bluuebunny/crossref_metadata_2025 huggingface dataset:
Transpedicular Biopsy versus Bone Densitometry in Diagnostic Process for Osteoporosis
Authors: Tellez Duarte Agustin
Published: May 2015

Introduction

Osteoporosis is a pandemic disease that affects women and men worldwide, being the principal cause for bone fractures after the age of 75 years, making a gigantic cost in health for families, institutions, and countries. There is a need for a simple, sensible, and specific system of detection and diagnosis for this disease. It is also needed for it to be identified as a disease apart from other vertebral and bone destruction processes. Bone densitometry does give us a good sensitivity 95% but less than 45% of specificity, so many times other bone diseases get diagnosed wrongly as osteoporosis and mistreated and vice versa. Because of this situation, our study proposes the use of a transpedicular biopsy be added as part of the osteoporosis diagnostic schedule. We also took the advantage of our study for doing optic and electronic microscopic analysis of each sample to see the microarchitecture of the trabecular and transpedicular bone searching and describing specific disease patterns in osteoporotic bone.

Materials and Methods

Overall, 30 human vertebral body specimens, OSAT questionnaires, bone densitometer, Trans Quirurgical Jamshidi trocar, pathologic specimen analysis equipment for optic and electronic microscopy, and SPSS data analysis software. During the spine surgery consultation processes, all the patients older than 45 years were given OSAT questionnaires to answer. Patients who came out positive were subject for a bone densitometry. From this list of patient, those attending for a spine surgical procedure were under previous authorization summited to a transpedicular vertebral body biopsy. Each specimen was processed for optic and electronic microscopy then they were analyzed for the following microstructural characteristics: trabecular alignment and density, collagen fibers and their bonds, cell number, and collagen chain alignment. Three different observers analyzed all data and a Kappa analysis was determined, together with a Pearson correlation.

Results

This protocol is still in process and the results will be ready for February 25, 2015.

Conclusion

This protocol is still in process. Conclusion of the study will be ready for February 25, 2015.
Comparative Study of the Results and Complications of the Growing Rod System versus VEPTR System for the Treatment of Early Onset Scoliosis
Authors: Montero Carlos , Meneses David , Alvarado Fernando , Godoy Wilmer , Zuluaga Julian , Mendez Ricardo
Published: May 2015

Introduction

Congenital and neuromuscular scoliosis occurring in children younger than 5 years have a high likelihood of progressing and end in severe curves. The concepts of treatment have changed with the emergence of distraction systems as VEPTR (vertical expandable prosthetic titanium rib) and growing rods. The aim of this study is to compare the clinical outcomes and complications that occur with the two systems used in the Instituto de Ortopedia Infantil Roosevelt.

Methods

An observational study of the transversal, comparative cut was designed by evaluating spinal surgeries performed between 2008 and 2012 at the Instituto de Ortopedia Infantil Roosevelt, including patients in whom implantation of an elongation system was performed and then underwent a program of periodic lengthening with VEPTR technique or growing rods. The number of elongations performed analyzed the surgical time, postoperative Cobb angle, bleeding, and complications. For quantitative variables, measures of central tendency and dispersion measures and confidence intervals were obtained; for those qualitative variables, ratios and confidence intervals at 95% were obtained. Statistical differences between groups were evaluated using the Student t test, Mann–Whitney U, Pearson chi-square, and Fisher exact tests depending on the nature of the variable. Analyses were performed using SPSS statistical software Statistics Version 21.

Results

A total of 40 patients met the selection criteria, 17 patients with growing rods and 23 patients with VEPTR system. The composition of the two groups had similar clinical characteristics. No significant differences in mean elongations number, bleeding, and implantation time were observed; however, the average correction of the deformity with the growing rods system (50.89 degrees) was 15.89 degrees higher than with the VEPTR (30.0 degrees) system. The complications were more frequent with VEPTR system: for the growing rod system six patients (35%) had complications, while for the VEPTR system was 10 patients (43%). However, complications because of the failures in the implanted materials were more frequent in patients with rods 35.3%, compared with 4.3% in the VEPTR, and clinical complications were more frequent in the VEPTR 43%, compared with 11.8% in growing rods.

Conclusion

When comparing different elongation systems of the spine, used to treat the congenital and neuromuscular scoliosis in children younger than 5 years, we conclude from this study that the correction of the scoliotic curve is higher with the growing rods system, but with more complications related with implant failures and minor clinical complications compared with VEPTR; these results are similar to those found in the literature.
Preservation Technique of Autologous Bone in Scoliosis Surgery
Authors: Godoy Miguel Angel , Tello Carlos A. , Francheri Ida Alejandra , Noel Mariano A. , Galaretto Eduardo , Remondino Rodrigo G. , Bersusky Ernesto
Published: May 2015

Study Design

This is a retrospective study.

Objective

This study aims to describe surgical technique of locally wound autologous bone conservation when primary surgery becomes mandatory to be staged, described as well the evolution and technique complications.

Introduction

One of the goals of scoliosis surgery is to halt the progression of curves achieving solid fusion. The contribution of additional bone graft in particular cases is critical. There are different types of bone grafts or bone substitutes, with different costs, and technical complications; it has become increasingly important the way to obtain and preserve a good amount of autologous bone.

Patients and Methods

A total of 12 patients, who required two-staged surgical procedures, were operated from June 2012 to April 2014 in our Spine Department. A subfascial pocket was performed in paraspinal muscles at the distal end of the surgical field where we added 1 g of vancomycin every 50 mL of bone graft. Surgical procedure, surgical correction, and complications with a full detailed analysis of infectious complications were assessed and recorded.

Results

Overall, 12 patients were operated in our hospital Spine Department with a two-staged surgical procedure plan. Patients mean age at surgery was 14 years. The etiology of deformity consisted in five idiopathic scoliosis, three congenital scoliosis, one associated with high-grade spondylolisthesis, two neuropathic scoliosis, and one myopathic scoliosis. In five cases (41.6%), surgery was initially staged in two different surgical days according to surgeon criteria and spinal severity deformity, in the other seven cases (58.4 degrees), the surgeon in charge, resolved to reschedule the surgical procedure in two different stages because of some intraoperative urgent event. The mean preoperative scoliosis angular value was 92.8 degrees. The mean postoperative scoliosis angular value was 42.4 degrees. We found that every patient in this study group required three surgical procedures to solved spinal deformity. Five patients developed superficial or deep infection (41.6%).

Conclusion

The local conservation of autologous bone graft in severe scoliosis surgery that has to be rescheduled or was already staged in 2 different days can be performed by storing the local bone graft in a subaponeurotic or subfascial pocket, with proper bone fusion imaging recordings, without incurring in an increasing risk of infection diminishing health costs.
Evaluation of the VEPTR (Vertical Expandable Prosthetic Titanium Rib) Device in the Treatment of Patients with Congenital and Neuromuscular Spinal Deformities
Authors: Montero Carlos , Meneses David , Godoy Wilmer , Alvarado Fernando , Acosta Margarita
Published: May 2015

Introduction

Multiple methods are included in the management of congenital, neuromuscular, or idiopathic scoliosis in younger patients. The traditional surgical treatments, such as, in situ fusion and hemiepiphysiodesis have not addressed the thoracic deformity in three dimensions, and the results are usually insufficient and unpredictable. The objective of the VEPTR management is focused on the chest wall extensions, to provide more space for the developing lungs, and prevents progression of the scoliotic deformity. From results of studies on the effectiveness of patients with VEPTR within early onset scoliosis, we designed a retrospective case series study for clinical and radiological outcomes of VEPTR system in the management of patients with spinal deformities in congenital and neuromuscular scoliosis.

Patients and Methods

This is a retrospective case series study. A total of 23 patients, 15 women and 8 men, with congenital and neuromuscular scoliosis, treated with VEPTR implantation, from January 2008 to May 2014 were included. The average age for the initial insertion of VEPTR was 5 years (range, 8 months–12 years), with an average follow-up time of 26 months. Specific data for the construction of the implant were collected; the pre- and postoperative X-rays were measured by the Cobb method to evaluate the magnitude of the curve, and the total length of the system in the coronal plane before insertion of the VEPTR device, and after each elongation were measured. In addition, complications such as infection, failure of material, pressure zones, synostosis, and hemothorax were evaluated.

Results

Our results demonstrated that there was an improvement in the postoperative Cobb angle measurement in the coronal plane. In children with congenital scoliosis, the average correction was 13% ( p < 0.001) and in neuromuscular scoliosis was an average correction of 22% ( p < 0.001). Likewise, there was an increase of the thoracic length measured through the VEPTR device, developing an average elongation of 9% of the column in children with congenital scoliosis and 18% in children with neuromuscular scoliosis. In this study, complications such as device migration, costal synostosis, pressure injuries, rib fractures, hemothorax, and deep infection were identified.

Conclusion

The data analysis shows that the natural history of progressive spinal deformities in children with congenital and neuromuscular scoliosis was satisfactorily controlled by using the VEPTR device. This allows us to recommend the use of this implant and continue using it in the treatment of patients with these deformities.
An L2 Burst Fracture Complicated with Paraplegia and Full Recovery after Surgery Report a Case of Traumatic Cauda Equina Syndrome
Authors: Mosaja Alanya Victor David
Published: May 2015

The cauda equine syndrome is a rare but serious condition that affects multiple roots of the caudal part of the spinal cord; the discopatia is known as the most frequent reason. However, the traumatic reason remains with many questions. Reported here is the case of a 31-year-old woman who after fall of height developed a vertebral fracture of L2 without motor deficit initially, but a week after an inadequate transport, she presents paraplegia plus bladder dysfunction. The magnetic resonance showed a burst of the vertebra L2 with fragment inside fundamental channel. Patient receives treatment corticoide up to the moment of the surgery, a laminectomy decompressive plus transpedicular fixation with eight screws was performed. The patient later presents progressive recovery of the neurological functions; lucky to 4 months, patient presents a total recovery with deambulation without limitation. A discussion of the case is realized by the existing bibliography to clarify concepts about definition, importance of right diagnosis, imaging findings, timing of the surgery, and outcome for patient with traumatic cauda equine syndrome. In addition, support is done in the immobilization that must continue to an unstable fracture up to the moment of the surgery.
Mechanical Effect Characterization in Posterior Monosegmental Instrumentation in Burst Fractures: Biomechanical Analysis
Authors: Agon Rendon Mauricio Alexander , Avila Jose Maria Jimenez , Perez Oscar Atanacio , Avalos Nancy , Barba Herrera Mariana Shizuko , Fuentes Rita , Garcia Gonzalez Alejandro
Published: May 2015

Introduction

Different treatment options and approaches have been applied to treat thoracolumbar burst fractures. From an anterior to a combine 360-degree approach, none has proven to be a gold standard for this type of fracture. Considering the four principles for proper spinal patient management (stability, function, alignment, and biology), different treatment options arouse to treat thoracolumbar bust fractures. Short posterior instrumentations with an intermediate pedicle screw, which acts as an anchorage point, counterbalancing anterior forces and favoring the lumbar lordosis strength. And monosegmental instrumentation are been applied to preserve as much spine segments as possible, allowing mobility and maintaining spine stability. The objective of this study is to determine the biomechanical effects of posterior monosegmental constructs in burst fractures by a characterization analysis.

Material and Methods

Otherwise healthy swine thoracolumbar vertebrae were used to apply an axial load to simulate a burst fracture. Initial force, end force, and total displacement were analyzed. Posterior monosegmental instrumentation was performed in the thoracolumbar segment. Healthy swine vertebrae were used as control group. A CT scan was done in the instrumented segment. The images then were converted for biomechanical analysis using meshing and reconstruction software.

Results

Initial compression force: 34.92 N. End force: 1.44 kN. Total displacement: 11.27 mm. Healthy and instrumented specimens initial compression force: 2.311 and 2.657 kN, respectively. Young module in healthy and instrumented specimens was 123,276 versus 159.749 MPa. Maximum load applied 2.126 kN/m. Mean displacement was 5.30272 mm.

Discussion

There is much more resistance against deformation, even when the specimen is fractured. SolidWorks software is a useful tool for biomechanical testing. When comparing simulated results with live compression tests there is a 17.3% chance of error during the maximum load test
Primary Vertebral Lymphoma: Two Cases and Literature Review
Authors: Simon Reddy , Silva Juan , Jara Juan , Portillo Thamara
Published: May 2015

Introduction

Spinal non-Hodgkin lymphomas (NHL) seldom affect spinal cord as first presentation, as there are mostly extradural initially. Usually presented in dorsal region, they are mostly high degree, aggressive, type B on diagnosis. We report two cases with spinal cord compression as first clinical manifestation.

Patients and Methods

The case reports of two cases of primary vertebral lymphoma from our service were presented.

Results

A 65 year-old-man had months-long back pain with sudden sphincter-sparing paraparesis; magnetic resonance imaging (MRI) showed prevertebral mass in T3 with vertebral body fracture and medullary compression. HIV testing was positive. Urgent decompressive surgery with tumor resection and stabilization yielded good recovery of motor function. A 69-year-old woman had 3 months of exercise-induced back pain and 10 days of paraplegia before coming to our service. MRI showed epidural invasion with medullary compression. Laminectomy and tumor resection were performed but without neurologic recovery. Burkitt lymphoma was diagnosed in both the cases.

Conclusion

We report two cases of aggressive NHL presenting as acute spinal cord compression requiring urgent surgical intervention. One of them on a background of undiagnosed HIV infection.
Outcomes in Anterior Cervical Discectomy with Anchored Intersomatic Cage
Authors: Scheverin Nicolas , Roberto Castelli , Videla Kopp Nicolas , Sarotto Anibal , Sobrero Diego , Dino Dinelli , Steverlynck Alejandro
Published: May 2015

Introduction

The anchored cervical intersomatic cages made in PEEK is a new promising alternative to anterior cervical locking plates with autologous iliac bone graft for anterior cervical discectomy and fusion. The advantage of such devices is the lack of profile and can provide the stability needed to achieve the arthrodesis.

Objectives

This study aims to evaluate the outcomes and fusion rates of the anchored intersomatic cage for achieving a stable arthrodesis and compare this result with established fixation methods. The hypothesis is that this device would be associated with low short-term complications and dysphagia, and could achieve a solid fusion and maintains the pain relief.

Patients and Methods

This was a comparative study in a single center, 50 patients were enrolled; 25 patients who underwent anterior cervical discectomy and fusion with autologous bone graft and locking plate and 25 patients with cervical intersomatic cage with heterologous bone graft. The clinical features Neck and Pain Disability Index; radicular pain, neck pain, and patient satisfaction were evaluated with VAS; and dysphagia scores were recorded preoperative and postoperative. Radiographs evaluated the height of intervertebral disc, implant position, and cervical Cobb angle. All patients had a minimum follow-up of 12 months.

Results

In all the patients, we found that a stable arthrodesis was achieved; the neck pain and radicular pain significantly reduces after surgery, without change after 1 year of follow-up. We do not have any chronic dysphagia and only one patient complained of minor dysphagia that improved in 2 weeks.

Conclusions

The cervical-anchored intersomatic cages are new surgical alternative with good functional outcomes, low-complication rates, and better postoperative patient comfort. We think that this is a preliminary assessment and prospective randomized trials are necessary to confirm this observation.
Chondrodysplasia Punctata: Clinical and Imaging Impact on Spine
Authors: Sayago Luis Rene , Francheri Ida Alejandra , Tello Carlos A. , Noel Mariano A. , Galaretto Eduardo , Remondino Rodrigo G. , Bersusky Ernesto
Published: May 2015

Study Design

This study is a retrospective study.

Objective

This study aims to identify spinal deformities caused by chondrodysplasia punctata (CDP) in spine and assess our surgical treatment experience.

Introduction

CDP is a skeletal dysplasia characterized by stippled epiphyses. It has a wide spectrum of clinical manifestations. The classic vertebral involvement is dysplastic kyphoscoliosis and cervical instability which leads to extremely difficult surgical technique, associated with a high rate of complications, basically based on its great potential for progression and its early onset.

Patients and Methods

We evaluated six patients operated because of CDP (two, of those, had surgery in another health care institution) and all clinical and imaging results were assessed. Physical examinations, clinical charts, X-rays, MRIs, and CT scans were recorded, as well as demographics and spine deformity patterns.

Results

In total, five were females and one was male. The mean age at first clinical examination was 4 years and 7 months. Patient's mean follow-up within our hospital was 4 years and the other two patients, 5 years and 8 months. Dysplastic kyphoscoliosis was the most common deformity pattern founded (two patients needing additional surgeries), and one cervical instability. Surgical treatment consisted in instrumented fusion by posterior approach, considering growing rods technique when needed.

Conclusion

CDP produces large kyphoscoliosis angular values and usually has an early onset. We encourage definitive fusion to prevent neurological complications. CDP deformity surgical treatment is tied to poor results.
Direct Vertebral Rotation versus Derotation Technique in Lenke Type 1 Idiopathic Scoliosis
Authors: Melero Patricio , Schwember Rommy , Lopez Sebastian
Published: May 2015

Introduction

To date, most of scoliosis corrections are made by derotation and translation of the road from the concave side. The coplanar alignment (VCA) technique recovers the normal anatomy of the spine in its three dimensions, correcting rotation, translation, and restoring the surgical outcomes of VCA against derotation maneuver in selective fusions of patients with Lenke 1 idiopathic scoliosis.

Patients and Methods

Prospective trial of 21 patients with Lenke 1 idiopathic scoliosis. Fusion levels were determined according to Lenke criteria. In group A (10 patients), the VCA was used; and in group B (11 patients), we perform derotation maneuvers. Multiple radiographic variables were analyzed and SRS-22 was also measured.

Results

Both the groups were similar in terms of preoperative demographic and radiological variables. Coronal Cobb correction rate was 66.5% in group A and 70.06% in group B. There were no differences in postoperative thoracic kyphosis (group A: 29degrees/group B: 30 degrees, p = 0.9438), but we found a significant difference in the correction of apical translation (group A: 14.5 mm vs. group B: 17 mm, p = 0.0069). None of the groups presented vascular or neurological complications. The SRS-22 score improved significantly after 1-year follow-up without differences between the groups.

Conclusion

In treating Lenke 1 idiopathic scoliosis with selective fusion, both techniques provide good clinical and radiological results. The only advantage of VCA lies in allowing a better correction of apical translation.
Minimally Invasive Uniportal Multilevel Cervical Decompression versus Laminoplasty in Treatment for Cervical Stenosis. Clinical and Radiological Results
Authors: Arias Pesantez Carlos Fernando
Published: May 2015

Introduction

There are many options to decompress the cervical spine on posterior way, the open door laminoplasty is an effective procedure to get the goal in multilevel disease; however, the muscular injury is a big problem in traditional surgery, the minimally invasive procedures can achieve optimal decompression without muscle injury with less pain and improvement in short time.

Patients and Methods

We present a study with 20 patients, 10 of them underwent traditional open door laminoplasty and the other patients underwent minimally invasive uniportal multilevel minimally invasive decompression. We use VAS, neck disability index, and Nurick clinical scale with follow-up of 12 months.

Results

On laminoplasty, VAS pre-op mean was 8 and 5 on 12 months; for MIS decompression VAS pre-op mean was 9 and 2 on 12 months. Neck disability index on the first group was mean 19 pre-op and 15 post-op 12 months and MIS group was 20 pre-op and 10 post-op 12 months. The Nurick clinical scale on laminoplasty and patients with MIS show improvement of one level on both groups. The surgical time, blood loss, hospital discharge, and return to daily activities shows superiority on MIS group.

Conclusion

Our conclusions about the minimally invasive procedures can achieve the similar results than traditional procedures without muscular injury and let a better time to recovery and return to daily activities.
Subsidence in Single Level Cervical Disc Arthroplasty
Authors: Berg Andrew , Killen Maire-Clare , Khan Shoaib , Reddy Guru , Friesem Tai
Published: May 2015

Introduction

Motion preservation with cervical disc arthroplasty implants has consistently been shown, in numerous randomized controlled trials, to produce equivalent or superior clinical outcomes to anterior cervical decompression and fusion. Therefore, there has been a call, within the spinal surgery community, to compare outcomes between arthroplasty implants. Although it is important to evaluate positive outcomes, it is also of vital importance to analyze complications and assess the potential influence of different implant designs on complications. We have experience in a large series of using several different arthroplasty implants. We have reviewed our series and have identified implants that have subsided. We provide a commentary on these cases.

Material and Methods

A retrospective review of all single-level anterior cervical decompression and disc arthroplasty cases, performed at the authors' institution, between 2006 and 2012 was conducted. Postoperative X-rays were assessed for any degree of subsidence compared with immediate postoperative X-rays. Cases with evidence of subsidence were studied for potential implicated factors.

Results

A total of 157 cases were reviewed consisting 64 PRESTIGE LP Cervical Disc System (Medtronic, Minnesota, United States), 51 NUNEC Cervical Arthroplasty System (RTI Surgical, Inc., United States), 35 Discocerv (Scient'x-Alphatec Spine, Arras, France), and 7 other implants in small numbers. Overall, 11 (7%) cases showed evidence of implant subsidence—two (3%) PRESTIGE LP, five (10%) NUNEC, and four (11%) Discocerv. In the cases that subsided, there were three males and eight females. There was a following variety of location of subsidence: anterior, posterior and complete surface of the implant, superior, and inferior. Seven of the cases did not fully cover the disc space in the anteroposterior plane. Three cases appeared to have been impacted into osteophytes posteriorly but subsidence was not necessarily in this location. The majority of cases appeared to have abnormal motion/spondylotic changes in adjacent levels, raising the possibility of abnormal forces being placed through the replaced level.

Conclusion

Cervical disc arthroplasty implant subsidence may be influenced by implant design, patient factors, and surgical technique. In this series, because of the small number of cases that showed subsidence, we cannot draw any firm conclusions. This report nevertheless should serve as an important stimulus for discussion and development regarding modifiable factors implicated in complications such as device subsidence.
Modified Posterior Vertebral Column Resection for the Treatment of Vertebral Infections in Elderly Patients
Authors: Enercan Meric , Erturer Erden , Gokcen Bahadir , Kahraman Sinan , Sanli Tunay , Ozturk Cagatay , Alanay Ahmet , Hamzaoglu Azmi
Published: May 2015

Introduction

Modified posterior vertebral column resection (PVCR) technique described in this study enables resection of infected material, decompression of the spinal canal, restoration of the anterior column, and posterior stabilization at the same time. Multilevel resections (two or more) can be performed with low-complication rates.

Patients and Methods

A total of 24 elderly patients (16 females and 8 males average age of 73.8 years [range, 68–83 years]) with pulmonary comorbidity were included. Etiologic diagnoses were spinal tuberculosis in 10 patients and nonspecific spondylodiscitis in 14 patients. Surgical technique included placement of fenestrated titanium pedicle screws, followed by hemilaminectomy, unilateral pediculectomy, decompression of the spinal canal by subtotal vertebrectomy, and anterior column support by expandable cage. One level above and one level below prophylactic vertebroplasty were performed.

Results

There were 6 single level, 17 two level, and 1 four level resections. The mean operation time was 2.5 hours and the average blood loss was 670 mL. Average follow-up was 47 months (range, 14–80 months). Average resected level was 1.9 (range, 1–4). The mean preoperative local kyphosis angle 32.7∞ was decreased by 67.8%. Overall, 14 patients with partial neurologic deficit (10 patients ASIA grade D and 4 patients ASIA grade C) had significant improvement. The major complications were post-op deep infection in three patients (12.5%) and death because of the cardiac failure in one (4%) patient. The minor complication rate was 29.1% with three hematomas and four dural tears. None of the remaining patients required revision surgery for recurrence of infection or implant failure or pseudoarthrosis.

Conclusion

Modified PVCR seems to be good alternative to anterior or combined A + P approaches in treatment of vertebral infections in elderly patients with pulmonary comorbidity, as technique enables multilevel resections (two or more) with low-recurrence and low-complication rates.
The Effect of Patient Age on Recovery Kinetics in 149 Adult Spinal Deformity Patients with 2-Year Follow-Up: A Novel Area under the Curve Analysis
Authors: Scheer Justin , Smith Justin , Mundis Gregory , Klineberg Eric , Hart Robert , Kelly Michael , Deviren Vedat , Nguyen Stacie , McCarthy Ian , Bess Shay , Schwab Frank , Shaffrey Christopher , Lafage Virginie , Ames Christopher
Published: May 2015

Introduction

Elderly patients (pts) with adult spinal deformity (ASD) have worse baseline health-related quality of life (HRQOL) measures than younger patients. Current methods of reporting outcomes are limited to static time points perhaps diminishing the health impact of the entire postoperative recovery experience. This study aims to identify the effect of age on the recovery kinetics by examining the effect of HRQOL over time via an area under the curve analysis (AUC).

Materials and Methods

A retrospective review of a multicenter, prospective ASD database was included. The inclusion criteria included patients with ASD and ≥ 18 years. Patients were stratified by the following age groups: ≤ 45, 46 to 64, 65 to 74, ≥ 75 years. HRQOL collected included Oswestry Disability Index (ODI), Short Form-36 (PCS/MCS), and Scoliosis Research Society-22 (SRS22) at baseline, 6 weeks, 1 and 2 years, postoperatively. All HRQOL was normalized to each patients' baseline scores as a comparison relative to where the patients started. An AUC was then calculated across the entire 2 years. Standard HRQOL and AUC means were compared between the groups.

Results

A total of 149 pts met inclusion criteria (≤ 45:32, 46 to 64:67, 65 to 74:38, ≥75:12). Older patients had significantly worse pre-op ODI, PCS, SRS activity, pain, and total compared with their respective younger age groups ( p < 0.05 for all) with the exception of 65 to 74 versus ≥ 75 and 46 to 64 versus 65 to 74 ( p > 0.05 for all). All age groups significantly improved all HRQOL at 2 years compared with pre-op ( p < 0.05 for all) except SRS mental and MCS for all age groups and ODI and SRS activity for ≤45 ( p > 0.05). However, normalized 2-year AUC HRQOL for the younger pts was worse than their respective older age groups for ODI, PCS, SRS activity, pain, and total.

Conclusion

On the basis of the static HRQOL analysis, all the age groups improved HRQOL at 2 years following surgery with older pts having worse pre-op HRQOL than younger pts. AUC analysis, however, suggests that the recovery kinetics is significantly worse for younger pts than the older pts.
Spinal Pelvic Radiographic Thresholds for Regional Lumbar Disability are Age Dependent: Analysis of Multicenter Database of 833 Patients
Authors: Smith Justin , Lafage Virginie , Scheer Justin , Shaffrey Christopher , Lafage Renaud , Klineberg Eric , Gupta Munish , Hostin Richard , Kebaish Khaled , Bess Shay , Schwab Frank , Ames Christopher
Published: May 2015

Introduction

The sagittal plane is the primary driver of disability in patients with ASD and spinopelvic radiographic thresholds have been established for pelvic tilt (PT), pelvic incidence (PI), and lumbar lordosis mismatch (PI–LL), and C7 sagittal vertical axis (SVA) in which disability occurs based on an ODI of ≥ 40. However, the patients' age was not accounted for in determining these thresholds and ODI has been shown to vary with age. The objective was to determine new thresholds based on age.

Patients and Methods

This is a multicenter, prospective study of consecutive patients with ASD. Inclusion criteria included patients with ASD with the age > 18 years. Patients were stratified into the following age groups: ≤ 45, 46 to 64, 65 to 74, and ≥75 years. Multivariate linear regressions were conducted for baseline PT, PI-LL, and SVA with baseline ODI and age on all patients. On the basis of the previous studies, an ODI of 40 was used as the threshold for disability. Individual patient thresholds were calculated based on their age. The thresholds were averaged across the age groups.

Results

A total of 833 patients were included (396 operative and 437 nonoperative). Patients with only sagittal deformity for the age groups were the following: ≤ 45 (18.8%), 46 to 64 (19.4%), 65 to 74 (40.1%), and ≥ 75 (50%). Age alone significantly predicted ODI ( r2 = 0.17, p < 0.0001). Regressions for PT ( r2 = 0.27, p < 0.0001), PI-LL ( r2 = 0.27, p < 0.0001, SVA ( r2 = 0.32, p < 0.0001) including age were all predictive of ODI. Thresholds for the entire cohort were the following: PT = 21.9 ± 4.7 degrees, PI-LL = 11.6 ± 7 degrees, SVA = 6.7 ± 2.5 cm. Thresholds for the age groups were the following: PT (deg): ≤ 45 (15.3 ± 2.3), 46 to 64 (22.6 ± 1.5), 65 to 74 (26.2 ± 0.8), ≥ 75 (29.1 ± 0.8). PI-LL (deg): ≤ 45 (1.7 ± 3.5), 46 to 64 (12.5 ± 2.2), 65 to 74 (18 ± 1.2), ≥ 75 (22.4 ± 1.3). SVA (cm): ≤ 45 (3.3 ± 1.2), 46 to 64 (7.1 ± 0.8), 65 to 74(9.0 ± 0.4), and ≥ 75 (10.5 ± 0.4).

Conclusion

Spinopelvic radiographic thresholds correlated to moderate-to-severe regional low back disability increase as patients age. These results suggest that preoperative surgery planning and patient counseling should consider the patients' age. Further study of Schwab–SRS sagittal modifier correction goals for individual age groups is warranted.
Comparison of Best versus Worst Clinical Outcomes for Adult Spinal Deformity Surgery: A Prospective, Multicenter Assessment with Minimum 2-Year Follow-Up
Authors: Smith Justin , Shaffrey Christopher , Lafage Virginie , Schwab Frank , Protopsaltis Themistocles , Klineberg Eric , Gupta Munish , Hostin Richard , Ming-Fu Kai , Soroceanu Alex , Hart Robert , Burton Douglas , Bess Shay , Ames Christopher
Published: May 2015

Introduction

Adults with spinal deformity typically present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for ASD based on a prospective, multicenter patient population.

Patients and Methods

This is a multicenter, prospective analysis of consecutive patients with ASD electing for op or non-op care at enrollment. Inclusion criteria are age > 18 years and ASD. Propensity scores were used to match an op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI–LL), and leg pain numeric rating scale (NRS) score.

Results

A total of 689 patients met criteria, including 286 op and 403 non-op, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS ( p < 0.001) and had worse deformity based on pelvic tilt, PI–LL, and C7SVA ( p < 0.002). Before reaching minimum 2-year follow-up, 38 non-op patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up, all HRQL measures assessed significantly improved for op patients ( p < 0.001), but none of these measures improved significantly for non-op patients ( p > 0.11). Overall, 97 matched op–non-op pairs were identified based on propensity scores. At last follow-up, the 97 matched op patients had significant improvement in all HRQL measures assessed ( p < 0.001), but the 97 matched non-op patients lacked significant improvement in any of the HRQL measures ( p > 0.20). Paired op–non-op analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed ( p < 0.001), except SF36 MCS ( p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively.

Conclusion

Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, non-op treatment appears to at best maintain presenting levels of pain and disability.
Postoperative Cervical Deformity in 215 Thoracolumbar Adult Spinal Deformity Patients: Prevalence, Risk Factors, and Impact on Patient-Reported Outcome and Satisfaction at 2-Year Follow-Up
Authors: Passias Peter , Smith Justin , Soroceanu Alex , Boniello Anthony , Scheer Justin , Schwab Frank , Shaffrey Christopher , Kim Han Jo , Protopsaltis Themistocles , Mundis Gregory , Gupta Munish , Klineberg Eric , Lafage Virginie , Ames Christopher
Published: May 2015

Introduction

Despite recognition of its occurrence, reliable predictors of the development of cervical deformity (CD) following ASD surgery are elusive and the effects unclear. This study quantifies the incidence of CD after ASD surgery, identifies predictors of development and determines the impact outcomes.

Materials and Methods

This was a retrospective review of a prospective multicenter database evaluating surgical patients with ASD with complete 2-year follow-up. CD was defined by T1S–CL > 20 degrees, C2C7 SVA > 40 mm, or C2C7 kyphosis > 10 degrees. Univariate testing was performed using t tests, or tests of proportion. The impact of CD at 2 years on health-related quality of life (HRQL) and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate.

Results

A total of 215 patients were included. Overall, 63% were found to have CD at 2 years post-op. Patients with CD had a higher incidence of pre-op CD ( p = 0.0001) and diabetes ( p = 0.05). They also had lower baseline C2–T3 lordosis (5.49 vs. 11.97, p = 0.003), lower C2 tilt (71.5 vs. 79.28, p = 0.0001) and higher C2 slope (18.49 vs. 10.71, p = 0.0001) and T1 (26.08 vs. 22.2, p = 0.036) slopes, and C2-S1 SVA (84.32 vs. 57.57, p = 0.002). Patients with and without CD at 2 years experienced significant improvements in their HRQL scores: SF-36 ( p = 0.0001), ODI ( p = 0.0001), and SRS ( p = 0.0001). Rates of improvement and overall improvement were similar. CD was not a predictor of 2-year patient satisfaction ( p = 0.367).

Conclusion

Predictors of CD at 2 years include the presence of the following at baseline; CD, diabetes, higher C2 and T1 slopes, higher C2–S1 SVA, and lower C2–T3 lordosis. Significant improvements in 2-year HRQL scores occurred in the presence or absence of CD, and patient satisfaction was unaffected. Although this study identifies several predictors of CD, clinical significance remains unclear and further study is warranted.
Surgical Planning and Neurologic Outcome after Anterior Approach to Remove a Disc Herniation at the C7–T1 Level in 19 Patients
Authors: Falavigna Asdrubal , Righesso Orlando , da Silva Pedro Guarise , de Souza Olivia Egger , Betemps Alejandro , de los Rios Pablo Fernando Vela , Guimarães Rangel , Ziegler Marcus , Riew K. Daniel
Published: May 2015

Introduction

Disc herniations at C7–T1 are uncommon and there are a few large series in the literature describing the anterior treatment of such herniations. The purpose of this study was to report the neurological presentation, outcome, and surgical planning in a series of patients with a symptomatic single level C7–T1 disc herniation who underwent anterior surgical discectomy and fusion.

Patients and Methods

We performed a retrospective study of patients who underwent surgery for a C7–T1 disc herniation and reviewed the medical records, operative reports, and imaging studies. The surgeons' view line was drawn and its relation to the manubrium and the great vessels was determined on T1 sagittal magnetic resonance imaging (MRI). The location of the herniated disc in the spinal canal was determined using a T2 axial MRI and classified as central, foraminal, and central/foraminal. Loss of muscle strength was evaluated preoperatively and at the last follow-up according to the classification of the Medical Research Council (MRC). The disc space was approached anteriorly by a standard cervical supramanubrial Smith–Robinson approach.

Results

We identified 19 patients who had undergone C7–T1 discectomy and fusion. The mean age of the sample was 54.26 ( ± 8.65) years. There was a higher proportion of male patients (57.9%, 11/19). The clinical presentation was predominantly motor deficit in 15 of 19 cases (78.9%) in intrinsic hand muscles, and usually improved after surgery. The mean follow-up period was 27.05 ( ± 15.10) months. All the patients underwent an anterior cervical supramanubrial approach with microdiscectomy and fusion. Anterior cervical plate fixation was used in 9 of 19 cases (47.3%). In the rest of the cases, a stand-alone intervertebral device was placed.

Conclusion

An anterior cervical supramanubrial approach was easily accomplished in all patients. Motor deficit was the most common surgical indication.
Clinical and Functional Results of Patients with Surgically Treated Single Level Lumbar Disc Disease: Comparative Analysis of Patients with Disc Herniation, Stenosis of the Spinal Canal, and Lumbar Spondylolisthesis
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Conzatti Lucas Piccoli , Rizkalla Elisa Braun , Volquind Daniel
Published: May 2015

Introduction

Degenerative lumbar disc disease may occur in patients in different ways, according to their etiopathogeny, for instance, disc herniation, stenosis of the canal, and spondylolisthesis. The objective will be to evaluate the results of health-related quality of life measures in patients with surgically treated single-level degenerative disc disease.

Patients and Methods

A prospective study of 141 patients with a single level disc disease who had a 1-year postoperative follow-up. The indications for surgical treatment were algic syndrome refractory to clinical treatment and compatibility among the symptoms, neurological examination, and magnetic resonance imaging. The patients were evaluated preoperatively and 30 days, 6 months, and 1-year postoperatively with instruments validated for the evaluation of axial and radicular pain, functional capacity, quality of life, mood disorders, and satisfaction with the surgical treatment. The statistical analyses were conducted using the SPSS.

Results

A total of 92 patients with lumbar disc herniation (LDH), 13 with spondylolisthesis, and 36 with lumbar canal stenosis (LCS) were evaluated. The patients with LDH were presented to microdiscectomy and the others to decompression and arthrodesis. Preoperatively, the LDH group presented lower levels of axial pain compared with the others; the mean radicular pain during this period was different among the groups, higher in patients with LDH, followed by the patients with canal stenosis. One year postoperatively, no differences were observed in the levels of axial and radicular pain among the groups, nor in the functional capacity, quality of life, and depression and anxiety. Preoperatively, a deficit of force, sensitivity, myotatic reflexes, and Lasègue sign were most commonly found in patients with LDH, compared with the other groups. There was no statistically significant difference as to changes in the neurological examination among the groups in 1 year of follow-up. Dissatisfaction with the treatment was observed in 12.0% of the patients with LDH, 15.4% with spondylolisthesis, and 20.0% with LCS ( p = 0.508).

Conclusion

In 1 year of follow-up, the indicators of quality of life, functional capacity, residual pain, and changes in the neurological examination are similar among the patients with level 1 disc disease treated surgically.
Implications of Number of Fused Levels in the Outcome of Patients with Lumbar Degenerative Diseases
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , Merlin Luiz Henrique , Radaelli Lucas , Rizkalla Elisa Braun
Published: May 2015

Introduction

Patients with symptomatic lumbar degenerative disease can have one or more intervertebral disc involved according to several factors, such as age, smoking, weight, and profession. The objective of this study was to evaluate the outcome of patients with degenerative disease submitted to lumbar spinal fusion considering the number of levels fused.

Patients and Methods

Prospective comparative study in patients that were submitted to fusion of one (G1), two (G2), or three or more (G3) levels with a 6-month follow-up. The patients were evaluated preoperatively, at 30 days and 6 months postoperatively with the following validated instruments: NRS, ODI, HAD, and IDB. Comparisons among the groups were done with ANOVA and chi-square tests. The post hoc analyses were conducted with Bonferroni test.

Results

A total of 65 patients (G1 = 21; G2 = 25; and G3 = 19) were studied. The mean age was greater in G1 and lower in G3 ( p = 0.024). There was no difference among the groups regarding gender, previous surgery, evolution of the symptoms, and work compensation. The duration of surgery was longer, there was more bleeding and a greater incidence of postoperative complications ( p = 0.022) in G3 group ( p < 0.05). The intensity of pain was higher in G3 in the postoperative evaluation at 30 days, but that difference disappears postoperatively, within 6 months. There was no difference concerning hospital stay, transoperative complications, disability (ODI), depression and anxiety (HADS), and satisfaction among the groups ( p = 0.140).

Conclusion

There was no difference in relation to the pain, disability, depression and anxiety, and postoperative satisfaction among the groups. The patients with three or more fused levels were older and had higher rates of postoperative complications.
Comparison of Open Discectomy with Microendoscopic Discectomy in Lumbar Disc Herniations: Results of a Randomized Controlled Trial
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Chalá Fernanda
Published: May 2015

Introduction

Despite all of the technical refinements, surgical treatment of herniated discs still remains controversial. The objective of the current prospective randomized study was to compare the outcome of patients with persistent sciatica secondary to lumbar disc herniation treated with either open discectomy (OD) or microendoscopic discectomy (MED) technique.

Patients and Methods

We performed a prospective controlled randomized study of 40 patients with sciatica caused by lumbar disc herniations nonresponsive to conservative treatment who underwent OD or MED with a 24-month follow-up period. Pre- and postoperative neurological status, pain, and functional outcome were evaluated. Other studied variables were the duration of the procedure, blood loss, time of hospital stay, and time to return to work. Statistical analysis with a p value less than 0.005 was performed.

Results

The only statistically significant differences found were for size of the incision, length of hospital stay, and operative time. The former two were greater in the OD group ( p < 0.01 and p = 0.05, respectively), and the latter was greater in the MED group ( p < 0.01).

Conclusion

The few parameters that were found to be statistically significant between the groups did not affect the overall outcome. In the current series, the final clinical and neurological results were similarly satisfactory in both the OD and the MED groups.