bluuebunny/crossref_metadata_2025 huggingface dataset:
Mortality and Causes of Death in Patients Requiring VEPTR Surgery
Authors: Smith John , Heflin John , Vitale Michael , Samdani Amer , Morgan Jessica ,   Children's Spine Study Group
Published: April 2016

Introduction

The VEPTR device is used to treat a heterogeneous population of children with EOS and TIS. Complications associated with this treatment are known to be high, but there is limited documentation regarding risk of mortality in this population while undergoing treatment. The objective of this study is to report the 14 year mortality and cause of death from 4 major centers treating patients with TIS. This is a retrospective review of patients treated at 4 institutions for EOS and TIS. All patients were treated or had planned treatment with VEPTR instrumentation.

Methods

295 consecutive patients with EOS treated with VEPTR between 2000 and 2014 were reviewed. All patients were entered into a prospectively collected database. For the patients who died during or awaiting treatment, medical records were reviewed to determine the age and cause of death.

Results

292 patients treated with VEPTR and 3 patients awaiting surgery were included. 17 patients died during the study period, for an overall mortality rate of 5.76%. The etiology was varied in the patients who died (congenital/structural-1; neuromuscular-8; syndromic-5; idiopathic-3). There were 1261 total VEPTR-related procedures completed. Causes of death included: respiratory failure-8; shunt complications-2; cardiac failure-4; and GI complications-3. Two children died of pulmonary and nutritional complications while awaiting surgery. One patient died of a cardiac arrhythmia in the operating room.

Conclusion

EOS occurs in a complex heterogeneous group of children and is associated with multiple co-morbidities. The 2010 combined mortality rate for children 1–19 years of age was 54.1/100,000 while the rate for this group was 823.2/100,000 suggesting the long term natural history of this condition is associated with significantly increased mortality. While the aggressive surgical management of EOS compared with the natural history is not debated, there is clearly a need for a better understanding of the mortality risk over time for this patient population.
Predictors of Neurological Motor Decline in Complex Adult Spinal Deformity Surgery: Results of the Prospective, International, Multicenter Scoli-RISK-1 Study
Authors: Fehlings Michael , Lenke Lawrence , Nakashima Hiroaki , Nagoshi Narihito , Shaffrey Christopher , Kopjar Branko , Cheung Kenneth M. C. , Carreon Leah Y. , Dekutoski Mark , Schwab Frank , Boachie-Adjei Oheneba , Kebaish Khaled , Ames Christopher , Qiu Yong , Matsuyama Yukihiro , Dahl Benny , Mehdian Hossein , Pellise Ferran , Lewis Stephen , Berven Sigurd
Published: April 2016

Introduction

Significant variability in neurologic outcomes following surgical correction for ASD has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood. The objective of this prospective, multicenter, international cohort study in 15 sites is to evaluate the incidence and risk factors for postoperative neurological motor decline in patients undergoing surgery for complex adult spinal deformity (ASD).

Material and Methods

From September 2011 to October 2012, 273 consecutive patients were prospectively enrolled. One patient lacked baseline ASIA lower extremity motor score (LEMS), and one patient did not have follow-up LEMS leaving 271 (99.27%) subjects for analysis. Decline in neurologic motor outcomes was defined as deterioration in any of discharge or 6 weeks American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) compared with pre-operative status. To identify risk factors associated with decline in LEMS, two step statistical analysis was performed. First, 128 candidate variables consisting of demographics, comorbidities, treatment history, disease severity, radiologic parameters and surgical details were screened in bi-variate models. Then, 53 variables that had a p-value of 0.2 or less were included in a multivariate logistic stepwise model.

Results

70 (25.93%) patients showed decline and 200 (74.07%) had no decline in LEMS. Of those with a decline, nine patients (overall rate of 3.33%) had a severe deterioration of > 10 points on LEMS scale. Key factors associated with postoperative neurological deterioration included older age, non East Asian ethnicity, cardiovascular disease, preoperative motor weakness, kyphosis on T12 – S1, focal severe deformity angle, pedicle subtraction osteotomy, thoracic level fusion and intraoperative motor evoked potential change.

Conclusion

Although complex ASD surgery can enhance the quality of life of adult patients with severe deformity, a significant portion of patients with ASD experience a postoperative decline in LEMS. The risk factors identified in this study are useful to help clinicians to anticipate and potentially develop strategies to reduce the risk of postoperative neurologic complications.
Recovery Pattern in Surgical Management of Late Onset Myelopathy Due to Spinal Deformity
Authors: Gujral Amandeep , Bapat Mihir , Naskar Susmit
Published: April 2016

Introduction

Late onset paraplegia due to spinal deformity heralds a progressive death of neurological function. Evidence suggests that decompression and deformity correction offers a promising result.

Aims

To analyze recovery patterns after surgery for late onset myelopathy.

Methods

25 consecutive patients were reviewed. Average age was 17.84yrs and duration of pre-operative deficit was 4.6months. 18 patients had paraparesis and 7 quadriparesis. The average JOA score was 4.85/17 in quadriparetic and 5.33/11 in paraparetic patients. The average Nurick's grade was 2.7. The average spasticity was 2.2 (1- 4) as per Ashworth scale. 13 patients had bladder dysfunction. Deformity apex was cervical, cervico-dorsal, upper-dorsal and dorsal in 5, 4, 2 and 14 patients. 19 had kyphosis and 6 had multi-planar deformity. Vertebral resection osteotomy was performed in 13 and decompression alone in 12. Methodology: The records were obtained from software Horizon CSR used to register all patients form 2000–2009. The final follow-up was obtained by direct patient interview in 11, telephonic interview 5 and via email in 9.

Results

At 1year, significant improvement in JOA scores were seen recovery patters. Of the2 patients, 2 patients, 14 had immediate recovery (4 Weeks), delayed recovery (4 -12 Weeks) was seen in 9 patients and 2 patients developed deterioration after surgery. Out of the 13 patients with bladder dysfunction, 2 developed worsening post surgery. Average Nurick's grade improved from 2.7 to 2.3. Complications: Pulmonary complications developed in 5 patients, 4 patients had wound dehiscence, 2 patients showed Myelopathy progression, 1 patient developed Brachial plexus paresis and progression of deformity was observed in 6 patients.

Conclusions

(1) Severity and duration of pre operative deficit correlate with neurological outcome (correlation coefficient(r value) = 0.72). (2) Safe correction of deformity provides a better mechanical and physiological environment for lasting results.
Unilateral Approach for Bilateral Microsurgical Decompression of Lumbar Spinal Stenosis: Synopsis of 15 Years of Experience with this Surgical Method
Authors: Spetzger Uwe
Published: April 2016

Introduction

The surgical aim in the treatment of symptomatic lumbar spinal stenosis is the relief of the patient's complaints by an adequate neural decompression. In a preliminary cadaver study the unilateral laminotomy for bilateral access to the lumbar spinal canal was investigated, and the experiences were evaluated in a clinical study.

Material and Methods

Microsurgical decompression was performed by partial resection of the ipsilateral facet, the medial portion of the laminar arch, the contralateral facet and by complete removal of the ligamentum flavum bilaterally. Anatomical, radiological and morphometrical studies on 4 adult cadaver spine specimens have proved the feasibility of this unilateral approach. Complete bilateral flavectomy and partial bilateral facetectomy were the essential surgical steps for an adequate operative decompression. The clinical practicability in the treatment of lumbar spinal stenosis was initially confirmed in 254 patients.

Results

The postoperative morphometric evaluation in the cadaver study clearly demonstrates that bilateral ligamentectomy and recess decompression were adequately and successfully achieved via unilateral approach. The clinical evaluation of this technique was performed in 254 patients with symptomatic mono- or multisegmental lumbar stenosis. Postoperatively, 229 of the 254 patients with neurogenic claudication (90.2%) demonstrated a marked improvement of the walking distance. The follow-up of 249 patients (mean follow-up time was 37 months) demonstrated an excellent result without pain in 77 patients (30.9%); a good outcome with mild residual pain, but a normal working capacity in 130 patients (52.2%); and a fair outcome with unchanged postoperative low-back pain but markedly improved working capacity and walking distance in 41 patients (16.4%). There was only one patient with surgically induced, permanent neurological deterioration (0.5%). In nine patients, an inadvertent dural tear occurred, and due to unchanged symptoms three patients with a multisegmental stenosis had to be re-operated on at an additional level. During the past 15 years the author has experience with this method in over 1600 microsurgical decompression procedures.

Conclusion

Unilateral laminotomy and bilateral spinal canal decompression represents a safe, effective and minimally invasive surgical method and meanwhile is a routine microsurgical strategy for the treatment of patients with lumbar spinal stenosis.
Extreme Lateral Interbody Fusion Using Bone Marrow Aspirate Combined with a Porous Hydroxyapatite/Collagen Composite
Authors: Yoshida Makoto , Fujio Keiji
Published: April 2016

Introduction

Extreme lateral interbody fusion (XLIF) has been popular as a safe and reproducible method to obtain minimally invasive anterior spinal fusion. Autogenous bone, commonly from the iliac crest, constitutes ideal grafting. However, the amount of iliac crest bone available is limited and its harvesting is associated with significant donor site morbidity. Recently a porous hydroxyapatite/collagen (HAp /Col) composite has been developed as a substitute for conventional corticocancellous autografts. The aim of this study is to investigate the efficacy of a porous HAp /Col composite for XLIF.

Material and Methods

From November 2011, 15 consecutive patients (21 levels) underwent XLIF for lumbar degenerative diseases. In all cases, titanium cages filled with hybrid grafts using bone marrow aspirate (BMA) combined with a porous HAp/Co composite were inserted as intervertebral spacers and supplementary stabilization with posterior instrumentation were performed. In 4 cases (4 levels) pedicle screws (PS) were inserted unilaterally, and in 11 cases (17 levels) PS were inserted bilaterally. Fusion status was assessed using computed tomographic (CT) scans. A solid fusion was defined by the presence of bony bridging on 2 consecutive sections in at least 2 plains on CT imaging.

Results

At a follow up of 15.4months (minimum: 6 months), 66.7% of all patients (10 of 15) and 76.2% of all levels (16 of 21) were evaluated as solid fusion. In cases with bilateral PS, fusion rates were 81.8% of patients (9 of 11) and 88.2% of levels (15 of 17) respectively. Only one case with unilateral PS was evaluated nonunion due to PS loosening. No revision surgery for nonunion were requested.

Conclusion

Hybrid grafts using BMA combined with a porous HAp /Col composite were efficacious for XLIF as substitutes for conventional autografts. Rigid supplementary stabilization was considered necessary to obtain high fusion rates.
Multicolumn Spinal Cord Stimulation Surgical Lead Implantation Using an Optic Transligamentar Minimally Invasive Technique
Authors: Cam Philippe , Monlezun Olivier , Lorgeoux Bertille , Roulaud Manuel , Rigoard Philippe
Published: April 2016

Introduction

A new generation of neurostimulation surgical leads is used to increase the success of spinal cord stimulation (SCS) in difficult-to-treat indications such as Failed Back Surgery Syndrome (FBSS). This makes the implant procedure more invasive, which is likely to be a determinant factor in clinical and functional outcomes. Minimal access spinal technologies (MAST) have been previously used for surgical lead implantation. However, only a unilateral approach was described, causing some difficulties for median lead placement and not always preventing laminectomy. A recent MAST technique can be used to implant SCS leads without these limitations, which seems to be key in the positive outcomes experienced. The objective is to describe the original MAST technique used in the pilot study.

Material and Methods

Twenty-four consecutive patients were implanted with a multicolumn surgical lead for refractory chronic back and leg pain using the optic transligamentar MAST technique described extensively. Clinical outcomes, functional ability and adverse events (AEs), were recorded for up to 12 months after surgery.

Results

The MAST technique allowed median lead placement, facilitated visualization of the spine and permitted transligamentar insertion that minimized scarring and muscle damage, intraoperative blood loss and postoperative functional complications. Back pain decreased significantly at all follow-up, while functional status improved significantly at 1 year. No technique-related AEs were reported.

Conclusion

Use of MAST approach could be useful in safe implantation of multicolumn surgical leads and confer major advantages in difficult-to-treat refractory lower back pain conditions such as FBSS
Post Traumatic Stress Disorder Symptoms following Elective Spine Surgery. Is Surgery Really the Reason?
Authors: Shiban Ehab , Meyer Bernhard
Published: April 2016

Introduction

Recently, posttraumatic stress disorder symptoms (PTSD) were found in 20% of cases following elective spine surgery. PTSD was therefore attributed to surgery. Furthermore, PTSD symptoms were associated with reduced clinical benefit. However, PTSD is seen in up to 10% of the normal population. Aim of this study is to evaluate the incidence of PTSD before and after elective spine surgery and the influence of PTSD on clinical outcome.

Methods

A prospective study of patients undergoing elective spine surgery was performed. The patients were evaluated for PTSD using the PTSS score before surgery and 3 months postoperatively. In addition SF36 physical composite score (PCS), Oswestry Disability Index (ODI) and pain visual analog scale (VAS) were completed preoperatively and at 3 months postoperatively. Incidence and influence of PTSD symptoms on clinical outcome were examined.

Results

144 patients met all inclusion criteria. 78 patients were male (54.2%); mean age was 59.49 years. PTSD symptoms were reported in 59 patients (41%) before surgery. However, only 32 patients (22.2%) still had abnormal PTSS scores at 3 months follow up. Only 6 patients (4,17%) developed PTSD symptoms following surgery. PTSD was associated with worse clinical outcome before surgery in the ODI score (ODI: 18.45 versus 43.16, p = 0.000). There were also statistically significant differences in mean SF36 PCS score ( p = 0.000) and pain VAS ( p = 0.000) between both groups. At three months follow up patients with PTSD showed worse clinical outcome in the ODI score and VAS pain (ODI: 10.89 vs 28.43, p = 0.000; VAS: 11 vs 4.26, p = 0.000) and also in the SF36 PCS score ( p = 0.000).

Conclusions

PTSD symptoms are associated with worse outcome following elective spine surgery. However, the vast majority of patients with PTSD symptoms exhibit symptoms before surgery and only a small minority develop PTSD symptoms after surgery.
Episacral Lipomata as a Cause of Lower Back Pain: Series of Cases Managed by Excision
Authors: Singh Avthar , Ramalingam Kuharajan , Kai Lim Kang , Jeremy Satish Vincent
Published: April 2016

Introduction

Episacral Lipomata or the “back mouse” is a tender, fibro-fatty subcutaneous nodule found in the thoracolumbar fascia area in up to 16% of people. The “back mouse” can be a cause of significant low back pain in patients with associated disc disease, nerve root compression and facet hypertrophy. This is due to the particularly dense innervation with substance P positive free nerve endings in the posterior layers of the fascia.

Material and Methods

We studied the outcome of removal of the ‘back mouse’ in nine patients with twelve lipoma's (three had bilateral lipoma's). The diagnosis was made by clinical examination and all of the excised nodules were confirmed to be episacral lipoma on histo pathological examination subsequently. The outcome was measured with Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scoring. The average VAS reduced from 7.8 pre operatively to 4.8 post operatively.

Results

Six patients had improvement in ODI from moderate to minimal disability, one patient had improvement from severe to moderate disability and the ODI in three patients were unchanged. Seventy percent of the patients were happy with the outcome as the symptoms had significantly reduced despite having some other underlying spinal pathology.

Conclusion

In our opinion, episacral lipoma may be an unrecognized entity by both specialists and generalists and can be a treatable cause of low back pain. The excision provided relief to the compressive effect it had on the middle and posteriro layers of the lumbar fascia and the muscles it encloses. Marginal excision of a painful episacral lipoma may provide pain relief and improved lower back function in patients who are carefully selected for this procedure,
Evaluation of the Shoulder Imbalance Angular Parameters and the Usage of Midtrapezial Angle Clinically and Radiologically in Adolescent Idiopathic Scoliosis (AIS) Cases
Authors: Barishan Fatih , Akesen Burak
Published: April 2016

Introduction

Evaluating AIS patients with shoulder imbalance, radiologic angular parameters generally used are: radiographically costoclavicular intersection angle (CCA), angle of the line connecting the coracoids (Corac), the angle of line connecting the upper limit of the first costal angle (FRA), and the tilt angle of the first thoracic vertebra line (T1T). The angles shown on digital photographs are axillary folds line (ax), deltoids peak line (d) and midtrapezial line angle (tra) between the horizontal line.

Material and Methods

A total of 29 cases with AIS are separated into two groups, having distance of horizontal lines drawn from coraciods with 2cm shoulder height differences (SHD) and others. Statistics; paired-samples t-test or wilcoxon tests are used depending on normalization of variables. For each variable ROC analysis is performed. Pearsons correlation analyses used with the changes of shd valvues for each parameter.

Results

Sensitivity of ax is the highest value with 90% than to tra and cca of 80%. Tra and cca angles has highest spesifity valvues with 63.16% than to ax of 57,89%. All radiologic parameters changes found strongly correlated with the changes of shoulder height differences.

Conclusion

The mid trapezial and axillary fold angles over 2,8 and 2,9 degrees respectively is found in shoulder imbalance by cosmetic parameters. The costoclavicular intersection angle over 4 degree is found to be the radiologic shoulder imbalance parameter for ais. These cut off valvues can be usefull for determining the the shoulder imbalance for selection of upper enstrumantation levels in AIS. Midtrapezial angle can be used as a parameter of clinical cosmetic shoulder imbalance in adolescent idiopathic scoliosis. Axillary fold angles and costoclavicular intersection angle can also helpfull for defining shoulder imbalance in adolescent idiopathic scoliosis.
Pedicle Morphometric Analysis in Adolescent Idiopathic Scoliosis: Importance of Surgeon Familiarity with Patient Specific Variables
Authors: Sudarshan Pramod , Panda Aditya , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan
Published: April 2016

Introduction

A morphometric analysis of convex and concave pedicles in scoliotic spines depends on the three-dimensional reconstructions of the spine. As the standard of care relies on two-dimensional X-rays, there have been few reports on this topic and an underestimation of the morphological irregularities. We present our data of AIS patients who underwent HRCT as part of the preoperative planning for robotic-guided corrective surgery.

Material and Methods

A retrospective study of adolescent idiopathic scoliosis patients indicated for corrective surgery at our center. All patients underwent a CT scan with 1-mm slice thickness as part of their preoperative planning. The morphometric parameters documented were: transverse pedicle width, pedicle angle and maximum chord length in both convex and concave sides of the curve and were analyzed in the software (Renaissance) used for robotic guidance.

Results

We reviewed charts of 23 patients with an average age of 14.9 years. Average Cobb angles of the major curve measured 48.4° (Range 27.7° to 82.8°). There were 7 type 5 Lenke curves, 6 type 3 and type 1, and 4 cases of type 6. On the concave side 247 pedicles were measured, of which 104 (42%) were hypoplastic (i.e., transverse pedicle width <4 mm). Of the 249 convex pedicles measured, 74 (30%) were hypoplastic ( p < 0.005). Mean concave pedicle angle was 15.6 ± 3.8° and maximum chord length was 40.9 ± 7.1 mm, while the convex pedicle angle was 16.1 ± 3.9° ( p = 0.22) and maximum chord length was 40.8 ± 6.4 mm ( p = 0.82).

Conclusion

Knowledge of patient-specific anatomical variances is critical when instrumenting scoliotic vertebrae. Based on our findings, despite the patient's added exposure to radiation, we advocate the use of CT-based preoperative planning to maximize safety of the instrumentation and emphasize the importance of Surgeon familiarity with patient specific anatomic variances in instrumentation of scoliotic vertebrae.
Shilla Procedure and Crankshaft Phenomenon
Authors: Kharrat Khalil , Sebaaly Amer , Kreichati Gaby , Rizkallah Maroun
Published: April 2016

Introduction

To evaluate in a retrospective study the capability of Shilla technique in preventing the crankshaft phenomenon in the treatment of the severe scoliosis in young children.

Methods

11 scoliotic children (3M, 8F), Tanner 0, aged from 4 years 6 months to 11 years 6 months were operated by Shilla procedure and were reviewed with a followup from 3 years to 6 years 4 months.7 patients had their final fusion. The number of procedure, except for final arthrodesis was one in 5 patients and two in 6 patients.

Results

The mean preoperative Cobb angle was 57° (thoracic curve 67°, lumbar curve 55°). The growth continued in all children from 67 cm of the sitting height on initial examination to 72.5 cm at final follow-up. For the coronal angle, it was corrected form 57° to 34° at immediate post-op than an increase to 50° at final follow-up. In 7 children, the initial post-op correction was not maintained due to the crankshaft phenomenon observed in both fused instrumented apex curves (67° → 35° (immediate post op) → 51° on final follow-up) as well as in the non-fused non instrumented apex curves (54° → 40° (immediate post op) → 55° on final follow-up). Discussion and Conclusion: If the crankshaft was expected in bridged curves it also occurred in the apex fused-instrumented curves. Age of the children of 10 years 9 months, right in the growth spur appears to be its main cause. The children with controlled curves had a mean age of 7 years 8 months. In conclusion, the Shilla technique, even in apex fused instrumented curves was not able to control the crankshaft phenomenon during growth spurt. This should be taken in consideration for the timing of the final fusion.
Preoperative LIV Tilt Affects Post Operative Coronal Imbalance in Patients with Lenke 5C Scoliosis
Authors: Shetty Ajoy Prasad , Rajasekaran S. , Subramani Suresh , Kanna Rishi
Published: April 2016

Introduction

Lenke 5C curves are increasingly being treated through posterior pedicle screw based correction techniques. We evaluated different preoperative radiological parameters which could affect post operative coronal imbalance (POCI) in patients with Lenke 5C scoliosis treated with posterior instrumented correction.

Methods

We retrospectively evaluaed twenty-three cases with Lenke 5C scoliosis who underwent selective posterior pedicle screw based deformity correction. Fusion was performed from proximal neutral to distal stable vertebra. Preoperative, immediate post operative and final whole spine standing radiographs were analyzed. The pre-operavtive radiological parameters were assessed including lower instrumented vertebra(LIV) tilt and translation, Cobb angle,C7 offset from CSVL, lumbar lordosis and upper instrumented vertebra(UIV) tilt and translation. Post-operatively we assessed the correction in cobb angle and post-operative coronal imbalance.

Results

Twenty -three patients had a mean age: 11.8 ± 4.6 years, with 4 males and 19 females. There was a significant improvement in Cobb angle from mean of 55 ± 13.3° to mean of 14.7 ± 8.8°. Nineteen patients had lower instrumented vertebra at L4, 3 at L3 and one at L5. Correction was maintained with no significant loss in the late post op period (15.2 ±8.9 degrees). The mean pre op C7-CSVL distance was 24.7 mm While eight patients had immediate post operative coronal imbalance (POCI), six of them balanced at a mean 8.2 months. Four patients had POCI at the time of final follow-up including two, who developed late imbalance. POCI correlated with pre operative LIV tilt only > 25° ( p < 0.05) and not with LIV translation, UIV tilt or translation. Five of the eight patients with immediate POCI and all four patients with late POCI had preoperative LIV tilt > 25°.

Conclusion

In Lenke 5C scoliosis treated by posterior pedicle screw instrumentation, patients with a preoperative LIV tilt (>25°) have a risk of developing POCI.
Management of Children with Complicated Spinal Deformities in Countries with Minimal Resources
Authors: Ahmad Alaaeldin
Published: April 2016

Introduction

It is conceded that complicated spinal deformity in underdeveloped countries presents specific obstacles, but these are often made into “using cheaper screws” and being cost effective. In fact, this has become the main discourse for addressing scoliosis in the global South. It is not simply an extra problem on the margin but a fundamentally different institutional context which presents unique constraints and requires innovative solutions. We can innovate ways to make the surgery have less operative and postoperative demands, or to make those demands easier to deal with GIVEN the adverse institutional context. This is precisely where hybrid construct comes in as a surgical choice that is used for complicated spinal deformity in developing country with minimal resources for more than 5 years now.

Material and Methods

13 cases presented with severe spinal deformity, all previously surgically treated for scoliosis, 7 congenital, 3 iatrogenic, 2 syndromic, 1 idiopathic. 8 of them with other associated problems, 6 with scoliosis, 6 with kyphoscoliosis and 1 with kyphosis. The surgical management before the hybrid construct were 28 procedures done, 4 posterior fusion with instrumentation, 3 posterior fusion in situ,2 anterior and posterior fusion in situ, 2 growing rods, 1 VEPTER, 1 posterior fusion and instrumentation with removal of the implants in same day.

Results

Mean age at surgery with hybrid construct 10.5 years, with mean followup time 34 months, all were done with rib hooks proximally and pedicular or iliac screws distally. mean preoperative thoracic scoliosis was 83 became 66, thoracic kyphosis 113 became 70, thoracolumbar scoliosis 60 became 40, thoracolumbar kyphosis 63 became 22. Complications, 8 complications were detected 2 infection, 1 proximal hook dislodgment, 1 implant exposure, 2 broken rod, 1spinal stenosis, 1 died from non-surgical related cause.

Conclusion

With this complex and demanding medical condition in developing countries, we think that hybrid construct may be a good and safe surgical option.
Comparison of the DIERS Formetric 4D Scanner and Plain Radiographs in Terms of Accuracy in Idiopathic Scoliosis Patients
Authors: Kumar Vishwajeet , Cole Ashley , Breakwell Lee , Michael Antony Louis Rex
Published: April 2016

Introduction

Comparison of the DIERS Formetric 4D Scanner and plain Radiographs in terms of accuracy in AdolIdiopathic Scoliosis (AIS) Patients. This project aims to determine the accuracy of the DIERS scanner and help decide whether it could be used instead of radiographs for some, or all, AIS patients.

Material and Methods

Two patient lists were combined; both patients who underwent an operation between 2011–2014 and patients on the Spinecor bracing program. Only preoperative radiographs were used of the operative group. Both DIERS Formetric scan and radiograph were be taken on the same day to prevent time related changes to scoliotic curve. Patients were excluded if they had had an operation to treat their scoliosis. Patients with braces were included so long as their X-ray was of them not wearing the brace. There was no restriction on BMI. Some patients had a double curve (thoracic and lumbar) and it was decided to only compare the greater curve. The radiographs were assessed to show the Cobb angle and the position of the greatest scoliotic curve. To confirm the accuracy of measurements, a senior consultant remeasured a total of 50 X-rays. The results he found averaged a 3.1 degree difference to that measured by the medical students. It was decided that this showed sufficient correlation that not all of the Cobb angles needed to be re checked. Following the radiograph assessment the DIERS Formetric scans were reviewed.

Results

A total of 85 patients (41 Spinecor, 44 preoperative) were measured providing a total of 236 X-rays. 71 X-rays were excluded: 3 due to the Cobb angle not indicating scoliosis (<10°) and 68 due to a DIERS scannot being performed on the same day. A total of 165 X-rays remained for comparison. The range of Cobb angles was between 10.3 and 82 degrees. The DIERS scanner averaged a Cobb angle of -3.49° below that measured on the X-ray. However, although this result seems very good, it is not pure correlation that needs to be taken into account. It would be expected that correlation would be found but, more importantly is the difference between the angles measured on X-ray when compared with DIERS. Interestingly the scanner seemed to overestimate curves of a small severity and underestimate larger curves.

Conclusion

Overall the Formetric scanner did average a small underestimate of the Scoliosis angle measured, and showed a good correlation when compared with X-ray. However, especially in severe curves (>65°) the level of accuracy deteriorated rapidly. It could be concluded that the Formetric scanner could replace X-rays for follow up patients within boundaries of magnitude of curve, but that it could not replace X-rays for early diagnosis or when the patient is having a pre-operative assessment.
Is Radiographic Control Necessary after Every Lengthening of Magnetically Controlled Growing Rod?
Authors: Yilgor Caglar , Alanay Ahmet
Published: April 2016

Introduction

A well-accepted imaging follow-up protocol to confirm the amount of lengthening, and check for the curve and the status of the implants for MCGR is not yet established. AP-lateral XR after each lengthening (usually every 2–3 months) is suggested. The aim of this study was to find out whether radiation exposure after every lengthening can be justified or not.

Material and Methods

A retrospective analysis of 14 consecutive patients (12F, 2M) with EOS of different etiologies treated by MCGR. Mean age was 7 (3–10). Examination of the back in terms of implant prominence was done carefully after each lengthening. Lengthening interval was 2–3 months. Patients had pre- and post-lengthening AP-lateral XR in every visit in the beginning of experience and this was subsequently changed to only AP post-lengthening XR. The XR were analyzed for the presence of failure to lengthen, collapse between 2 procedures and incidental mechanical failures such as rod breakages, hook/screw pullout.

Results

Mean preop coronal Cobb of 69.6° (38–101) was corrected to 39.1° (16–76) at the final follow-up. Average followup was 24 months (6–52). A total of 101 lengthenings were performed. 173 pre- and post-lengthening XR (110 AP, 63 lateral) were taken. There were a total of 5 mechanical failures in 2 pts. 4 were rod or substance breakages and 1 was hook dislodgement. All 5 were diagnosed in a non-planned control with the patient applying for either prominence of implants and/or history of trauma or unremitting pain. No other incidental mechanical failures were noted in any routine XR.

Conclusion

Routine XR taken before and after each lengthening procedure of a MCGR is not likely to reveal any significant findings. Post-lengthening AP XR with a decreased frequency (every 6 months) and AP-lateral XR only after a significant complaint or clinical findings should be considered.
All Pedicle Screw Instrumentation for Scheuermann's Kyphosis Correction
Authors: Koptan Wael , El-Sharkawi Mohammad , ElMiligui Yasser
Published: April 2016

Introduction

Scheuermann's kyphosis has long been treated by a two staged fusion and instrumentation with a hybrid construct using hooks, pedicle screws and sublaminar wires. Interest in all pedicle screws constructs led to its use in the treatment of Scheuermann's kyphosis.

Materials and Methods

The study included 18 patients who underwent a single stage correction by segmental all pedicle screw constructs (Group 1) and 17 who underwent a two staged fusion and instrumentation with a hybrid construct (Group 2). The average age was 16y+3m and 16y+8m respectively. The average preoperative dorsal kyphosis was 88 degrees (Group 1) and 80 degrees (Group 2).

Results

Both groups were followed for a minimum of 2 years. The deformity correction of Group 1 had an average of 57% postoperatively with 2.2% loss at final follow-up in comparison to Group 2 where the correction was 48% postoperatively with 3% loss at final follow-up. The operative time was considerably less in Group 1 with an average of 3.5 hour than Group 2 with an average of 5.15 hour. The average blood loss was 550 cc in Group 1 and 910 cc in Group 2.

Conclusions

The use of multiple levels all pedicle screws technique allowed a rigid anchor for posterior correction of the deformity with less operative time, blood loss, hospital stay without the need for anterior release.
Quality of Life of Children and Adolescents with Idiopathic Scoliosis Treated Conservatively with DoboMed Method
Authors: Kapustka Bartosz , Zimon Michalina , Matusik Edyta , Pawel Chodakowski , Durmala Jacek
Published: April 2016

Introduction

The purpose of this study was to determine the Quality of Life of children and adolescents with IS (idiopathic scoliosis) treated conservatively with DoboMed method.

Material and Methods

We examined group of 63 patients (54 girls) with mean age (14,7 years) – 32 were treated with a DoboMed method only and 31 were treated both with DoboMed method and with Cheneau brace. Mean patients' Cobb angle was 24,2° and mean apical vertebral rotation (AVR) was 11,4°. We also analyzed the patients' BMI (body mass index) z-score, the age of the diagnosis, the deformity location and the duration of brace application. Two questionnaires were used: BSSQ-Deformity and BSSQ-Brace, patients were examined twice at the beginning and at the end of hospitalization.

Results

At the beginning of hospitalization, the median value of BSSQ-Deformity was 18 and for BSSQ-Brace 9,5. Statistically significant correlations between BSSQ-Deformity results and patient's age, BMI z-score and numer of hospitalizations in the Department were observed. In the group of patients treated with a DoboMed method and a brace, we observed the higher level of stress associated with application of the brace (median=9,5) than the level of stress associated with a deformity (median=16) ( p = 0,0001). This group presented also a higher level of stress evaluated with BSSQ-Deformity than group treated only with DoboMed (median=19) ( p = 0,041).

Conclusion

Children and adolescents with a scoliosis treated with a DoboMed method presented a low or moderate level of stress associated with the deformity. Higher observed the level of stress was significantly correlated with an older age of patients, a higher BMI z-score value and more hospitalizations in the Department. There was no correlation between the patients' quality of life and the duration of a brace aplication. Group of patients treated with both: the physiotherapy and brace presented the higher level of stress associated with deformity. The level of stress associated with the brace usage (BSSQ-brace) is higher than a stress associated with deformity (BSSQ-deformity) in a group treated with the Chenau brace.
Posterior based 2 or 3 Column Spinal Osteotomies and Release followed by a Controlled Halo-Pelvic Distraction in the Management of Neglected and Complicated Spinal Deformities: A Safe and New Technique
Authors: Kanagaraju Vijayanth , Chhabra Harvinder
Published: April 2016

Introduction

Neglected severe and rigid spinal deformities pose a big challenge to spine surgeons. The neglect adds other risk factors like decompensated respiratory function, fused rigid curve and neurological deficit to an already complex problem. Single stage and anterior surgery are fraught with complications in an already compromised lung condition. The visco-elastic properties of spine utilized through awake halo-pelvic distraction aided by posterior release and a posterior based 2 or 3 column osteotomy allow safe correction of deformity before a definitive procedure is planned. We present our experience of treating 3 such cases.

Materials and Methods

Retrospective review of hospital records identified three patients. Two patients had neglected early onset congenital spinal deformity with intra-spinal anomaly. The third patient was an old operated case of neuromuscular scoliosis with fused spine with crankshaft phenomenon. All three patients presented with a poor pulmonary function on admission. The curves were severe( > 90°) and rigid with flexibility of only 10%. All three patients were managed by posterior release and periapical posterior based 2 or 3 column osteotomies with halo-pelvic distraction and finally posterior spinal instrumentation and fusion.

Results

Mean preoperative coronal cobb's angle 102° corrected to 72.33° after posterior based osteotomies and halo-pelvic distraction alone and was 56° after final posterior instrumentation with or without intraoperative manoeuvring. The results were encouraging at three years follow-up, with improved pulmonary function.

Conclusion

Staged surgeries with controlled and awake, axial distraction using halo-pelvic apparatus with posterior based spinal osteotomies and release offer a safe and effective option in the treatment of severe rigid three plane deformities of the spine with severe respiratory compromise.
Analysis of Curves of Allowances Submitted to Patients Arthrodesis Selective in Curves Lenke Type 1: Fellow up Two Years
Authors: Junior Charbel Jacob , Debom Tadeu Gervazoni , Maia Thiago Cardoso , Junior José Lucas Batista , Cardoso Igor Machado , Brazolino Marcus Alexandre Novo
Published: April 2016

Introduction

Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity, by definition is in the coronal plane deformity greater than 10 °, associated with the rotation of the vertebrae and costotransversais joints presents no definite etiology. The treatment of such deformity depends on the magnitude and location of the curve and be in accordance with the degree of growth potential of the patient. The goals of surgery are to correct the curve, restore balance in the coronal and sagittal plane, prevent progression and possible cardiopulmonary complications and consequently a cosmetic improvement.

Objective

To evaluate radiographically the behavior of the secondary curves in the coronal and sagittal plane in AIS patients classificad as Lenke I, who underwent surgical treatment of posterior arthrodesis selective in fellow up the two years.

Methods

A prospective study where of analyzed 40 patients with AIS, 33 female. The measurement of used radiographic parameters followed the recommended by Cobb with fellow up the 2 years.

Results

The mean Cobb index in the anteroposterior radiographs preoperatively examination was 29.97 ° for proximal thoracic curve, 59.08 ° for main thoracic curve and 35.26 ° for lumbar curve. The average postoperative was 19,56°, 14,73° and 12.5 ° respectively, with percentage of 34.73% correction, 75.06% and 64.64% for the respective curves

Conclusion

Surgical treatment by selective arthrodesis AIS Lenke type I provides correction of compensatory curves in the coronal and sagittal plane maintenance in fellow up the two years.
Intrinsic Sacral Deformity in L5 Istmic Lythic Spondylolysthesis
Authors: Díez-Ulloa Máximo-Alberto , Barahona-Lorenzo Daniel , Gallego-Goyanes Adrian
Published: April 2016

Introduction

A deformity in the sacrum has been reported in patients with spondylolysthesis (Antoniades, Spine 2000)

Hypothesis

Besides sagittal profile, the sacrum in itself is deformed, probably due to a fixed point in the sacoiliac joints acting as fulcrum and deforming force from ventral displacement of gravity line.

Matherial and Methods

A control group (group C), matchable for age and gender, was compared with a series of 83 patients with L5 istmic lythis spondylolysthesis (group A), which was later subdivided in low grade (Meyerding types I and II, group A1, n = 67) and high grade (Meyerding III or IV, group A2, n = 16)

Variable

Proximal sacral kyphosis measured by the angle formed by the S1 posterior wall and the S2 posterior wall, if S1 was kyphotic on S2 then it was considered a positive angle, other wise being negative.

Statistics

SPSS 21.0, working with means or medians and appropriate tests after studying whether the variable showed a normal distribution.

Results

Group C lordosis -2° (minimum -8°; maximum +7°). Group A kyphosis +10° (minimum -11°; maximum +30°). And then: Group A1 kyphosis +10° (minimum -11°; maximum +30°). Group A2 kyphosis +15° (minimum +5°; maximum +26°). There were statistically relevant differences between group C and group A and also between groups A1 and A2.

Conclusion

Besides spinopelvic balance issues, there is an intrinsic deformity in the sacrum of patients with L5 istmic lythic spondylolysthesis, even more in high grade lysthesis.
How Much Deformity Correction and Maintenance Can We Obtain by LLIF and will it be Affected by Approach Side or Levels?
Authors: Cho Woojin
Published: April 2016

Introduction

Lateral lumbar interbody fusion (LLIF) is one of the minimally invasive surgeries that have shown the successful surgical outcome. The purpose of this study is to report the amount of deformity correction achieved with LLIF, and to compare the effect of convex versus concave approach side on the magnitude of correction.

Methods

Out of 512 LLIF cases, 100 stand-alone LLIF cases for degenerative lumbar scoliosis were identified after excluding previous fusion, posterior fixation, and cases without scoliosis. Radiographic and clinical data were analyzed retrospectively. In each patient, overall and segmental deformity correction (difference between postop and preop) and maintenance (difference between final and postop) were measured, and the amount of segmental correction and maintenance was compared in terms of approach side (convex versus concave). Also, correction was compared between groups with or without end plate fracture, and maintenance was compared between the groups with or without subsidence.

Results

Total 34 patients with follow up were included, and a total of 86 levels were treated. The amount of overall and segmental correction and maintenance is illustrated in Table 1 . Overall and segmental scoliosis correction was more predictable than lordosis creation. The upper levels had the tendency of more segmental scoliosis correction, but not significant. There was no difference in the amount of segmental correction and maintenance in between convex and concave side. The group without the endplate fracture showed more segmental scoliosis correction significantly, the group without the subsidence showed more segmental scoliosis and lordosis maintenance significantly.

Conclusion

We report the amount of overall and segmental deformity correction and maintenance by LLIF procedure. Segmental scoliosis correction is very predictable unless endplate breakage occurs during surgery. Segmental deformity correction maintained well until final follow up unless subsidence occurs. Overall or Segmental lordosis creation is less predictable as we proposed it is dictated by the position of the cage. There was no difference in the amount of segmental correction and maintenance in between convex and concave side. [Table: see text][Figure: see text]
Influence of the Level of Pedicle Subtraction Osteotomy on Pelvic Tilt Change in Adult Spinal Deformity
Authors: Sebaaly Amer , Kharrat Khalil , Kreichati Gaby , Rizkallah Maroun
Published: April 2016

Background

Spine osteotomy is used for patients with rigid severe spinal deformity. Pedicle Subtraction Osteotomy (PSO) is performed by removing the posterior elements and both pedicles, removing a wedge from the vertebral body, and closure of the osteotomy by hinging on the anterior cortex. This technique is demanding and have very steep learning curve. We analyze the effect of the level of PSO on the change of pelvic tilt

Methods

this is a retrospective study of 35 patients (mean age, 60.7 years; range, 45–81 years) undergoing thoracolumbar PSO at a single institution in the past 4 years. One patient underwent PSO at T11, two patient underwent PSO at L2, and 16 patients underwent PSO at L3 and 16 at the L4 level. Seventy percent of the patients had undergone at least one previous spine surgery in the region of the PSO.

Results

the mean pelvic incidence in the cohort was 54.5. There was no change in the pelvic tilt between the preoperative and postoperative state (24.8 vs 22; p > 0.05). On the other hand, lumbar lordosis (26 vs 44), thoracic kyphosis (27 vs 38.8) and T1 pelvic angle (26.6 vs 14.7) had all significant improvement. Mean PSO resection was 35°. With subgroup analysis, mean pelvic tilt change -3.3° at the L3 level and -8.6 ° at the L4 level.

Conclusions

The degree of PSO resection correlates greatly with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, and T1PA). More importantly, PSO level impacts postoperative PT correction; L4 level PSO have shown a better correction of the pelvic tilt than L3 PSO.