bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Pediatric Scoliosis with Daytona Instrumentation Using the Cluster Technique
Authors: Ling Tah , Cardoso Pedro , Alves Cristina , Balaco Ines , Matos Gabriel
Published: May 2015

Introduction

The authors show their experience with the use of Daytona instrumentation in the treatment of pediatric spine deformities. In the correction maneuvers it is important to build up clusters that are groups of pedicle screws joined together for stability in the derotation and provide greater force in the correction and also to prevent the hypokyphosis effect of all screw construct in the scoliosis correction.

Materials and Methods

Our department used the Daytona system in 81 patients with pediatric scoliosis since March 2011. The Daytona instrumentation is a novel instrumentation that uses pedicle screws with long tulips in their basic construction. The screws are uniplanar or polyaxial and the tulips are 30 mm long, which makes it much easier to put the rod in the construction without the need of a persuader and helps in the initial correction maneuver. The caps are specially designed to embrace the rod and prevent splaying of the screw during the tightening and untightening. The scoliosis correction maneuver that we used were rod derotation, derotation of the spine with groups of screws (cluster), “in situ” bending, compression and distraction, and segmental derotation. Using the clusters, there are less chances of screw pullout and splaying. Generous Ponte osteotomies are important for spine flexibility and better correction. We use Lenke's classification for the classification of scoliosis. We analyze the follow-up time, curve angles, flexibility, and the Cincinnati index. For patients with idiopathic scoliosis, we use the SRS 22r outcomes questionnaire.

Results

Retrospectively, we analyze 81 patients with scoliosis, 64 female and 17 male, with a mean age of 13.96 years (10–17 years). A total of 88% of the patients had idiopathic scoliosis. Others are neuromuscular and syndromic patients. Preoperatively, the mean angle was 78.09 degrees (38–120 degrees) and the mean flexibility index was 30.7%. Postoperatively, the mean angle was 23.6 degrees (5–62 degrees). Correction percentage was 68.1% and the Cincinnati index was 3.33%. The mean follow-up time was 16.9 months, at last follow-up the mean curve angle was 24.7 degrees, representing a loss to the postoperative period of 5% of loss of correction. The most frequent complications that we encounter were temporary loss of MEP and screw breakage. Comparing with the literature, the Daytona system is as effective as other systems in the market.

Conclusion

The Daytona instrumentation is a very good system for the treatment of adolescent idiopathic scoliosis; it is as effective as other systems with the added advantage of being much easier to place in the patient, and with the cluster technique we can save money with fewer screws and the derotation maneuver with clusters is a powerful correction technique.
ACDF Graft Selection by Surgeons: Survey of AOSpine Members
Authors: Yoon S. Tim , Konopka Jeff , Brodke Darrel S. , Youssef Jim , Wang Jeffrey , Park Jong-Beom , Meisel Hans Jörg
Published: May 2015

Introduction

The choice of graft material for anterior cervical disc fusion (ACDF) surgery is presumed to be very important in achieving fusion. Worldwide, a large diversity of graft options exists but no published data exist on actual use. Our objective is to determine the most commonly used graft materials in ACDF, whether the choice is affected by surgeon's training, years in practice, geographical location of practice setting, or surgeon's perceived difficulty in achieving fusion for a particular case. We also want to confirm our previous assumption that surgeons feel that the choice of graft material is important for outcome and that there is sufficiently good comparative and safety data on the most common grafts.

Materials and Methods

A 23-question survey was sent out to 5,334 surgeons using the Global AOSpine database. Response data were then stratified into surgeon training, years of practice, practice type, and global region. To further characterize type of ACDF graft, we classified common graft materials into structural and nonstructural components.

Results

Nearly all surgeons, 94.6%, performing ACDF believe that cervical disc fusion is important for a successful patient outcome. Overall, 89.3% of the surgeons believe that graft impacts fusion rates and 86.0% affect time to fusion. The use of a cage is currently the most common structural graft component used worldwide at 64.1%. Of the surgeons who use cages, the PEEK cage makes up for 84% of them. North American surgeons have stopped this trend and use composite allograft more commonly. Surgeon experience seems to be positively related to the use of a cage because surgeons with a greater number of years of practice are more likely to select a cage. The choice to add a nonstructural graft component was reported at 74%. This result was similar for performing multilevel fusions at 72.8%. The most common nonstructural graft material depends on the type of surgery, simple or complex. For simple cases, local autograft is most common and for multilevel fusions, allograft iliac cancellous is most widely used. Most surgeons are not satisfied with the available literature comparing the effectiveness of grafts, but believed there was sufficient evidence to support the use of their chosen graft.

Conclusion

Almost all surgeons believe that fusion is important to ACDF surgery outcomes and that most surgeons believe choice of graft impacts fusion. However, this survey indicates that there is great variability in the type of graft material used by spine surgeons across the world and surgeons feel that there is insufficient comparative data to help choose between graft types. This variability in surgeon practice and gap in the literature indicate an important opportunity to change surgeon practice with well-conducted comparative studies.
Multilevel Anterior Cervical Discectomies and Cage-Augmented Fusion without Plate Fixation
Authors: Maati Hossam
Published: May 2015

Objective

The number of surgical techniques of decompression and solid interbody fusion as a treatment for cervical degenerative disc disease (DDD) has increased rapidly. Cage-assisted anterior cervical discectomy and fusion (ACDF) has proven to be a safe and effective procedure for one and two-level DDD. Multilevel cervical discectomy usually requires plate and screw fixation for maintaining the spinal curvature and increasing the graft fusion rate. Clinical results after three or four-level interbody cage-augmented ACDF have been reported in very few literatures. We investigated the safety and effectiveness of cages used in such procedures without plate fixation and evaluated the results.

Methods

Forty-five patients suffering from three or four-level cervical DDD underwent cage (PEEK or titanium)-assisted ACDF without plate fixation. The cervical DDD was confirmed by radiography and magnetic resonance imaging. The patients underwent radiographic evaluation to assess cervical lordosis, segmental height of cervical spine, foraminal height, cross-sectional area of foramina, the angle between the two adjacent endplates, and spinal stability. Neurological outcomes were assessed using the Prolo scale. Neck pain was assessed using the visual analogue scale (VAS). The follow-up period ranged from 27 to 53 months (mean, 35 months).

Results

A significant improvement ( p < 0.001) in the Prolo scale scores (preoperatively 7.9 ± 1.7 and postoperatively 8.7 ± 1.1) and VAS pain scores (preoperatively 8.8 ± 1 and postoperatively 3 ± 1.5) was demonstrated. A significant increase in cervical lordosis, segmental height, foraminal height, cross-sectional area of foramina, and angle between the two adjacent endplates was noted. Good stability was obtained in all patients 12 months postoperatively and the complication rate was 0%.

Conclusion

Multilevel (3 or 4) anterior cervical discectomies and cage (PEEK or titanium)-augmented interbody fusion without plating is a good method for management of multilevel cervical DDD. It provides long-term stabilization, increases lordosis, segmental and foraminal height, and cross-sectional area of foramina. Satisfactory neurological outcomes can be obtained and donor site complication can be avoided.
Morphometric Study of the Hypoglossal Nerve and the Hypoglossal Canal for the Surgery of the Upper Cervical Spine
Authors: Hong Jae Taek , Kim Il Sup , Kim Joon Yeong , Kim Moon Seok
Published: May 2015

Objective

The upper cervical pathology is not an uncommon disease in the congenital anomaly, elderly population, and patients with rheumatoid. Newly developed operative techniques in high cervical region could be related to neurovascular injury. The objective of this study was to determine the anatomic relationship of the hypoglossal nerve (HN), internal carotid artery (ICA), bony structures, and hypoglossal canal and demonstrate the vulnerability of the neurovascular structures.

Methods

Eleven fresh cadavers (5 male and 6 female) were dissected bilaterally to expose neurovascular structures of the high anterior cervical region and hypoglossal canal. The anatomical relationship was evaluated between C1 bony structures (midline, lateral mass, and C1 transverse process) and the ICA and HN. The angle of the hypoglossal canal was also evaluated.

Results

The HN consistently traveled toward the midline at C2–3 and was safe caudal to C3–4. The HN is usually located lateral to the ICA. Relative anatomical relationship between the HN and surrounding bony structures at the level of C1 are as given below. The mean diameter of the HN was 2.4 mm (2–3.5 mm). The mean distance between the midline and the HN was 30.15 mm (24–35 mm). The mean distance between the margin of the C1 lateral mass (LM) and the HN was 4 mm (−3–11 mm). The mean distance between the C1 transverse process and the HN was 9.3 mm (3–16 mm). The transverse angle of the hypoglossal canal was between 31.6 and 55.5 degrees. The mean distance between the midline and the ICA was 26.06 mm (18–32 mm). In the cases of the medially displaced ICA, the HN is located more on the medial side relative to the LM. There was no reversed anatomical location of the HN and the ICA in the studied specimen.

Conclusion

On the basis of this study, spine surgeons can have enhanced knowledge of upper cervical anatomy. Although it has been rarely reported in the literature, the hypoglossal nerve and the ICA may be damaged during upper cervical spine surgery, especially in the cases with the ICA displaced medially.
Anterior Cervical Discectomy and Fusion: Comparison between Zero-Profile Implants and Anterior Cervical Plate and Spacer
Authors: Alimi Marjan , Njoku Innocent , Hofstetter Christoph P. , Kesavabhotla Kartik , Tsiouris Apostolos J. , Boockvar John , Härtl Roger
Published: May 2015

Introduction

Interposition grafts combined with anterior plating currently remain the gold standard for anterior cervical discectomy and fusion. The use of anterior plates increases fusion rates, but may be associated with higher rates of postoperative dysphagia. The current study aimed to compare the clinical and radiological outcomes following anterior cervical discectomy and fusion (ACDF) using zero-profile anchored spacers versus standard interposition grafts with anterior plating.

Materials and Methods

This was a retrospective case series. A total of 53 male and 51 female consecutive patients (164 total operated levels) who underwent ACDF between 2007 and 2011 were included. The mean clinical follow-up was 15.7 ± 1.2 months (SEM) for patient with zero-profile implants and 14.8 ± 2.1 months for patients with conventional ACDF with anterior plating. Patient demographics, operative details, clinical outcomes, complications, and radiographic imaging were reviewed. Dysphagia was determined using Bazaz criteria.

Results

Clinical outcome scores were similar between the two groups as measured by the modified JOA and Nurick scores. Zero-profile constructs gave rise to significantly less prevertebral soft-tissue swelling compared with constructs with anterior plates postoperatively (15.74 ± 0.52 vs. 20.48 ± 0.85 mm, p < 0.001, respectively) and at the latest follow-up (10.88 ± 0.39 vs. 13.72 ± 0.67 mm, p < 0.001, respectively). At latest follow-up, there was a significantly lower incidence of dysphagia associated with utilization of zero-profile constructs as compared with anterior plate (1.5 vs. 20%, p = 0.001, respectively).

Conclusion

Zero-profile implants lead to functional outcomes similar to standard anterior plate constructs. Avoiding the use of anterior locking plate may decrease the risk of postoperative dysphagia.
Intraoperative Cone Beam CT (O-Arm) and Stereotactic Navigation (StealthStation) System in Complex Adult Spine Surgery: Early Experience and Learning Curve
Authors: Contreras Ana , Batke Juliet , Dea Nicolas , Dvorak Marcel , Fisher Charles , Street John
Published: May 2015

Introduction

Computer-assisted navigation and intraoperative imaging systems have been shown to improve pedicle screw accuracy in a variety of instrumented spine surgeries. There is limited data evaluating the clinical learning curve for surgeons and its relationship to patient outcomes when using intraoperative navigation and imaging systems. We examined the clinical learning curve and patient outcomes of using O-Arm and StealthStation for six fellowship-trained spine surgeons at our institution, a single quaternary referral center, from 2009 to 2013.

Materials and Methods

This ambispective study examined 231 surgical cases where O-arm and StealthStation were used to facilitate pedicle instrumentation. The learning curve was determined by examining the year-by-year total operative time and blood loss, operative time and blood loss per surgical level, and the incidence of surgery-related adverse events. Adverse events were prospectively collected using the spine adverse events severity system (SAVES).

Results

O-arm and StealthStation were acquired at our institution in late 2008 and all spine surgeons were using this navigation system by the beginning of 2009. A total of 231 patients had screws placed using the O-arm and StealthStation between January 1, 2009 and December 31, 2012. There were 430 screws placed in 27 cases in 2009, 556 screws in 54 cases in 2010, 674 screws in 59 cases in 2011, and 758 screws in 75 cases in 2012, p < 0.05. The average estimated blood loss (EBL) decreased from 1,229 mL in 2009 to 907 mL in 2012, p < 0.05. The EBL per case per number of levels instrumented decreased from 5.72 mL in 2008 to 2.39 mL in 2012, p < 0.05. Mean operating time decreased from 407 minutes to 378 minutes from 2009 to 2012, p < 0.05. The number of misplaced screws per case decreased from 0.78 to 0.54 from 2009 to 2012, p < 0.05. There were no significant differences in incidences of dural tear, surgical site infection, or other surgical adverse events during the study period.

Conclusion

Our results demonstrate that there is a learning curve to the use of intraoperative CT-based navigation, as measured by OR time, intraoperative blood loss, and screw malposition. There were no significant differences in surgical adverse events during this learning period.
A Comparison between Anterior and Posterior Surgical Approaches in the Treatment of Cervical Spondylotic Myelopathy
Authors: Tan Gamaliel , Fehlings Michael , Koh Deanna
Published: May 2015

Introduction

Cervical spondylotic myelopathy (CSM) is a common problem in our aging population. We aim to compare the efficacy and safety of anterior and posterior approaches in the surgical treatment of CSM using validated outcome measures in a prospective cohort study.

Materials and Methods

Patients with defined clinical features of CSM were recruited from three hospitals in Singapore between October 2009 and December 2010. A total of 17 participants were recruited, and baseline demographic variables and outcome measure scores were established. Namely, the modified Japanese Orthopaedic Association (mJOA) score, Nurick, Short Form-36 (SF-36) Health Survey Questionnaire score, and Neck Disability Index (NDI). Participants underwent decompressive surgery by anterior or posterior approach, with choice of technique left to surgeon preference. Scores were retaken at 6, 12, and 24 months after surgery for comparison against baseline, within and between groups through the follow-up period.

Results

Patients who underwent anterior approach surgery were younger, had fewer comorbidities, less extensive disease, better SF-36 physical functioning, and mJOA scores at baseline. Both groups had clinically significant improvement in scores based on validated minimum clinically important difference (MCID) values at the end of the 2-year follow-up period. Score improvement was more sustained in the anterior group, whereas in the posterior group improvement in scores was greatest at 6 months post-decompression, but declined thereafter (albeit to values still three times that at baseline). A patient who underwent posterior approach surgery developed anemia secondary to perioperative blood loss. There were no cases of implant-related complications or cases of revision surgery.

Conclusion

This study highlights the differences in patient and disease factors influencing choice of surgical approach and shows the safety and efficacy of CSM surgery regardless of approach.
Subaxial Cervical Sagittal Alignment following C1–C2 Fusion for Atlanto–Axial Osteoarthritis
Authors: Kang Daniel , Lehman Ronald , Wagner Scott , Riew K. Daniel
Published: May 2015

Introduction

Few studies have evaluated the outcomes following C1–C2 fusion for atlanto–axial osteoarthritis (AAOA). Previous studies in rheumatoid arthritis (RA) patients with atlanto–axial instability have demonstrated unexpected development of subaxial kyphosis following C1–C2 fusion; however, this complication in patients with AAOA remains unknown. Therefore, we set out to evaluate the subaxial cervical sagittal alignment following C1–C2 fusion for AAOA.

Methods

We performed a retrospective review of all patients following C1–C2 fusion from a single center, single-surgeon from 2002 to 2012. All charts, records, and imaging studies were reviewed for each case, and preoperative, immediate postoperative, and final follow-up plain films were evaluated. Patients were divided into three diagnosis categories for further comparison: AAOA, rheumatoid, and trauma.

Results

A total of 29 patients were included in the review, with an average radiographic follow-up of 38 months. There were 14 patients with AAOA, 4 patients with RA/gout (1 gout patient with C1–C2 pannus causing spinal cord compression), and 11 patients treated for a traumatic etiology. Overall, we found that patients with AAOA did not have a significant change in subaxial sagittal alignment from preoperative to final follow-up (−11.7 to −13.8 degrees, p = 0.23, [− degrees] = lordosis, [+ degrees] = kyphosis), which was similar in the trauma group (−9.7 to −8.4 degrees, p = 0.47). This was comparable to the RA/gout group that demonstrated a significant change in sagittal alignment from −20.5 to −0.2 degrees ( p = 0.04).

Conclusion

Our study demonstrates that patients with nonrheumatologic conditions (AAOA and trauma) undergoing C1–C2 fusion do not develop postoperative subaxial cervical kyphosis. We postulate that the loss of subaxial lordosis in the rheumatologic patients may be a function of their underlying systemic disease.
Biomechanical Evaluation of a New Posterior Stabilization Device
Authors: Hartensuer Rene , Riesenbeck Oliver , Schulze Martin , Gehweiler Dominic , Raschke Michael J. , Pavlov Paul W. , Vordemvenne Thomas
Published: May 2015

Introduction

Over the last two decades, different techniques to stabilize the spine have been developed. The gold standard in spinal stabilization today is the pedicle screw. However, different techniques like different types of facet fixation devices are available. Based on different principles of facet fixation, a new implant is available, the so called “Facet Wedge.” The purpose of this study is to evaluate the primary stability of this new approach for facet fixation in comparison with established posterior fixation techniques such as pedicle screws and translaminar screws with and without anterior cage interposition.

Materials and Methods

In a two-arm biomechanical study using a robot-based spine tester, 24 monosegmental fresh frozen nonosteoporotic human motion segments (L2–L3 and L4–L5) were tested. Facet Wedge stand-alone and in combination with an anterior fusion cage was compared with pedicle screws and translaminar screws.

Results

All tested techniques could stabilize an intact motion segment effectively. In the used setup, Facet Wedge was comparable to pedicle screws for lateral bending, extension, and flexion and slightly superior for axial rotation. Facet Wedge showed a superior kinematic capacity compared with translaminar screws.

Conclusion

Facet Wedge offers a novel posterior approach in achieving primary stability in lumbar spinal fixation. In the used model, Facet Wedge has a comparable primary stability to pedicle screws and potential advantages over translaminar screws.
Evaluation of Cartilaginous End Plate and Annulus Fibrosus in Lumbar Disc Degeneration using OFF Resonant Saturation Ratios Assessed by a 3D Ultra Short Echo Time Sequence at 3 Tesla
Authors: Gebhard Harry , Martirosian Petros , Springer Fabian , Grosse Ulrich , Schick Fritz , Nikolaou Konstantin , Syha Roland
Published: May 2015

Introduction

Ultrashort echo time (UTE) imaging in combination with off-resonant saturation ratios (OSR) is increasingly used for characterization of tissue with fast signal decay, such as the annulus fibrosus (AF) as well as the upper and lower cartilaginous end plate (EP). The aim of this study was to assess effects of age, gender, and location of OSR measurement on evaluation of lumbar disc degeneration.

Materials and Methods

A total of 35 lumbar intervertebral discs of 12 fresh-frozen cadaveric specimens (median age 66 years, range 49–75 years) were examined in a whole-body MR scanner using a sagittal 3D UTE sequence with an isotropic submillimeter resolution of 0.7 mm (TE 0.07 milliseconds, TR 10.3 milliseconds, FoV 128 mm, and FA 10 degrees) with and without off-resonant saturation preparation pulse at 3 T. The off-resonance frequency varied between 1 and 5 kHz. OSRs of images with and without preparation pulse were calculated for upper and lower EP as well as for AF. Intervertebral discs were classified healthy (CO, n = 20), mild degeneration (MIL, n = 7), and severe degeneration (SEV, n = 8) concerning morphology and signal alteration in conventional MR sequences and UTE imaging. A nonparametric U-test reports level of significance. Correlation between age and OSRs is calculated using Spearman rank correlation coefficient. Effects of different off-resonance frequencies and measurement locations on lumbar disc degeneration are investigated using logistic regression and ROC analysis. Cut-off values, sensitivity, and specificity are given.

Results

Best differentiation between mild and severe degeneration was seen at an off-resonance frequency of 1 kHz for AF (sensitivity 87.5%/specificity 87.5%/cut-off 0.34) and the lower EP at 1.5 kHz (sensitivity 100%/specificity 85.7%/cut-off 0.29). Comparison of CO and MIL groups revealed best differentiation at 1 kHz for upper EP (sensitivity 100%/specificity 80%/cut-off 0.35). A reasonable correlation between age and OSRs in healthy lumbar discs was seen in AF for all investigated frequencies, ρ = 0.49 (5 kHz) to 0.61 (2 kHz), and in lower EP for frequencies above 2 kHz, ρ = 0.51 (3 kHz) to 0.71 (5 kHz). Significant differences between OSR measurements were seen in AF of healthy female and male lumbar discs for all investigated sequences and in upper EP at 1 kHz.

Conclusion

OSR assessment might be a suitable method for detection of early stage lumbar disc degeneration and should be preferably performed using off-resonance frequencies between 1 and 2 kHz. Age might influence OSR measurement in AF and lower EP. Gender seems to influence results of OSRs, especially in evaluation of AF. [Figure: see text]
Minimally Invasive Transforaminal Lumbar Interbody Fusion: Meta-Analyses of the Fusion Rates. What is the Optimal Graft Material?
Authors: Parajón Avelino , Alimi Marjan , Christos Paul , Torres-Campa Jose M. , Navarro Rodrigo , Moriguchi Yu , Härtl Roger
Published: May 2015

Introduction

It had been previously shown that minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has similar fusion rates and complication rates compared with open TLIF surgery. Different graft materials are being used for fusion. However, no previous studies have compared the fusion rates of different graft materials. The aim of this study was to compare the fusion rates of different graft materials used in MIS TLIF, via meta-analysis of the published literature.

Materials and Methods

A MEDLINE search was performed to identify the studies reporting fusion rates of MIS TLIF using different graft materials. A database was created which included patient demographics, preoperative data, type of graft material, clinical outcome, fusion rate, and duration of follow-up. Groups were defined based on the type of graft used. Meta-analysis of the fusion rate was performed using the StatsDirect statistical software.

Results

Forty series with a total of 1,320 patients were included. Age and gender distribution were homogeneous in almost all series. The most frequently operated level was L4/L5. Implanted cages were made of PEEK, titanium, or Hydrosorb. Significant clinical improvement was observed in all studies. Fusion rates were high, regardless of the type of the graft, ranging from 92 to 99% with different graft materials. Comparison of all rhBMP series with all non-rhBMP series showed fusion rates of 96.6 versus 92.5%, respectively. Iliac bone graft alone compared with non-Iliac bone graft showed fusion rates of 92.8 and 92.4%, respectively. The lowest fusion rate was observed with an isolated use of autologous local bone (91.7%). However, the addition of rhBMP to local bone increased the fusion rate up to 95% and the addition of non-rhBMP grafts to the local bone increased it up to 93%. The median complication rate was 8.82%, varying between 0 and 35.71%.

Conclusion

Utilization of rhBMP for MIS TLIF resulted in high fusion rates. Isolated use of local bone resulted in the lowest fusion rate. Addition of non-rhBMP grafts to local bone increased the fusion rate moderately, and addition of rhBMP was associated with a higher increase. Given the potential complications of iliac bone harvesting and rhBMP, the decision on the type of graft material should be made separately for each patient, based on specific characteristics. When rhBMP is used, efforts should be made to use the lowest possible amount.
Rates of Fusion Procedures following Lumbar Microdiscectomy
Authors: Singh Paramjit , Wang Justin , Cohen Jeremiah , Smith Lance , Buser Zorica , Wang Jeffrey
Published: May 2015

Introduction

Ten percent of the patients with lumbar herniated disc disease end up having chronic pain and disability from herniation. Microdiscectomy has long been the standard treatment for lumbar disc herniation. Given the high physical stresses experienced by the lumbar spine, there is a risk of adjacent segment disease following microdiscectomy and need for fusion. However, fusion rates in patients who have undergone lumbar microdiscectomy are unknown. Goal of our study was to define the demographic characteristics and the rates of single and multilevel fusions following lumbar microdiscectomy.

Materials and Methods

The PearlDiver database was searched using ICD-9 diagnostic codes for lumbar disc herniation, disc degeneration, and spinal stenosis from 2007 to 2010 using United Healthcare database. Current Procedural Terminology (CPT) codes were used to identify patients who underwent microdiscectomy and had a single or multilevel lumbar fusions procedure afterwards. Patients were stratified by year of diagnosis, age, and gender.

Results

In 2007 and 2008, there were 8,374 patients who underwent lumbar microdiscectomy. The average age of patients was 45 years. From those patients, 3.47% (291) required a fusion procedure within the 1st year, 1.8% (151) patients had fusion surgery within 2, and 0.63% (53) within 3 years after microdiscectomy. Across 4 years from 2007 to 2011, the 1-year fusion rate following lumbar microdiscectomy was 3.61%.

Conclusion

According to our results, a patient's likelihood of requiring a fusion within a year of lumbar microdiscectomy is 3.61%. After 2 years, a patient's likelihood of requiring a fusion decreases significantly. Spinal instability following lumbar microdiscectomy is a potential complication that will occur only in a very small percentage of patient population and should be considered before undergoing operation. Next steps involve analyzing single versus multilevel fusions and separating conditions that can lead to microdiscectomy and fusion.
Minimally Invasive Transforaminal Lumbar Interbody Fusion versus Lumbar Lateral Interbody Fusion: Patient-Centered Results
Authors: Briski David C. , Cook Brandon W. , Zavatsky Joseph M.
Published: May 2015

Introduction

The documented benefits of minimally invasive surgery (MIS) continue to be elucidated. These include decreased soft-tissue disruption, blood loss, and shorter hospital length of stay (LOS). The various MIS techniques have inherent benefits. The direct patient benefit of the one procedure over the other (LLIF vs. TLIF) has yet to be clinically established. We analyzed the operative time and blood loss, postoperative VAS scores, and LOS associated with each procedure.

Methods

A retrospective multicentered review was performed from 2008 to 2014. All patients with one and two-level MIS TLIF and LLIF procedures were included. Total operative time, blood loss, immediate postoperative, and day of discharge VAS pain scores along with LOS were recorded. Patients were divided into two groups. Group 1 had LLIF procedures. Group 2 had TLIF procedures.

Results

A total of 92 patients were treated during this time period. Group 1 included 52 patients. Group 2 included 40 patients. There was no difference in BMI, number of levels fused, perioperative complications, and immediate postoperative or discharge VAS scores, between the two groups. A statistically significant benefit was observed in the LLIF group compared with the TLIF group when assessing the number of patients discharged on postoperative day (POD) 1 (48 vs. 0%, p < 0.001), overall length of stay (2.1 vs. 3.5 days, p < 0.001), mean operative time (154 vs. 265 minutes, p < 0.001), and total operative blood loss (102 vs. 206 mL, p < 0.001).

Conclusion

The benefits of MIS surgery continue to be validated and include decreased soft-tissue damage, blood loss, and shorter hospital LOS. The overall LOS was significantly shorter in the LLIF group. There were also a greater number of patients discharged on POD 1 in the LLIF group and total operative time and blood loss were also significantly lower in the LLIF group. Further prospective analysis is required to better delineate the benefits of one procedure over the other.
Comparative Analysis between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis and Lumbar Spondylolisthesis
Authors: Wang Dechun
Published: May 2015

Introduction

To compare the effectiveness between minimally invasive transforaminal lumbar interbody fusion (TLIF) and open TLIF for the treatment of lumbar spinal stenosis and lumbar spondylolisthesis.

Materials and Methods

A total of 84 cases separated randomly into Mini-TLIF group and open group were involved in the prospective study from August 2012 to July 2013. All patients underwent Mini-TLIF or open TLIF by the same group of surgeons. Operation time, length of incision, volume of blood loss, volume of postoperation drainage, intraoperative fluoroscopy time, and postoperative ambulation time were compared according to different surgical levels. Changes of VAS and CPK around the surgery were calculated. Length of hospital stay and cost were also counted and analyzed.

Results

In cases with single-level disorders, compared with open TLIF, length of incision, volume of postoperative drainage, length of postoperative ambulation time, and hospital stay were less, but operation and fluoroscopy time were much longer for Mini-TLIF ( p < 0.05). There were no differences between the two groups in volume of blood loss, cost, and changes of VAS and CPK. In cases with two-level disorders, volume of postoperative drainage was less for Mini-TLIF versus open TLIF, but operation and fluoroscopy time during operation were much longer ( p < 0.05). There were no differences in other terms between the two groups.

Conclusion

In treatment of lumbar spinal stenosis and lumbar spondylolisthesis, for those cases with single-level disorders, Mini-TLIF has smaller incision, reduced volume of postoperative drainage, decreased postoperative ambulation time, and shorter hospital stays with the same efficiency, but will take more time for operation and fluoroscopy. As for those with two-level disorders, Mini-TLIF has reduced postoperative drainage, but needs more time for operation and fluoroscopy.
Freehand Thoracic Pedicle Screw Placement Techniques: A Comprehensive Review of Safety and Efficacy
Authors: Sattarov Kamran , Skoch Jesse , Avila-Guerra Mauricio , Abbasifard Salman , Patel Apar , Walter Christina , Baaj Ali
Published: May 2015

Introduction

Freehand techniques for thoracic pedicle screw placement have gained popularity as they reduce intraoperative radiation exposure and overall operative time. The goal of this work is to present our technique as well as systematically and comprehensively review the published literature on this topic.

Material and Methods

A PubMed search from 2001 to 2014 was performed, focusing on clinical studies that describe technical aspects of freehand thoracic pedicle screw placement. Cadaveric studies were excluded.

Results

The search yielded 15 studies and, of those, only 5 described technical aspects of thoracic screw placement. Definitive entry points were represented in four studies, and in one study entry point varied by a thoracic level. There were no definitive guidelines for sagittal or an axial trajectory with an exception of a one study in which sagittal trajectory was based on suboptimally visualized endplate. In our technique, we identified a uniform entry point for each thoracic level that is 3 mm caudal to the junction of the transverse process and the lateral margin of the superior articulating process. The sagittal trajectory is orthogonal to the dorsal curvature of the corresponding spine.

Conclusion

Freehand thoracic pedicle screw placement is safe and effective based on published reports in the literature. Few studies, however, detail the technique and provide meaningful instructions for trainees. We are hopeful that precise parameters that rely on less variability in entry point and trajectories will facilitate trainee education.
Microscopic Transoral versus Endoscopic Endonasal Approach to the Craniocervical Junction
Authors: Paidakakos Nikolaos , Sklavounou Maria , Bouramas Dimos
Published: May 2015

Introduction

Odontoidectomy represents the treatment of choice in case of irreducible atlanto–axial dislocation with compression of the ventral spinal cord. The transoral–transpharyngeal approach represents the gold standard and more commonly used technique. The endoscopic endonasal approach represents a new technique that provides direct, minimal access to the odontoid process.

Materials and Methods

We reviewed our experience with both techniques (47 transoral, 6 transnasal), analyzing technical factors, intraoperative nuances, caveats and complications, and functional outcomes.

Results

Endoscopic endonasal odontoidectomy proved to be a safe, effective, and well-tolerated procedure. Anatomically, there is considerable overlap at the pharyngeal level in the structures that can be viewed by the transoral and transnasal routes. The transoral approach provides a wider corridor with less restricted manipulation of instruments than the transnasal approach, but the transnasal approach provides a better view of the clivus, upper part of the craniovertebral junction, and the structures posterior to the removed odontoid and anterior arch of C1.

Conclusion

The two different approaches for odontoidectomy should be considered complementary rather than strict alternatives: the endonasal endoscopic can be advantageous in selected cases, presenting some anatomical conditions related to the oral cavity (micrognathia and macroglossia) and to high position of the odontoid. Combined approaches can also become necessary in particular cases. Careful patient selection and preoperative surgical planning is critical to obtaining satisfactory removal and low rate of postoperative complications.
Bicortical S1 Screw Fixation May Obviate the Need for Iliac Screws in Minimally Invasive Surgery for Adult Spinal Deformity
Authors: Zavatsky Joseph M. , Cook Brandon W. , Briski David C.
Published: May 2015

Introduction

Minimally invasive surgery (MIS) allows for the maintenance of the spine's soft-tissue envelope, preserving many of its stabilizing structures. Lumbosacral stability increases when S1 screws are placed in a bicortical fashion. MIS techniques, along with bicortical S1 screw placement, may obviate the need for iliac screw fixation in the treatment of adult spinal deformity (ASD).

Methods

A retrospective review from 2009 to 2014 included all patients treated for ASD using MIS techniques. Lateral interbody fusion (LIF) was performed for all lumbar interbody fusion levels L1–L5. Transforaminal lumbar interbody fusion (TLIF) was performed at all L5–S1 levels. Patients were divided into two groups. Group 1 (Hybrid) had open pedicle screws with bilateral iliac screw fixation. Group 2 (MIS) had percutaneous pedicle screws without iliac screws. All S1 pedicle screws were placed in a bicortical fashion in both groups. CT scans were obtained at 1-year postoperation. Two independent board-certified radiologists assessed fusion.

Results

Twenty-seven patients met the inclusion criteria and were at least 1 year out from surgery. Average follow-up was 2 years. Group 1 included 11 patients (38 levels); Group 2 included 16 patients (52 levels). There was no difference in age, height, weight, BMI, number of lateral levels fused, and pre- or postoperative Cobb angles between the two groups. There was a statistical difference in the mean length of the posterior construct between Group 1 and Group 2 (10 vs. 6 levels, p < 0.05), mean blood loss (1,727 vs. 465 mL, p < 0.001), mean operative times (505 vs. 329 minutes, p < 0.001), number of complications (8 [72%] vs. 5 [31%] patients, p = 0.03), and mean length of stay (14 vs. 7.6 days, p = < 0.01). CT scans were available for 25 of the 27 patients and both radiologists agreed there was solid fusion at all interbody levels including L5–S1 (100% fusion rate). Two patients, one from each group, had full-length scoliosis X-rays that demonstrated fusion, without evidence of hardware failure, radiolucency, migration or sacral fracture.

Conclusion

MIS techniques preserve many of the spine's stabilizing structures. Additional stability is observed when S1 screws are placed bicortically and may obviate the need for iliac screw fixation. These techniques resulted in a 100% interbody fusion rate without failure, thus questioning the dogma that iliac screw fixation is required in long ASD MIS constructs.
Evaluation of the Usefulness of the Biopsy Guided by Computerized Axial Tomography for the Etiological Diagnosis of the Spine Destruction Syndrome
Authors: Reyes-Sánchez Alejandro , Obil Chavaria Claudia , Sánchez-Bringas Guadalupe , Lara Eleazar
Published: May 2015

Introduction

It has been observed in biopsy directed by TAC as an axis for the diagnosis of vertebral syndrome of destruction. Material and Method: Cross-sectional, analytical study of diagnostic tests, which took place in individuals of any age who were admitted with a diagnosis of the syndrome of vertebral destruction, attended for the first time. The sample size consisted of 91 patients. Computerized axial tomography–guided biopsy was performed. We compared the results of the biopsy between the two pathologists from different institutions.

Results

Definitive histological findings were grouped into the following seven categories: osteomyelitis (15.3%), tumors (38.46%), metastasis (37.36%), normal tissue (3.29%), inflammation (2.19%), showing inadequate (0%), and Pott disease (3.29%). According to the values of Z obtained by a test of two proportions, with n = 91, p = 0.05, the critical value of Z, two-tailed, was from 1966 (+ and −); they found no significant difference between the results reported by the two different pathology services in vertebral biopsy guided by CT in vertebral destruction syndrome; determining that this part of the process is a counselor on a 96.7% and final by 79%.

Conclusion

Percutaneous biopsy guided by tomography is an essential tool for the diagnosis of the syndrome of vertebral destruction approach and the ability to get diagnostics in the 96.7% indicates that it is a fundamental in the study of this syndrome.
Acute Calcific Tendinitis of the Longus Colli Muscle: A Little Recognized Cause of Cervical Pain; concerning Four New Cases and Literature Review
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Roman Veas Javier , Salgado Castillo Santiago
Published: May 2015

Introduction

The purpose of our study is to describe four new cases of this condition, to deepen knowledge of the clinical and imaging findings of this condition, which we must consider in all nontraumatic cervical pain (literature review) so as to avoid complementary examinations or unnecessary, invasive treatments.

Materials and Methods

A retrospective study of four clinical cases in the emergency service, reporting posterior cervical pain, radiating to the base of the neck, slowly progressive with no relation to a traumatic event. This study included clinical evaluation, physical examination, and imaging studies.

Results

The following were evaluated: history, clinical picture, age, gender, type of images requested and their results, treatment undertaken, and time of evolution of the symptoms. A literature review of this condition was made, comparing what has been published with our experience.

Conclusions

It is important to recognize that a patient presenting with cervical pain and dysphagia can raise different diagnoses; among which it is worth emphasizing an infection for its severity or an abscess in the retropharyngeal space. Calcific tendinitis of the longus colli muscle must also be recognized as a possible cause, as a proper diagnosis determines behaviors completely different to those that must be taken in the event of any infectious process.
Spondylolysis and Spina Bifida Occulta in Pediatric Patients: Prevalence Study using Computed Tomography as a Screening Tool
Authors: Urrutia Julio , Zamora Tomas , Cuellar Jorge
Published: May 2015

Introduction

The prevalence of spondylolysis reported from radiograph-based studies has been questioned in the recent computed tomography (CT)–based studies in adults; however, no new data are available in pediatric patients. Spina bifida occulta (SBO), which has been associated to spondylolysis, may be increasing its prevalence, according to the recent studies in adults in the last decades, but without new data in pediatric patients. We aimed to determine the prevalence of spondylolysis and SBO in pediatric patients using abdomen and pelvis CT as a screening tool.

Patients and Methods

We studied 228 patients, 4 to 15 years' old (107 males), who were evaluated with abdomen and pelvis CT scans for reasons not related to the spine. The entire lumbosacral spine was evaluated to detect the presence of spondylolysis and SBO. We compared the prevalence of spondylolysis in patients with and without SBO. A logistic regression analysis was performed to determine the effect of age and sex as independent predictors of spondylolysis and SBO.

Results

The mean age of all study patients was 11.2 ± 2.7 years. A total of 107 patients were males (46.9%) and 121 were females (53.1%). The prevalence of lumbar spondylolysis was 3.5%, 95% CI: 1.1 to 5.9% (eight patients). Spondylolysis was observed at L5 in seven patients and at L4 in one; seven patients exhibited bilateral spondylolysis, while one patient had a unilateral pars defect. Among the patients with spondylolysis, two exhibited olisthesis (0.9% of the sample), both corresponding to grade I slip. Males exhibited a 4.7% (95% CI: 0.6–8.7) prevalence of spondylolysis (five patients) compared with a 2.5% (95% CI: 0.3–5.3) prevalence in females (three patients), p = 0.48. The prevalence of SBO was 41.2%, 95% CI: 34.8–59.2% (94 patients). Overall, 6 patients had SBO at L5 (6.4%), 80 patients at S1 (85.1%), and 8 patients at S2 (8.5%). SBO was found in 51.4% of males (95% CI: 41.8–61) and in 32.2% of females (95% CI: 23.8–40.7), p < 0.01. The prevalence of SBO decreased with increasing age. The prevalence of spondylolysis was 5.3% in the patients with SBO and 2.2% in patients without SBO, p = 0.28. Logistic regression analysis revealed that male sex (OR = 2.1, 95% CI: 1.2–3.7; p < 0.01) and age (OR = 0.8, 95% CI: 0.7–0.9; p < 0.01) were significantly related to the presence of SBO. Conversely, neither sex (OR = 2, 95% CI: 0.5–8.5; p = 0.32) nor age (OR = 1, 95% CI: 0.8–1.4; p = 0.78) were significantly related to the presence of spondylolysis.

Conclusion

This is the first study using CT as a screening method to evaluate the prevalence of spondylolysis and SBO in a pediatric population. We found a 3.5% prevalence of lumbar spondylolysis and a 41.2% prevalence of SBO in this cohort. Most patients with spondylolysis had a pars defect at L5. We also demonstrated that SBO was independently influenced by male and younger age.