's ligament both of which would be encountered in anterior surgical exposure prior to the nerve itself. We believe that this will help spinal surgeons refine their surgical technique to identify this nerve where necessary and thus reduce the incidence of iatrogenic injury. [Figure: see text][Figure: see text][Figure: see text]
Cervical-thoracic Spine Inclination (CTSI): Anatomy Peculiarities and Surgical Options
Authors: Mushkin Alexander , Ryabykh Sergey , Gubin Alexander , Kolesov Sergey , Vissarionov Sergey , Snischuk Victor , Eduard Ulrikh
Published: April 2016

Introduction

The bayonet congenital abnormality of cervical-thoracic spine was previously described as a rarest clinical case under the title “congenital upper spine spondylolisthesis ” (Tokgozoglu AM et all., 1994) or “congenital dislocation of the cervical spine” (Shintaki M et all., 2013) without detailed description of anatomy and principles of surgical treatment. Our series include analysis of 10 CTSI cases from 4 clinics.

Material and Methods

Clinical, X-ray, CT and MRI peculiarities of 10 patients aged from 1 year 8 mns till 15 years were analyzed. The repeated cervical-thoracic abnormality included antero-posterior and cranial-caudad shift of the spine into the cervical spinal canal. All patients had arcs dysplasia, but any case has a complete posterior segmental defects, MMC or split spinal cord syndrome.

Results

According to Frankel scale the neurological status was estimated as a type E in one patient, type D – in 4, type C - in 4 and type B in one, incl. two paraparesis and 7 tetraparesis cases. Cranial spine was formed by 4 till 8 vertebrae (max – 6 vertebrae in 5 cases). Abnormality was accompanied by Sprengel disease in 2, by neurofibromatosis type I in one, by failure of segmentation (Klippel-Feil syndrome) in 5 and neural arc dysplasia in 10 cases. 9/10 patients were operated. The operations included circular decompression of spinal cord and posterior instrumentation; 8 operations were done from posterior approach only, 1 - from anterior and posterior approaches. Four procedures were done with Halo-cast fixation to produce pre-surgical local spinal stability. The post-op follow up floated from 7 month till 5 years. 6/9 patients demonstrated significant improvement in neurological sighs (one or more steps in Frankel scale) ; the neurological deterioration was occur in 2/9 cases, followed by a partial recovery in one and complete in another.

Conclusion

Our 10 cases series demonstrates a extremely rare type of the cervical-thoracic spinal abnormality. We the term “the cervical-thoracic spine inclination (CTSI)” because it reminiscent the cranial-vertebral pathology known as “the inclination of dens of C2 into foramen magnum.” From our point of view the inclination is a combined type of pathology which included an anterior-posterior and cranial displacement of caudal spinal segment(s); this pathology typical for transitional spinal zones and looks like spinal segmental dysgenesis but differ due to the absence of circular spinal column defect despite the combination of different types of vertebral abnormalities. CTSI is a repeated spinal syndrome which has a high risk of neurological complications. The spinal cord decompression and instrumentation are mandatory for this abnormality; the surgery could be done from the posterior approach only.
Anatomic Guideline for Approach to Lateral Thoraco-Lumbar Interbody Fusion
Authors: Cho Woojin
Published: April 2016

The decision making process for incision location during the course of lateral thoraco-lumbar interbody fusion (LLIF) at 857 levels was evaluated retrospectively, in an attempt to develop a clinically robust anatomic guideline.

Introduction

The minimally invasive technique of LLIF has shown powerful segmental deformity correction, with excellent fusion rates and minimal morbidity. However, in certain settings, adequate lateral access to permit a proper working angle into the disc space may be difficult to achieve. The purpose of this investigation was to establish a clinically robust anatomic guideline for incision location, with respect to laterality and level.

Methods

The operative reports and plain films of the thoraco-lumbar spine of 512 consecutive patients undergoing LLIF at our institute between 2009 and 2011 by the mini-open transpsoas method were reviewed.

Results

Distribution of operative levels is depicted in Table 1 . [Table: see text] The primary determinant of laterality (side) of operative approach involving the L4–5 disk space was coronal angulation of the L4–5 disk space, as depicted on 15° up-tilt view. A secondary determinant of feasibility of accessing the L4–5 disk space is a line drawn through the center of the L4 vertebra, parallel to the inferior end plate of L4. Extension of this line cephalad to the ipsilateral iliac crest indicates that this level will be surgically accessible. In the absence of segmental coronal angulation, the symptomatic side was chosen. In the setting of regional scoliosis, the concavity was the preferred side of approach, as up to three levels can be reached through a single small incision. There were no instances of approach failure using the method outlined above.

Conclusion

A clinically robust and worthwhile anatomic guideline to LLIF, with respect to level and laterality of incision placement, is presented.
Chronic Painful Osteoporotic Vertebral Compression Fractures (OVCFs) of Thoracolumbar Spine: Percutaneous Vertebroplasty versus Conservative Management among Egyptian Patients
Authors: Hasan Khaled , El-Sharkawi Mohammad
Published: April 2016

Introduction

Vertebral augmentation procedures are widely used today in treating Osteoporotic vertebral compression fractures (OVCFs) especially in acute and subacute fractures. However, percutaneous vertebroplasty for patients with chronic painful OVCFs has been less well studied. The purpose of this study is to compare the efficacy and safety of percutaneous vertebroplasty with conservative management for the treatment of chronic painful OVCFs in the thoracolumbar spine among Egyptian patients.

Patients and Methods

This prospective cohort study included 60 patients with chronic OVCFs (38 females, 22 males, mean age: 65.42 ± 8.63) who presented with severe back pain to the outpatient clinic during the period from October 2005 to December 2011. Twenty-eight patients were treated with percutaneous vertebroplasty (vertebroplasty group). Thirty two patients refused surgical treatment and constituted the control group (Conservative group). The inclusion criteria included: Chronic painful OVCFs (at least 3 months), at least 50 years old, T5 to L5, osteoporosis (T-score -2.5 or lower), Visual Analogue Scale (VAS) at least 5, and absence of neurological deficits. At presentation, all patients of both groups received back brace, analgesics, anti-osteoporosis therapy. All patients were evaluated with X-rays and CT scan, where Cobb angle and the anteroposterior height comparison (APHC) were measured. Overall pain and quality of life were assessed with the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).

Results

All patients were followed for at least 12 months (range, 12 to 28). Statistical analysis of the demographic data of the two groups could not reveal any significant differences. At latest follow up, there was significant improvement in Cobb angle and APHC in vertebroplasty group compared with conservative group ( p < 0.05). Twenty nine patients (90.63%) showed complete union in the conservative group while all patients (100%) showed complete union in the vertebroplasty group at latest follow up. VAS and ODI were significantly better in vertebroplasty group than conservative group ( p < 0.05) at latest follow up. Cement extravasation into the disc occurred in 2 patients (5.41%), and into the paravertebral tissue in 3 (8.11%); none was associated with neurological symptoms, cement embolism, or infection. Recent fracture occurred adjacent to the formerly cemented ones in 2 patients (7.14%) and in non-adjacent level in one (3.57%). In conservative group, 3 patients (9.37%) presented with new osteoporotic vertebral fractures in adjacent levels and 2 (6.25%) in non adjacent levels. Three patients (9.37%) showed non union.

Conclusion

Percutaneous vertebroplasty is safe and effective in treatment of symptomatic chronic osteoporotic vertebral compression fractures with significantly better clinical and radiological outcomes when compared with conservative management.
Does Level of Response to SI Joint Block Predict Response to SI Joint Fusion?
Authors: Polly David W. , Cher Daniel , Whang Peter , Frank Clay , Lockstadt Harry , Harvey Charles , Sembrano Jonathan
Published: April 2016

Introduction

The threshold percent pain relief required to diagnose sacroiliac joint (SIJ) dysfunction during a diagnostic SIJ block (SIJB) is not known. Although there is no gold standard, one reference standard is response to definitive treatment.

Methods

Subgroup analysis of 320 subjects in two prospective trials of SIJ fusion: INSITE (NCT01681004) a randomized trial versus nonsurgical management (NSM) and SIFI (NCT01640353), a singlearm study. All participants were diagnosed with SIJ dysfunction via history (buttocks/leg pain and a positive Fortin finger test), at least 3 positive provocative physical examination signs, and a standardized diagnostic SIJB using fluoroscopically guided injection of local anesthetics in the target joint with a reduction of at least 50% in pain at 30 or 60 minutes after SIJB. The degree of improvement in VAS SIJ pain and Oswestry Disability Index (ODI) scores, expressed as absolute or percentage improvement from baseline, was correlated with the average acute improvement in SIJ pain during the SIJB, calculated as per Cohen et al.

Results

The average pain reduction during the first hour after SIJB was 79.3%. Pain reduction during block was unrelated to standard demographic predictors. Six months after SIJ fusion, the mean VAS SIJ pain reduction was 50.9 (28.6) points and the mean ODI reduction was 24.6 (20.5) points. SIJ pain and ODI reductions at 12 months in the SIJ fusion group were 50.8 (29.2) and 25.8 (20.5) points, respectively. There was little correlation in 6 or 12month improvements in SIJ pain or ODI with average reduction in pain during SIJB. In the SIJF group, the proportion of subjects achieving meaningful reductions in SIJ pain and ODI scores did not vary by average response during SIJB ( p = 0.8407 and 0.3069, respectively for 6 month changes, and p = 0.6368 and 0.5913). Similarly, response during SIJB did not predict the proportion of patients with followup pain scores < 30 or ODI < 20. Conclusions. In this study of > 300 patients with carefully diagnosed with SIJ dysfunction, the degree of improvement in acute pain during an SIJB did not predict 6month improvements in VAS SIJ pain or ODI score. Based on our study, a 50% acute pain reduction threshold during SIJB was resulted in excellent postsurgical results. The use of overly stringent selection criteria for determining which patients should undergo SIJF may serve to withhold a beneficial procedure from a substantial number of patients with SIJ dysfunction.
Double Blind Placebo-controlled Trial of Percutaneous Vertebroplasty (VOPE)
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. Since two double-blind RCTs in 2009, there has been a debate, whether Percutaneous Vertebroplasty (PVP) has any beneficial effects in treating acute osteoporotic VCFs. The two studies have been criticized in order of design and possible bias in results. PVP is a minimally invasive procedure, primarily used in patients with severe pain after VCF. Our objective was to investigate the clinical effects of PVP compared with a SHAM procedure when treating acute osteoporotic VCFs, with intense focus on VAS-activity and the first 3 months postoperative.

Material and Methods

Study Design - Double-blind randomized controlled trial. 52 patients were included in the study, and they were randomized to either PVP or SHAM, at the Center for Spine Surgery and Research, Middelfart Hospital. During the trial period 4 patients were excluded due to need for further spine surgery, and 2 patients excluded due to malignancy in peroperative biopsy. During the trial patients, investigators collecting data, and the statisticians were blinded.

Results

46 patients were eligible for statistical analysis, 22 patients in the PVP group and 24 patients in the SHAM group. In both groups the VAS-scores, and health related Quality of life scores (SF-36; PCS-score and Eq. 5D-scores) improved significantly from baseline values ( p < 0.05). There was a statistical significant higher VAS-score in the SHAM-group throughout the trial period ( p = 0.001), with the main contribution from the VAS-activity.

Conclusion

Our study shows a statistical significant higher VAS-score in the SHAM group during the trial period, both groups improved significantly in all clinical parameters. Focus in the future of PVP and acute OVCFs must be on the 3 months convalescence period and the cost benefit analysis of early mobilization.
Health-related Quality-of-life in Adolescent Idiopathic Scoliosis Patients 25 years after Treatment
Authors: Simony Ane , Carreon Leah Y. , Christensen Steen Bach , Andersen Mikkel Ø.
Published: April 2016

Introduction

The purpose of this study was to evaluate the long-term clinical outcomes using validated measures of health-related quality of life (HRQOL), 25 years after termination of scoliosis treatment, in a cohort of Adolescent Idioapthic Scoliosis Patients.

Material and Methods

219 consecutive patients treated with Boston brace or posterior spinal fusion using Harrington-DTT between 1983–90, were invited to participate in a long-term evaluation study. A validated Danish version of the Scoliosis Research Society 22R (SRS22R) and Short Form-36 (SF36V1) were administered to the patients two weeks before the clinical and radiological examination.

Results

159 (72,6%) patients participated in the clinical follow up and questionnaires, 11 patients participated only in the questionnaires, 8 emigrated, 4 were excluded due to progressive neurological disease and 2 were deceased. The total follow up was 170 patients (83%), average follow up was 24,4 years (22–30 years). SRS 22-R domains scores were within the range described as normal for the general population with no statistical difference between the two treatment groups except in the Satisfaction domain, were the PSF group had better scores than the braced group. The SF 36 PCS and MCS scores in both AIS cohorts were similar to the scores for the general population.

Conclusion

HRQOL, as measured by the SRS 22-R and SF-36, of adult AIS patients treated with Boston brace or PSF during adolescents were similar to the general population. No clinical progression of the deformity has been detected during the 25-follow up period. The PSF group had a small but statistical significant higher score in the Satisfaction domain compared with the braced group.
Quality of Life after Scoliosis Surgery in Cerebral Palsy
Authors: Wood David Ian , Cooke George , Michael Antony Louis Rex , Breakwell Lee , Cole Ashley
Published: April 2016

Introduction

Radiological correction of scoliosis in quadriplegic cerebral palsy (CP) after posterior instrumentation is well established but patient and caregiver outcomes are required to justify this high risk and high cost surgery. The aims of surgical correction is to improve the patients sitting postion and pain from costo-pelvic impingement by reducing the spinal deformity and pelvic obliquity.

Material and Methods

To use the modified DuPont Hospital questionnaire to evaluate the quality of life, physical function and caring demands of patients who had undergone instrumented scoliosis correction for CP. Patients were identified and after initial contact, the parent completed the modified DuPont Questionnaire. The outcome measures were DuPont Questionnaire, Cobb angle and pelvic obliquity from radiographs before and after surgery.

Results

Between Jan 2003 – Sept 2013, 83 operations were undertaken by 4 Spinal Surgeons at Sheffield Children's Hospital in patients with quadriplegic CP. Two died during surgery (cardiac arrest) and two had died by follow-up from causes unrelated to the surgery. 79 families were contacted and 63 families agreed to be involved (80% return rate). 87% felt that their child's deformity was very much improved. 77% felt that their child's overall appearance was much improved. 60% felt it had improved their child's ability to feed and breathe. 64% felt that it was easier to bathe and dress their child. 94% said they would recommend surgery to another member of their family in similar situation. Cobb angle improved from 70° to 30° (47%) and pelvic obliquity from 24° to 11° (46%).

Conclusion

Surgical correction is still reserved for significant and progressive deformity with decreasing function. This remains a high risk intervention in patients at the severe end of CP spectrum with an on table mortality of 2%. Parental satisfaction scores were high and similar to currently published literature. High Satifcaction levels were found in those families who chose to undertake surgery.
Spinal Cord Drift after Non Instrumented Posterior Cervical Laminectomy
Authors: Kharrat Khalil , Sebaaly Amer , Moussa Ronald
Published: April 2016

Objective

To assess the mean value of spinal cord drift after laminectomy for cervical spondylitic myelopathy and its relation to preoperative alignment and postoperative neurologic recovery rate.

Materials and Methods

35 patients with a mean age of 62 were operated for cervical spinal myelopathy (CSM) by laminectomy with evaluation of preoperative and postoperative MRI (Min 6 months). Functional outcome was measured (Japanese Orthopedic Association score (JOA), Nurick score, and recovery rate) and radiological analysis was also made (Cobb angle and postoperative cord migration). The mean follow up period was 58.7 months

Results

The mean preoperative JOA score was 11.3 and the mean postoperative JOA score was 14.6 with a mean recovery rate of 63%. The Nurick score went from 2.11 to 0.65 with a recovery rate of 69%. The postoperative cord migration was 3.82 mm. Younger age, more than four level laminectomy were correlated with better prognosis. While spinal cord drift to more than 3 mm was correlated with better outcome and to the extent of the laminectomy

Conclusion

Cervical laminectomy is an indirect way of relieving the anterior compression since it allows posterior spinal cord displacement while widening of the canal. This displacement is greater when lordosis rather than kyphosis is present with positive correlation with neurological outcome.
Determination of the Center of Rotation for Flexion/Extension before and after Insertion of 3 Different Types of Disc Prostheses, and Comparison with In-Vivo MRI-Derived Data from Healthy Volunteers
Authors: Muhlbauer Manfred , Tomasch Ernst , Sinz Wolfgang , Trattnig Siegfried , Steffan Hermann
Published: April 2016

Introduction

An in-vivo biomechanical study is presented investigating the Center of Rotation (COR) for flexion/extension before and after insertion of 3 different types of cervical disc prostheses. The aim of the study was to investigate whether the pre-operative coordinates of the COR deviate from that of Healthy Volunteers (COR-HV), and further whether and how the COR-coordinates change after insertion of the different disc prostheses.

Material and Methods

15 healthy volunteers underwent MRI-investigation of their cervical spines. Data for flexion/extension were collected in 5 different positions from maximum extension to maximum flexion for determination of the COR-HV. Further, from 30 patients with a one-level cervical disc prosthesis (10 respective patients who received a Bryan-, Discover- or Prestige-prosthesis) the routinely taken pre- and post-operative cervical flexion/extension X-rays underwent graphical analysis for determination of the respective COR from C3/4 to C6/7. The pre- and post-operative CORs were compared with the corresponding CORs-HV.

Results

Concordant to the literature a different COR-HV was determined for each respective level from C3/4 to C6/7, and it could be demonstrated that the COR for flexion/extension shows migration during motion. In the patient-study, in all 3 subgroups (Bryan-, Discover-, Prestige-prosthesis) the pre-operative COR for flexion/extension deviated considerably from the COR-HV. After prosthesis insertion the coordinates of the COR changed in all levels from C3/4 to C6/7 regardless of the operated segment; in the Bryan-group the COR was shifted toward the COR-HV; in the Discover-group it was shifted away from the COR-HV; and in the Prestige-group it was shifted partly toward and partly away from the COR-HV.

Conclusion

It must be presumed that in patients who are candidates for cervical arthroplasty the COR is not congruent anymore with the COR in healthy individuals. Further, the insertion of a disc prosthesis can change the position of the COR in all levels of the lower cervical spine, irrespective from the level of insertion. It seems that the biomechanical design of the implant can considerably influence the way how the COR changes its position: prosthesis with a simple ball-socket design could shift the already abnormal COR to an even more unphysiological position; devices with a more flexible biomechanical design however can contribute to normalize the COR toward the coordinates that were found in healthy individuals. Further studies on this topic with higher numbers of datasets should be undertaken to support the improvement of the biomechanical design of cervical disc prostheses.
Postoperative Evaluation of Sagittal Spinal Balance in Lenke 1A and 5C Type of Adolescent Idiopathic Scoliosis: A Prospective Study
Authors: Mezentsev Andriy , Petrenko Dmytro , Demchenko Dmytro , Krishnappa Vijaykumar
Published: April 2016

Introduction

The aim of the study to evaluate the effect on sagittal spinal balance parameters postoperatively between short segment Bone-On-Bone anterior spinal fusion (ASF) and selective posterior spinal fusion (PSF) treated adolescent idiopathic scoliosis (AIS) (Lenke1A & 5C) patients.

Material and Methods

This prospective study evaluates radiographs (lateral and AP view) for sagittal spinal balance parameters pre and postoperatively on 36 AIS (Lenke1A & 5C) patients, who were divided into two groups of 18 each according to the treatment underwent in a single clinical institute since 2006–2013. Group 1 underwent short segment Bone-On-Bone ASF (mean age 17 years, 12–25) and Group 2 with selective PSF (mean age 16 years, 12–27).

Results

In Group 1, lumbar lordosis and sacral slope decreased (mean pre-op 50.4 & 38.6 to mean post-op 36.0 & 35.4), pelvic tilt increased (mean pre-op 12.8 to mean post-op 14.5), whereas thoracic kyphosis and pelvic incidence were similar enough to pre-op values. In Group 2, lumbar lordosis, sacral slope, pelvic incidence and pelvic tilt were decreased(mean pre-op 41.9, 35.5, 56.1 & 16.0 to mean post-op 34.1, 29.7, 52.7 & 12.1), whereas thoracic kyphosis similar enough to pre-op value.

Conclusion

According to our study, no significant difference found in sagittal spinal balance parameters postoperatively on radiographs between two groups except with slight decrease in lumbar lordosis post-op mean value in both groups. So, our study suggest that short segment Bone-On-Bone ASF and selective PSF procedures do not affect the sagittal spinal balance significantly in the treatment of Lenke1A and 5C type AIS cases postoperatively.
Junctional Kyphosis after Long Segment Fusion
Authors: El-Sharkawi Mohammad , Gad Wael , Elkott Amer , Tammam Hamdy , El-Meshtawy Mohamed
Published: April 2016

Introduction

The incidence of junctional kyphosis (JK) varies in the literature from 7% to 40%. We here present our experience with JK. The aim of this work is investigate the incidence of JK after long spinal segment fusion, to identify the underlying factors leading to its development, and to discuss treatment outcome.

Patients and Methods

This combined retrospective/prospective cohort study included sixty-four consecutive patients (40 women and 24 men) with a mean age of 20.7 years, who underwent long segment spinal fusion (≥ 5 vertebrae) for treatment of spinal deformity. The average length of follow-up was 2 years. Risk factors analyzed included patients’ factors, surgical factors, and radiographical parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, and pelvic incidence.

Results

Radiological JK occurred in 14 patients (22%). Ten cases were proximal junctional kyphosis (PJK), two cases were intercalary junctional kyphosis (IJK), and two cases were distal Junctional Kyphosis (DJK). Only seven patients (50%) out of the 14 with JK were symptomatic. Six cases have undergone revision surgery. In nine cases, the original deformity was kyphosis (1 Ankylosing spondylitisS, 1 post-tuberculous, 3 Sheuermann's kyphosis, 4 congenital kyphosis). The other 5 cases were scoliosis (3 idiopathic and 2 congenital). Preoperative TK more than 40 ° was associated with PJK. In all cases PI, PT, SS, SVA were within normal range, but it was noticed that SVA had negative values in 5 cases. LIV in the dorsolumbar junction was associated with DJK.

Conclusion

Pre-existing TK more than 40°was identified as an independent risk factor. Negative sagittal balance may be a risk factor for PJK. A surgical strategy to minimize Junctional kyphosis may include careful preoperative planning for reconstructions with a goal of optimal postoperative alignment.
Incidental Dural Tears during Lumbar Surgery: Incidence and Management
Authors: Elfalaky Omar , Elzarief Ashraf
Published: April 2016

Background

In spite of the fact that Incidental dural tears (IDTs) is being a well known intra-operative complication during lumbar surgery, true incidence is not accurately known, and different techniques have been suggested for management. Aim of the Work: Detect incidence of incidental dural tears (IDTs) in lumbar surgery with evaluation of our intraoperative technique used for management.

Materials and Methods

A total number of 834 degenerative lumbar spine cases were reviewed, during the period from 2008 till 2013 in our institutions. Among those cases 191 were recurrent cases. Cases complicated with IDTs were identified, managed intra-operatively using our technique that was based on many layers tight closure, cases with persistent leak that needs re-operation are identified and reviewed.

Results

The incidence of ITDs during lumbar surgery in our series was 7.3% (61 of 834 cases) During primary surgery it was 5.9% (38 of 643 cases), among recurrent cases it was 12% (23 of 191 cases), all cases were repaired intra-operative using 3–0 vicryle suture and a muscle graft was sutured as an enforcing layer, tight closure of fascia, subcutanous, subcuticular layers and skin, no sub-fascial drains used. One case showed persistent leakage and 2 cases complicated with pseudomeningocele, cases of pseudo meningocele were managed conservatively and the case of leakage re-operated, with no further complications.

Conclusion

IDTs is a common complication in lumbar surgery with a higher incidence in recurrent cases. The corner stone in the management of IDTs is intra-operative identification and tight closure in many layers that was proved by our surgical technique, a success rate was 98.4%, one case of 61 cases (1.6%) needed a second operation.
Plate Construct versus Stand-Alone Cage in ACDF. Does the Plate Maintain a Sagittal Plane Correction: Clinical Outcome and Radiological Findings Correlation
Authors: Alhammoud Abduljabbar , Aboulebda Mohanad , Baco Abdul Moeen
Published: April 2016

Introduction

Anterior cervical discectomy and fusion (ACDF) is the treatment of choice of cervical degenerative disc disease which cause neurological symptoms include radiculopathy and myelopathy, and it can be done by different techniques which includes several options for implants like disc spacers made of autograft or allograft bone, porous metal, polyether ether ketone (PEEK) and anterior plates and screws. The purpose of this study is to compare the role of anterior plate constructs (ACDF-CPC) and stand-alone cage (ACDF-CA) in maintain of Sagittal plane correction, clinical and radiological findings.

Material and Methods

Retrospective study of 24 patients who underwent ACDF in Hamad General Hospital, 16 cases with ACDF-CA and 8 cases ACDF-CPC. Radiological findings (cervical lordosis, segmental lordosis, cage subsidence, disc height) and clinical outcome (Odom's criteria, dysphagia and swallowing problems) are compared (pre-op, 3–6 months post op, 12–18 months post op).

Results

Cervical Lordosis, segmental lordosis, and disc space height at the operated levels increased an average of 5.4°, 3.1°, and 1.5 mm in ACDF-CA and 3.2°, 3.4°, 3.5 mm in ACDF-CPC, with good to excellent result in ACDF-CA and fair to good result in ACDF-CPC according to Odom's criteria, with more dysphagia and dysphonia in ACDF-CPC. The maintaining of sagittal plane correction, disc space height, and cage subside are decrease during follow up in both groups, but clinical outcome was stable in most of the cases comparing to immediate post op finding.

Conclusion

Anterior cervical discectomy and fusion by stand-alone cage or anterior plate is achieved good clinical outcome and significant correction in sagittal plane and disc space height, but no significant difference between two groups in maintaining the sagittal plane correction and disc space.
Cognitive Impairment following Adult Spinal Deformity Surgery
Authors: Nabiyev Vugar , Ayhan Selim , Yuksel Selcem , Mmopelwa Tiro , Sabat Montse Domingo , Pellise Ferran , Alanay Ahmet , Perez-Grueso Francisco Javier Sanchez , Kleinstuck Frank , Obeid Ibrahim , Acaroglu Emre ,   European Spine Study Group (ESSG)
Published: April 2016

Introduction

Elderly patients undergoing major surgery may experience cognitive deterioration due to lesser plasticity in their brain tissue. This so called postoperative cognitive dysfunction (POCD) syndrome is characterized with non-specific dysfunction in memory, concentration and analysis skills. It is not known whether adult spinal deformity (ASD) surgery is associated with POCD. Purpose of this study is to analyze the cognitive abilities of older patients undergoing spinal deformity surgery before and after the surgery so as to understand whether ASD surgery is associated with POCD.

Material and Methods

A prospective longitudinal study was performed on surgical patients older than 50 years enrolled in a prospective multi-centric database. Mini mental state examination (MMSE) was performed to assess cognitive functions in addition to the health related quality of life (HRQOL) tests (SF-36, ODI and SRS-22) at preoperative, post-operative 6th week and 6th month points. Demographics, preoperative health status, comorbidities, surgical characteristics were also analyzed. Descriptive statistics and repeated measures of variance analysis were performed.

Results

A total of 90 patients with a mean age of 67.4 ± 8.2 were enrolled in the study; all had 6th week and 58 had both 6th week and 6th month follow-up MMSE evaluations. Averages (standard deviation) of surgical time, estimated blood loss (EBL), number of screws used and hospital stay were 240.1 (111.9)min, 1621.2 (1058.7)ml, 11.2 (4.4) and 14.2 (11.45)days respectively. On analysis, it was seen that there was even a slight increase in mean MMSE score (p > 0.05) between time points (Table 1). There was a decrease of > 2 points (3 or 4 points) in 6 patients (6.7%) at both time points.

Conclusion

Although ASD surgery in older patients is recognized as challenging, this study suggests that it is not necessarily associated with a significant deterioration in the cognitive abilities of patients undergoing it. These results are different compared with those reported for other major surgical interventions. This may be due to the relatively minor influence of ASD itself on the cognitive abilities of the patients involved as well as to the relatively stable hemodynamic conditions obtainable during modern ASD surgery.
Reduction of Pelvic Tilt after Surgical Correction of Low-grade Isthmic Spondylolisthesis is Correlated with Rather Improvement of Back Pain than Quality of Life
Authors: Maciejczak Andrzej
Published: April 2016

Introduction

It is generally believed that the restoration or improvement of sagittal spino-pelvic alignment may impact clinical outcomes of surgical treatment of high-grade isthmic spondylolisthesis. Little is known about the impact on low-grade slips. The purpose of the study was to determine whether clinical outcomes are correlated with the restoration or improvement of pelvic balance after surgical correction of low-grade isthmic spondylolisthesis.

Material and Methods

Prospective non-randomized study based on a single-institution series of consecutive patients with isthmic spondylolisthesis during a 10-year period from 2002–2012. 63 adult patients with a low-grade isthmic slip and adequate pre- and postoperative radiograms were available for measurement of spino-pelvic parameters and final assessment of their clinical outcomes. The latter were assessed at least 1 year after the surgery with the use of the Oswestry Disability Index (ODI) and a back pain visual analogue scale. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbosacral angle (LSA) and lumbar lordosis were measured on standing lateral view radiograms. We assumed postoperative reduction in pelvic tilt (PT) to reflect improvement in pelvic balance. The Spearman's rank correlation test was used to assess the correlation between the improvement in pelvic balance and the improvement in ODI and back pain. The Mann–Whitney U test was used to identify significant differences in clinical outcomes between patients (i) with a balanced and unbalanced pelvis postoperatively, (ii) who regained and did not regain pelvic balance postoperatively, (iii) who maintained and lost pelvic balance postoperatively, and (iv) with an improved (reduced PT) and worsened (increased PT) pelvic balance postoperatively.

Results

There were no significant differences in clinical outcomes between patients with a balanced and unbalanced pelvis postoperatively regardless of whether they lost, maintained, or regained pelvic balance after the surgery. However, we found a weak (R= -0.3) but statistically significant ( p = 0.035) negative correlation between the degree of reduction in pelvic tilt and intensity of postoperative back pain and a weak (R=0.2) but statistically significant ( p = 0.034) positive correlation between the degree of reduction in PT and reduction in back pain. No correlation was found between improvement in pelvic balance and quality of life

Conclusions

Postoperative reduction of pelvic tilt may impact improvement of rather back pain than quality of life in low-grade isthmic spondylolisthesis. The latter might be a result of rather neural decompression and stabilization of the affected segment than improvement of pelvic balance.