bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteomyelitis and Destruction of the Atlas and Axis in a 4-Week-Old Infant: 4-Year Follow-Up
Authors: Banczerowski Peter , Czigléczki Gábor , Papp Zoltán
Published: May 2015

Introduction

Neonatal vertebral osteomyelitis is not an uncommon condition, but osteomyelitis simultaneously involving the atlas and the axis is distinctly unusual and no other infant case has been published so far in the literature. We present the case of an infant with retropharyngeal abscess, which led to the destruction of the C1–C2 vertebrae.

Materials and Methods

MRI examination revealed a multilocular abscess in the right mastoidal area penetrating to the cervical region and causing destruction of the C1 and C2 vertebrae, and an epidural abscess with signs of spinal cord compression at the level of the Th5–Th7 vertebrae. The retropharyngeal and thoracic abscesses were surgically removed and the therapy was completed with antibiotics. The child was placed in a custom-made fixation device for 8 weeks. Follow-up was performed with MRI, CT scans, and functional X-ray diagnostics.

Results

CT scans with 3D reconstruction demonstrated the absence of normal osseous structures at the craniospinal region, but undamaged ossification centers in the C3 vertebra and below. Functional X-ray diagnostics, performed in general anesthesia showed no significant instability of the cervical spine. Normal motor development and independent walking were allowed. During a 4-year long follow-up period, no signs of neurological impairment were observed, neck movements were limited but painless. It is assumed that the remnants of the bony elements of C1–C2 vertebrae and the massive interconnecting postinflammatory scar tissue make some degree of neck movements possible. His development was undisturbed, similar to his age group.

Conclusion

C1–C2 osteomyelitis is a very rare entity even in children. There is limited experience with treatment and rehabilitation, but the temporary immobilization of the neck, surgical debridement, antibiotic treatment, and continuous physiotherapy can be recommended. Close follow-up is required to check the reconstitution of affected bones and ligaments, any development of instability, and the necessity of surgical stabilization.
Incremental Cost-Effectiveness of Adult Spinal Deformity Surgery by Classification of Deformity
Authors: Robinson Chessie , Hostin Richard , McCarthy Ian , O'Brien Michael , Gupta Munish , Ames Christopher , Smith Justin , Lafage Virginie , Schwab Frank , Hart Robert , Klineberg Eric , Shaffrey Christopher
Published: May 2015

Introduction

We investigate the incremental cost-effectiveness of ASD surgery relative to nonsurgical treatment by classification of sagittal modifier using the SRS–Schwab classification.

Methods

This is a retrospective study of consecutive surgical and nonsurgical patients with ASD. Surgical data were from a single center observational data set, whereas nonsurgical data were from a prospective multicenter database. Hospital costs were collected from administrative data and QALYs were calculated from the SF-6D, each discounted at 3.5% annually. We analyzed the incremental cost-effectiveness ratios (ICERs) based on classification of sagittal modifier at baseline. The three modifier types considered were mild (SVA < 4 cm, PT < 20 degrees, PI–LL within 10 degrees), moderate (at least 1 of SVA 4–9.5 cm, PT 20–30 degrees; PI–LL 1020 degrees, and no severe modifiers); and severe (at least 1 of SVA > 9.5 cm, PT > 30 degrees, PI–LL > 20 degrees). The difference in QALYs between the surgical and nonsurgical cohorts at 2 years was projected through 5-year follow-up. 95% confidence intervals were calculated using nonparametric bootstrap methods.

Results

Two-year follow-up was available for 278 patients (168 surgical and 110 nonsurgical), predominantly female ( n = 245, 88%) with average age of 52 years (range, 18–81 years). Total surgical costs averaged $121,857, including readmissions. The 2-year ICER was least cost-effective for patients with severe sagittal modifiers at $424,978 and most cost-effective for patients with mild modifiers at $206,730. Projected through 5 years, the ICER among patients with severe sagittal modifiers was $151,689, reducing to $73,790 for patients with mild modifiers.

Conclusion

On the basis of the World Health Organization's suggested upper threshold for cost-effectiveness (three times GDP, or $140,000), ASD surgery appears cost-effective after a 5-year period for mild and moderate sagittal modifier types. Although average 5-year ICERs for severe modifier types are above this threshold, the threshold is included within the confidence interval, indicating the 5-year ICER is not statistically significantly higher than the threshold value. The ICER is expected to further decrease over extended follow-up.
Safety of Day Case Lumbar Decompressive Surgery in an NHS (Public) Hospital Setting
Authors: Hoggett Lee , Vadhva Mukta , Khatri Manoj
Published: May 2015

Introduction

This study is to assess the safety of day case lumbar decompressive surgery. Patients and Method: Retrospective study of 233 consecutive patients undergoing DCLDS who were identified from a prospective electronic database.

Results

Between January 2011 and April 2014, 131 open and 102 microscopic surgeries were done in patients with mean age of 46 (range, 16–88) years and male:female ratio of 136 (59%):97 (41%). Inclusion criteria were no known anesthetic reaction, ASA grade I or II, BMI < 35 mg/kg2, less than 30 minutes travel time, and responsible home care. Patients were discharged after clinical assessment with cauda equina advice and emergency contact number. A total of 215 (92%) procedures were single level, of which 188 (87%) unilateral and 27 (13%) were bilateral procedures. Overall, 18 (8%) procedures were multiple levels, of which 12 (67%) were unilateral and 6 (33%) were bilateral procedures. Majority, 107 (50%), 97 (45%) procedures were done at L5/S1 and L4/L5 levels, respectively, and rest 11 (5%) at higher level. The 7-day and 30-day representation figures were 7 (3%) and 15 (6.4%) that are as follows: pain ( n = 3), medication ( n = 2), wound issues ( n = 5), infection ( n = 2), headache ( n = 2), and VTE ( n = 1). Overall, 11 patients were sent home and 4 (1.7%) were admitted with two requiring further surgery, one revision discectomy and one wound washout. No cauda equina or compressive hematoma were encountered.

Conclusion

This study demonstrates that open and microscopic lumbar discectomy at single or multiple levels can be performed safely as a day case procedure. The representation rate to the ED can be potentially reduced by better advice and pain management.
New Classification System of Minimal Invasive Techniques based on the Location of the Pathologic Lesions in the Spinal Canal
Authors: Banczerowski Peter , Papp Zoltán , Veres Róbert , Vajda János
Published: May 2015

Introduction

Minimal invasive procedures in spine surgery to remove pathologies located in the spinal canal have undergone significant development in the recent times. These procedures have the common aim of avoiding biomechanical complications associated with some traditional destructive methods and improving efficacy. These new techniques prevent damage to crucial posterior stabilizers, and preserve structural integrity and stability of the spine. In this review, authors first provide a classification system of minimal invasive techniques based on the location of the pathologic lesion to be treated, to help the surgeon in selecting the appropriate procedure.

Material and Methods

A classification system was introduced, which pairs various intraspinal pathologic lesions, taking into account their location topography relative to the spinal cord, with the appropriate minimal invasive techniques. Classification of the different surgical methods is presented with the aim of helping the surgeon in selecting the appropriate minimal invasive procedure based on the location topography of the pathology in the spinal canal. This classification system can be applied in the daily routine of spine surgery.

Results

Lesions within the spinal canal may be segmental or longitudinal to the spinal levels, and axial or lateral relative to the spinal cord. The following four types of lesion locations are defined in the classification system: segmental-lateral, segmental-axial, longitudinal-axial, and longitudinal-lateral. Hemi–semi laminectomy (partial hemilaminectomy) and its variants are appropriate methods for the removal of various types of segmental-lateral located pathologies with preservation of dorsal spinal stability. Both unilateral and bilateral laminotomy for bilateral decompression can be used for the treatment of spinal stenosis, with good clinical outcomes. Foraminotomies with or without modifications are alternative surgical approaches for the treatment of segmental-lateral pathologies located in the neuroforamen. Split laminotomy and its variant, para split laminotomy are mainly recommended for the removal of longitudinal–axial located intraspinal lesions. Its “arch bone” modification enables the moderate enlargement of the spinal canal.

Conclusion

In summary, sufficient evidence is available for each minimal invasive techniques to be used as a clinically effective treatment option. Our classification system enables the surgeon to select and apply the appropriate minimal invasive technique and to remove the lesions located in the spinal canal. This overview of the minimal invasive techniques can be applied and recommended in the daily routine of spine surgery.
Extreme Lateral Interbody Fusion for Unilateral Symptomatic Vertical Foraminal Stenosis
Authors: Hofstetter Christoph P. , Alimi Marjan , Tsiouris Apostolos J. , Elowitz Eric , Härtl Roger
Published: May 2015

Introduction

Spinal deformity of the adult lumbar spine may occur de novo because of the degenerative disease or following decompressive surgery. Asymmetric loss of disc height may lead to unilateral vertical foraminal stenosis and radiculopathy. Aims/Objectives: This study aimed to investigate whether restoration of foraminal height at the symptomatic level using single-level extreme lateral interbody fusion (ELIF) may alleviate unilateral radicular pain.

Methods

In a retrospective cohort study, patients with single-level unilateral vertical foraminal stenosis (foraminal height < 15 mm) and corresponding unilateral radicular pain who underwent ELIF were included. Demographic and perioperative data were collected. Functional data (Visual Analogue Scale [VAS] for buttock, leg and back, as well as Oswestry Disability Index [ODI]) and radiographic measurements (bilateral foraminal height, disc height, segmental coronal Cobb angle, and regional lumbar lordosis) were collected preoperatively, postoperatively, and at the last follow-up.

Results

A total of 23 patients with a mean age of 66 years were included. The foraminal height of stenotic side was significantly increased by ELIF from the preoperative value of 11.0 to 18.1 mm postoperatively ( p < 0.001). The increase was durable at last follow-up of 11 ± 3.7 (SE) months (17.1 mm; p < 0.001). Preoperative VAS buttock and leg on the stenotic side, VAS back, and the ODI (7.3, 7.2, 6.5 and 48.0, respectively) were significantly improved postoperatively (1.5, 2.3, 3.3 and 25.4, respectively) and at the last follow-up (to 0.7, 1.1, 3.3 and 23.0). The postoperative FH on the stenotic side showed correlation with the VAS buttock and VAS leg on the stenotic side. In addition, at the last follow-up, FH on the stenotic side showed correlation with VAS leg on the stenotic side.

Conclusion

Single-level ELIF is an effective procedure for treatment of symptomatic unilateral vertical foraminal stenosis.
Impact of the Cage Height, Diameter, and Positioning on Clinical and Radiographic Outcome of the Extreme Lateral Interbody Fusion
Authors: Hofstetter Christoph P. , Alimi Marjan , Tsiouris Apostolos J. , Elowitz Eric , Härtl Roger
Published: May 2015

Introduction

Extreme lateral interbody fusion (ELIF) is a novel technique for anterior spinal fixation and indirect decompression of neural elements. The aim of this study was to determine certain parameters of the interbody cage that would result in better radiographic and clinical outcomes.

Patients and Methods

We performed a retrospective analysis of 145 ELIFs in 90 patients. Intervertebral disc height, foraminal height, cage position, and lumbar lordosis were determined on preoperative, postoperative, and the latest follow-up studies. Clinical outcomes were evaluated by Oswestry Disability Index and Visual Analogue Scale.

Results

At the time of last follow-up (17.7 ± 1.1 months), two of the following factors determined restoration of foraminal height: the amount of increase in the disc height (implant height—preoperative disc height) and the footprint of the intervertebral spacer. Cages that had increased the disc height by 6 to 9 mm yielded in significantly greater restoration of foraminal height compared with the grafts that had increased the disc height by 0 to 3 mm ( p < 0.01) or 3 to 6 mm ( p < 0.05). In addition, 22 mm spacers allowed for a significantly higher increase in the foraminal height compared with 18 mm spacers ( p < 0.001). Interestingly, neither cage position nor posterior instrumentation had statistically significant influence on restoration of foraminal height. Both, lordotic and nonlordotic cages allowed for increased lumbar lordosis on postoperative imaging. Clinical evaluation revealed a mean ODI, VAS back, buttock, and leg pain improvements of 21.1%, 3.7, 3.6, and 3.7 points, respectively.

Conclusions

In ELIF, cage width and height but not cage position, determine restoration of foraminal height.
Saphenous Nerve Somatosensory Evoked Potentials Monitoring during Lateral Interbody Fusion
Authors: Bederman Samuel S. , Jain Nick , Yanni Daniel , Guillen Heriberto , Lilit Mnatsakanyan
Published: May 2015

Introduction

Lateral transpsoas interbody fusion (LIF) is a novel minimally invasive technique reducing risks related to traditional anterior approaches. Despite advantages, transpsoas exposure carries up to 30% risk of lumbar plexus injury. Intraoperative neuromonitoring is utilized to prevent postoperative deficits, but to date there is no reliable technique to detect upper lumbar plexus injury.

Materials and Methods

Saphenous nerve somatosensory-evoked potentials (SSEPs) were obtained by stimulation of inferior medial thigh with needle electrodes and recording from scalp. Primary outcome was measured by testing reproducibility of SSEPs at baseline, changes during procedure, and relevance to standard modalities. Intraoperative changes were identified and correlated to primary outcome.

Results

A total of 38 patients were included in the study (average age 63.5 years, 25 females, 13 males) and underwent surgery on 88 total levels. Reliable saphenous SSEPs were recorded bilaterally in 34 of 38 patients. Reduction of amplitude > 50% in two cases was observed during expansion of the tubular retractor. The posterior tibial SSEP remained unchanged. The saphenous returned to baseline after collapsing the retractor and no clinical deficits were observed.

Conclusion

Saphenous SSEPs can be used to detect electrophysiological changes to prevent femoral nerve injury during LIF. A larger sampling size is underway as to validate whether this technique offers increased sensitivity/specificity, and correlates with the postoperative outcomes.
Incidence of Lumbar Plexopathy while Utilizing Mechanomyography for Transpsoas Lateral Lumbar Interbody Fusion
Authors: Zavatsky Joseph M. , Waddell Bradford S. , Briski David C. , Sama Andrew , Wollowick Adam , Zahrawi Faissal
Published: May 2015

Introduction

Previous studies utilizing electromyography (EMG) have reported that the incidence of thigh complications during transpsoas lateral lumbar interbody fusion (LLIF) ranged from 0.7 to 75%. The reliability of EMG has been questioned because of false-positives, false-negatives, and electrical interference from common operating-room equipment. Mechanomyography is a new neuromonitoring technique that functions by measuring the mechanical activity in muscles, or “twitch,” noninvasively using surface-mounted accelerometers on the skin following nerve stimulation and muscle contraction. MMG may provide an alternative to EMG for neuromonitoring. In this study, we evaluated the incidence of thigh complications during transpsoas LLIF utilizing MMG to monitor the lumbar plexus.

Materials and Methods

A retrospective review of prospectively collected data of four different surgeons at four separate institutions was performed. A total of 85 consecutive patients, with 175 instrumented levels, were included who underwent transpsoas LLIF surgery (L1–L5) during a 1-year period. Immediate postoperative and routine follow-up clinical examinations at 3, 6, and 12 months were obtained.

Results

The rate of all ipsilateral thigh symptoms (pain, numbness, and weakness) was 21.2% (18/85). Eight patients (9.4%) had iliopsoas or quadriceps weakness (3/5 motor strength). Overall, 10 patients (11.8%) had anterior thigh pain and/or numbness. Most patients with postoperative thigh symptoms (16/18) had 3 or 4 level procedures performed for adult degenerative scoliosis (ADS) and included the L45 level. All thigh symptoms resolved within 3 months.

Conclusion

MMG is a safe and effective alternative to EMG for nerve mapping during transpsoas LLIF surgery and overcomes deficiencies related to the high rates of false-positives and false-negatives inherent to EMG. In addition, unlike EMG, MMG is not affected by electrical artifact seen with common operating-room equipment such as the bovie electrocautery and bair hugger body warmer. With the use of MMG, the rate of ipsilateral thigh symptoms was 21.2%, which is consistent with currently reported rates for transpsoas LLIF procedures utilizing EMG. In our study, most thigh symptoms occurred in patients with multilevel LLIF procedures performed and direct trauma to the psoas may have contributed to our results and the actual rate of nerve-related thigh symptoms might be lower. All symptomatic patients had L45 included in their construct. MMG is a safe alternative to EMG to monitor the lumbar plexus when performing transpsoas LLIF.
Novel Minimal Invasive Surgical Techniques for the Treatment of Segmental-Lateral Pathologic Lesions of the Spine
Authors: Papp Zoltan , Vajda János , Veres Robert , Banczerowski Peter
Published: May 2015

Introduction

Laminectomy, commonly used dorsal approach for the surgical removal of most of the pathologic lesions, situated in the spinal canal and the neuroforamen destroying the dorsal stabilizing structures of the spinal column. Retraction and detachment of the longitudinal muscles, removal of the vertebral arches (laminectomy), and injury of the joint capsules and ligaments are responsible most of short and late-time complications. Among these complications, spinal deformities, segmental instability, and permanent spinal pain are most often mentioned in the literature. The main objective of the authors was to develop and evaluate the novel minimally invasive techniques suitable for exploring and treating different segmental-lateral pathologies, expanding to the neuroforamen or even paravertebrally, with preservation of the stability of the spine. One of the key issues of this article was to summarize these procedures, with evaluating the safety and efficacy in the routine spine surgery.

Patients and Methods

A total of 167 patients were operated and followed up during 2000 to 2011 in our Institute with segmental lateral spinal pathologies. For the surgical treatment, we used “Over-the-top” decompression, hemi–semi laminectomy, supraforaminal burr-hole, open-tunnel, and paravertebral approaches alone or in combination. These surgical techniques are mostly our developments, or modifications of previously used surgical techniques.

Results

The new surgical procedures developed or modified by our team are effective techniques for treating the spinal pathologies located in the spinal canal, neuroforamen, or even the paravertebral space. The posterior stabilizing structures of the spine, as the vertebral laminae and the longitudinal musculature are mostly preserved. Leaving the longitudinal paraspinal musculature innervations intact, and with the preservation of the bone–muscle attachments and ligaments, the dynamic stability of the spine remains unchanged. Retaining the bony structures (vertebral arches) and the vertebral joints the static stability of the spinal column remain intact, the chance of developing the long-term spinal deformation is minimal. During the follow-up, we performed static and dynamic X-ray, MR, and CT scans, completed with neurological examinations to evaluate the progression of the illness, the neurological deficit, and the actual state of the spinal column. With clinical use and evaluation of the various surgical approaches, we determined the main indications and contraindications of the surgical procedures, highlighting the pit-falls and limitations.

Conclusion

The aforementioned minimally invasive surgical approaches are suitable for treating segmental–lateral spinal pathologies. For the routine clinical use, we organized the surgical techniques into a complete framework based on the location of the pathologic lesions.
Fat Fraction Quantification of Lumbar Paravertebral Muscle in Magnetic Resonance Imaging using Six Echoes Dixon Technique
Authors: Shin Dong-Eun , Seo Jeong Ho , Kim Hak-Sun , An KiChan , Lee Young-Sang
Published: May 2015

Introduction

Increasing studies on the muscles volume in the lumbar spine of low back pain patients is available in the literature. So far, these studies were focused only on the volume of the muscle, but the quality of muscle is more important, and the quality of muscle can be evaluated with the fat fraction ratio. To measure fat fraction of muscle, currently, 2, 3 points echo Dixon techniques were used, but its accuracy is a problem. Therefore, we use the first 6 points echo Dixon and to compare accuracy of 2 echo Dixon, 3 point Dixon imaging with that from MR spectroscopy as reference.

Patients and Methods

A total of 69 patients (39 women and 22 men; 54.3 ± 19.1) underwent MRI at a 1.5 T scanner. In addition, using T2-corrected Dixon sequence with 2, 3, and 6 echoes were obtained at the L4–L5 levels for fat-signal fraction. Fat-signal fraction from MR spectroscopy was also obtained at lumbar muscles of L4–L5 levels. Fat-signal fractions were measured directly by drawing region of interest at the automatically obtained fat-signal fraction mapping images from the three sequences. ROIs were drawn at the three consecutive slices of mapping images at the same location of the spectroscopic voxel by two musculoskeletal radiologists in consensus and the average values were obtained. The Student t test and Bland–Altman plots were used to quantify agreement between the values obtained from mapping images and those from spectroscopy. The p values < 0.05 were considered to be statistically significant.

Results

A total of 120 spectroscopic measurements were performed bilaterally. Mean spectroscopic fat-signal fraction percentage was 14.0 ± 11.8 (range, 2.9–63.6). Correlation between spectroscopic and all imaging-based fat-signal fractions was statistically significant ( R2 = 0.92 [2 echo], 0.91 [3 echo], and 0.96 [6 echo], all p < 0.001). Fat-signal fractions obtained from 6-echo T2-corrected Dixon sequence best correlated among all imaging-based fat-signal fractions with statistical significance ( p < 0.001).

Conclusion

T2-corrected 6-echo Dixon sequence best correlates with spectroscopic fat-signal fractions as compared with 2 echo and 3 echo sequences, thus being expected to be used as an accurate quantification tool for measurement of muscle fat quantification in lumbar spine MR imaging.
Treatment of C2 Vertebral Body and Dens Tumors with Intraoperative Transoral or Transpedicular Vertebroplasty and Occipitocervical Posterior Fixation
Authors: Papp Zoltan , Marosfoi Miklos , Szikora Istvan , Banczerowski Peter
Published: May 2015

Introduction

Metastatic spinal tumors of the atlantoaxial region are quite uncommon thus surgical treatment is difficult and challenging procedure. The origin of these metastatic tumors are mainly breast, lung, and prostate neoplasms, or part of hematopoietic disorders such as myeloma multiplex, lymphoma. Clinical management of the C2 metastatic lesions includes open surgery, radiotherapy, vertebroplasty, and external immobilization. The aim of our study was to evaluate the safety and efficacy of simultaneous intraoperative transoral or transpedicular vertebroplasty combined with posterior fixation in case of C2 vertebral metastatic disease.

Patients and Methods

We enrolled five patients with osteolytic C2 vertebral metastasis. The origin of the metastatic tumors was breast cancer in two cases, lung cancer in two cases, and multiple myeloma in one case. In three cases, we made purely posterior approach by dorsal open C2 biopsy and transpedicular vertebroplasty followed by posterior occipitocervical fixation. In the other two cases, patients underwent transoral C2 biopsy and vertebroplasty and dorsal occipitocervical fixation in the same session. The patients were followed with regular fluoroscopy, MRI, CT scans, and neurological examinations immediately after the operation and thereafter at 6 months. The HALO fixation device was removed after the first postoperative CT examination.

Results

During our 8 to 19 months (average 13 months) follow-up period, we had no surgical or neurological complications with respect to this combined approach. The incidence of postoperative cervical pain was lower, compared with the preoperative pain. Preoperative VAS was 7 (6–8), while postoperative VAS was 3.5 (2–5). On postoperative neurological and radiological follow-up, no surgical or neurological complications developed with respect to this combined approach of the atlantoaxial region of the spine. The average volume of PMMA injected was 4 mL. We filled more than 60% of each patient's C2 vertebral body and dens.

Conclusion

In this small series of simultaneous intraoperative transoral or transpedicular vertebroplasty and dorsal occipitocervical fixation proved to be a safe and effective treatment for patients with osteolytic C2 metastatic tumors. These techniques may provide excellent pain relief and improvements in quality of life. The true value of these combined techniques should be evaluated in larger series.
Systematic Review of Surgical Treatment Outcomes of Prostate Metastases to the Spine
Authors: Clarke Michelle , Molina Camilo , Fourney Daryl , Fisher Charles , Gokaslan Ziya , Schmidt Meic , Rhines Laurence , Fehlings Michael , Laufer Ilya , Patel Shreyaskumar , Rampersaud Raja , Reynolds Jeremy , Chou Dean , Bettegowda Chetan , Mendel Ehud , Weber Michael , Sciubba Daniel
Published: May 2015

Introduction

Treatment of symptomatic spinal metastases through surgical decompression and reconstruction is known to improve quality of life in patients with cancer. However, most studies have been performed on patients with mixed tumor histopathology. We systematically review the literature for prognostic factors specific to the surgical treatment of prostate metastases to the spine to determine the indications and outcomes of the surgical treatment.

Material and Methods

A systemic review of the literature was conducted to answer the following questions: Q1. Describe the survival and functional outcomes of surgery or vertebral augmentation for prostate metastases to the spine; Q2. Determine whether overall tumor burden, Gleason score, preoperative functional markers, and favorable hormonal naivety for operative intervention; Q3. Establish whether clinical outcomes vary with the evolution of operative techniques. Expert consensus was obtained using a modified Delphi process.

Results

A total of 16 studies met the preset inclusion criteria. These studies were all retrospective series with a level of evidence of IV. Included studies consistently showed a large effect of hormone naivety on overall survival. In addition, studies consistently demonstrated an improvement in motor function and the ability to maintain/regain ambulation following surgery resulting in moderate strength of recommendation. All other parameters were of insufficient or low strength.

Conclusion

There is scant literature on the surgical treatment of prostate metastases to the spine, which represents an opportunity for future research. On the basis of the existing evidence, it appears that the surgical treatment of prostate metastases to the spine has consistently favorable results. While no consistent preoperative indicators favor nonoperative treatment, hormone naivety and high Karnofsky Performance Scores have positive effects on survival and clinical outcomes.
Radiotherapy-Induced Tumors of the Spine, Peripheral Nerve, and Spinal Cord
Authors: Falavigna Asdrubal , Righesso Orlando , da Silva Pedro Guarise , Cagliari Carolina , Mourão Livia , Teixeira William
Published: May 2015

Introduction

The development of a secondary malignancy in the field of radiation is a rare, but well-recognized hazard of cancer treatment. Radiotherapy-induced (RT-I) tumors have become increasingly important because of the longer life of the general population, even the oncologic patients. The goal of this study is to report a case of RT-I neural tumor located in the spine and to perform a systematic review of the secondary tumor induced by radiotherapy to the spine.

Materials and Methods

A case of neural tumor secondary to radiotherapy to the spine was reported and a literature search of the cases of RT-I spine tumors was performed using an online database, Pubmed.gov. After exclusion criteria, 22 articles with 28 cases were included in the study. The variables analyzed were patient's age, gender, primary and secondary tumor histology, tumor location, time of development of the secondary tumor, treatment options, and outcome.

Results

The mean age of the patients at diagnosis of the induced tumor was 39.20 ( ± 17.02) years. Most of them were males (62.1%). The main type of primary disease was neural tumors (27.6%). The RT-I tumors were diagnosed within a mean of 17.1 ( ± 9.6) years after the radiotherapy (min 3–max 40). The most common type of histology was fibrosarcoma (20.7%). No difference was found in age, gender, and time for diagnosis between neural and nonneural tumors. The mean survival after the diagnosis of the secondary tumor was 10.66 months ( ± 12.96) and neural tumors had a longer survival period ( p = 0.031).

Conclusion

Most of the RT-I tumors are secondary to the treatment of Hodgkin Lymphoma with radiotherapy, sarcoma being the most frequent. The current gold standard is complete resection with clear margins. The neural tumor type had a longer survival period.
Surgical Treatment of Sharp Angular Kyphotic Deformity with Neurological Deficit due to Neglected Dorsal Hemivertebra in Adult Population
Authors: Gokcen Bahadir , Enercan Meric , Kahraman Sinan , Kilic Mesut , Erturer Erden , Ozturk Cagatay , Alanay Ahmet , Hamzaoglu Azmi
Published: May 2015

Introduction

Treatment of neurological deficit and deformity because of the neglected dorsal hemivertebra is a challenging procedure. Restoration of the sagittal balance is also technically demanding because of the sharp, angular kyphotic deformity. The aim of this study is to evaluate the results of the patients treated by dorsal hemivertebra resection via posterior approach for spinal decompression and deformity correction.

Patients and Methods

A total of 11 patients (8 M and 3 F) with average age 32.1 years (range, 19–49 years) were operated via dorsal hemivertebrectomy with posterior only approach. In the surgical technique, following 2 to 3 levels above and below pedicle screw fixation, wide laminectomy was performed one level above and below the apex of the deformity and spinal canal was decompressed by removing the dorsal hemivertebra. Deformity correction included sequential gradually compression from posterior and distraction from anterior column to prevent any dural buckling. Finally, an expandable cage was placed for anterior column support and distracted while final compression applied from posterior to correct local kyphosis totally. Spinal cord monitoring was used at all stages of surgery in all patients. Sagittal and pelvic parameters were measured on pre-op and post-op standing X-rays.

Results

The mean follow-up was 27.5 months (range, 24–32 months). The mean surgical time was 6.5 hours (range, 5–9 hours), average blood loss was 3,200 mL. Pre-op average local kyphosis angle was 57.250 and improved to 9.30 with a correction rate of 83%. There was no significant improvement in other parameters. All patients with neurologic deficit (eight patients ASIA grade D, two patients ASIA grade C, and one patient ASIA grade B) had significant improvement to ASIA grade E. There were no major complications including pseudarthrosis and implant failure. Minor complications included two (18%) superficial wound problems and one (9%) hematoma which responded well to debridement.

Conclusion

Posterior wide laminectomy and dorsal hemivertebra resection provide decompression of the neural structures. Correction of the local kyphosis and restoring sagittal balance are very challenging in sharp angular kyphosis. Ideal correction technique should include anterior column elongation with gradual posterior compression sequentially and placement of expandable cage to prevent any dural buckling.
Intraspine Interlaminar Device: Clinical, Radiological, and Safety Results of a Mini Case Series (10 Cases)
Authors: Carrabs Gabriele , Sessa Giovanni , Oliva Giovanni , Magliulo Maurizio , Pipola Angelo Michele , Silvestro Antonio , Sica Giuseppe
Published: May 2015

Introduction

Patients with low back pain and neurogenic claudication suffer chronic disability and in 40 to 50% of these, degenerative disc disease (DDD), and foraminal stenosis seem to be the principal causes. This preliminary mini case series assessed the clinical efficacy and radiological results of the Intraspine interlaminar device implanted in 10 patients.

Patients and Methods

We operated 10 patients (five males and five females) with a mean age of 67.5 years (ranging from 56 to 80 years) at our institution. The mean follow-up was 6 months. We evaluated patients with to the following end points: clinical outcome (according to Odom criteria) and radiological widening of neural foramina.

Results

A total of 10 Intraspine interlaminar device were implanted in 10 single-level procedures. One month after the surgery, according to Odom criteria, all the patients experienced good-to-excellent functional recovery with improvement of LBP and neurogenic claudication. At 6 months, the patients were clinically stable with two cases of further clinical benefit. The diameter of adjacent (above and below) neural foramina was weakly affected by the positioning of the interlaminar spacer indicating a reduced workload adjacent effect. No complications were associated with surgery.

Conclusion

The clinical and radiological results suggest that the Intraspine interlaminar device is a safe and effective alternative to commonest interspinous device with the advantage of reduced workload on adjacent levels.
The Comparison of Sequestrectomy and Conventional Discectomy for the Treatment of a Lumbar Disc Herniation: A Systematic Review
Authors: Azarhomayun Amir , Shirdel Saeedeh , Vaccaro Alexander , Shokraneh Farhad , Saadat Soheil , Chou Roger , Rahimi-Movaghar Vafa
Published: May 2015

Study Design

This is a systematic review.

Objective

This study aims to compare effects of sequestrectomy versus conventional microdiscectomy for lumbar disc herniation.

Summary of Background data

Open surgery for LDH can be performed by sequestrectomy or conventional discectomy. Generally, it has been assumed that the former is associated with higher risk of recurrence and less radicular pain and low back pain after surgery.

Methods

We searched MEDLINE and EMBASE from 1980 to November 2014. We selected randomized controlled trials (RCTs) and prospective studies that compared conventional discectomy versus sequestrectomy for adult patients with LDH and evaluated the following primary outcomes: radicular pain or LBP as measured by a visual analogue scale, neurological deficit of lower extremity. We also evaluated the following secondary outcomes: complications of surgery, reherniation rate, duration of hospital stay, postoperative analgesic use, and health-related quality of life measures. Two authors independently reviewed citations and articles for inclusion. We assessed the risk of bias as well as the level of evidence for each study, and we used standard methodological procedures recommended by the Cochrane Collaboration.

Results

We identified five studies (746 participants) that met our inclusion criteria comparing sequestrectomy versus microdiscectomy. Comparison revealed that with low-quality evidence, there is no significant difference for radicular pain, LBP, functional outcome, complications, and hospital stay for 2 years. In addition, with moderate-quality evidence, there is no significant difference for recurrence rate. Meanwhile, there is very low-quality evidence that analgesic consumption is lower in sequestrectomy than micro/discectomy.

Conclusion

Both interventions had similar effect on pain after surgery, recurrence rate, functional outcome, and complications; however, sequestrectomy may be superior in terms of postoperative analgesic consumption.
Ozone Therapy and Surgical-Related Complications: Preliminary Data and Alert
Authors: Vanni Daniele , Sirabella Francesco Saverio , Guelfi Matteo , Pantalone Andrea , Sparvieri Antonio , Galzio Renato , Salini Vincenzo , Magliani Vincenzo
Published: May 2015

Introduction

Ozone is able to react with proteoglycans, glycosaminoglycans, and other macromolecular complex and to induce galactose glucuronic acid, glycine, and 4-hydroxyproline oxidation. In this way, intra- and intermolecular chemical bonds are broken, releasing an amount of entrapped water. Subsequently, after the water reabsorption, intradiscal and periradicular pressure decrease and as a consequence pain and symptoms improves. Nowadays, oxygen-ozone therapy is increasingly used to treat lumbar disc hernia not responsive to conservative management. In most cases, this therapy is proposed as an alternative to surgery, although its effects could be often only temporary.

Patients and Methods

From June 2013, 23 patients (14 M and 9 F, mean age 51.3 years) underwent spinal surgery for lumbar disc hernia or lumbar segmental stenosis. Each of them were previously subjected to ozone therapy in a period between 12 and 24 months. Before surgery, all the patients were subjected to an MRI evaluation, as standard protocol. In eight of them a contrast-enhanced MRI was also performed.

Results

During surgery, many hard adhesions between soft tissue and bony structures were evaluated. Specifically, the dural and periradicular adhesions required a more demolition approach, to achieve the resolution of the disease. In one case, an iatrogenic dural cysts with roots invagination was noticed. This lesion was also detected at the preoperative MRI, but it had appeared only after ozone therapy treatment. It is necessary to observe that none of these patients were previously subjected to spine surgery and that these specific pathologic pattern of adhesion were not observed in patients that did not receive ozone therapy.

Conclusion

Our observation is a crucial starting point. Although these data are preliminary and it is important not to create unnecessary alarms, it is mandatory to assert that ozone therapy procedure may be associated with major complications. Therefore, it would be necessary a guideline revision and protocols adaptation with regard to ozone therapy application.
Complications in Spinal Surgery: To know in Order to Prevent. Analysis of 917 Cases Treated in 3 Years
Authors: Brodano Giovanni Barbanti , Halme Jarkko , Gasbarrini Alessandro , Bandiera Stefano , Terzi Silvia , Colangeli Simone , Ghermandi Riccardo , Babbi Lisa , Boriani Stefano
Published: May 2015

Introduction

The surgical treatment of complex spinal deformity and vertebral oncological diseases is becoming more common. The aim of this study was to prospectively record all the major complications observed in the perioperative and postoperative period for surgeries performed at our Division of Spine Surgery in the 2010 to 2012 period, correlating this score with different parameters to determine possible risk factors.

Material and Methods

A total of 285 surgeries were registered in 2010, 324 in 2011, and 308 in 2012. All the complications observed during the procedure and the follow-up period were recorded and classified according to the type (mechanical complications, neurological complications, infection, hematoma, cerebrospinal fluid fistula, systemic complications, and death related to the surgery).

Results

In 2010, on 285 surgeries 47 patients (16.5%) had 69 complications (24.2%): 25.7% for the treatment of oncological diseases, 23% for the treatment of degenerative diseases, 27% for the treatment of pathologies of traumatic origin, and 11% for the treatment of spondylodiscitis (infectious diseases). In 2011, on 324 surgeries 35 patients (10.8%) had 54 complications (16.7%): 16.3% for the treatment of oncological diseases, 16.3% for the treatment of degenerative diseases, 20% for the treatment of pathologies of traumatic origin, 28.6% for the treatment of spondylodiscitis. In 2012, on 308 surgeries, 25 patients (8.1%) had 36 complications (11.7%): 14.4% for the treatment of oncological diseases, 7.2% for the treatment of degenerative diseases, 16.7% for the treatment of pathologies of traumatic origin, and 20% for the treatment of spondylodiscitis.

Conclusion

On 917 spinal surgeries performed from January 2010 to December 2012, 159 complications (17.3%) were recorded, with a prevalence of mechanical complications and infections. The correlation of these complications with different parameters, such as age, sex, presence of comorbidities, previous spine surgery, type of surgery, will be analyzed to detect potential risk factors to be taken into consideration in the decision-making process for complex spinal surgery.
How to Reduce Bilateral Cervical Facet Joint Dislocation in Anterior Approach: A Trick to Avoid Anterior-Posterior-Anterior Surgical Procedures
Authors: Jaeger Martin
Published: May 2015

Introduction

Cervical facet joint dislocation is a common injury of the lower cervical spine. These flexion distraction lesions in cervical spine occur as a subluxation or unilateral/bilateral dislocation of the facet joints, which often be accompanied by direct spinal cord and nerve root injury. The presence of herniated intervertebral disc requires an anterior approach to decompress the spinal cord. Because often it is not possible to reduce facet joint dislocation while performing anterior surgery an additional posterior approach and then the fixation trough an anterior approach again is necessary. This method (supine-prone-supine) creates difficulties for surgeons because of the prolonged operation time; the need for frequent changes in patient position; and a subsequent high incidence of complications.

Materials and Methods

On the basis of a case, we present a maneuver to use pins such as joysticks in vertebral body during anterior approach to reduce dislocated facet joints in cervical spine fractures. After cervical discectomy/corpectomy, we use the pins to put the vertebral body in kyphotic position following rotational motion to reduce the facet joints. Results and Conclusion: Since we implemented this procedure, we had no more to perform posterior approach in surgical treatment in the last 15 cases of bilateral facet joint dislocation with herniated intervertebral disc in cervical trauma.
Solving the Schrödinger equation of molecules by relaxing the antisymmetry rule: Inter-exchange theory
Authors: Nakatsuji Hiroshi , Nakashima Hiroyuki
Published: May 2015

The Schrödinger equation (SE) and the antisymmetry principle constitute the governing principle of chemistry. A general method of solving the SE was presented before as the free complement (FC) theory, which gave highly accurate solutions for small atoms and molecules. We assume here to use the FC theory starting from the local valence bond wave function. When this theory is applied to larger molecules, antisymmetrizations of electronic wave functions become time-consuming and therefore, an additional breakthrough is necessary concerning the antisymmetry principle. Usually, in molecular calculations, we first construct the wave function to satisfy the antisymmetry rule, “electronic wave functions must be prescribed to be antisymmetric for all exchanges of electrons, otherwise bosonic interference may disturb the basis of the science.” Starting from determinantal wave functions is typical. Here, we give an antisymmetrization theory, called inter-exchange (iExg) theory, by dividing molecular antisymmetrizations to those within atoms and between atoms. For the electrons belonging to distant atoms in a molecule, only partial antisymmetrizations or even no antisymmetrizations are necessary, depending on the distance between the atoms. So, the above antisymmetry rule is not necessarily followed strictly to get the results of a desired accuracy. For this and other reasons, the necessary parts of the antisymmetrization operations become very small as molecules become larger, leading finally to the operation counts of lower orders of N, the number of electrons. This theory creates a natural antisymmetrization method that is useful for large molecules.
Screening and sheath formation in a nonequilibrium mixed Cairns-Tsallis electron distribution
Authors: Bouzit Omar , Gougam Leila Ait , Tribeche Mouloud
Published: May 2015

The effects of electron nonextensivity for a given nonthermality state, on Debye shielding and electrostatic sheath formation are examined. A physically meaningful Cairns-Tsallis distribution is outlined and a generalized expression for the Debye screening length λDq,α is obtained. It is shown that an increase of the entropic index q causes λDq,α to decrease whatever the amount of plasma nonthermality α. In addition, smaller pertinent values of q along with relatively higher values of α provide larger values of λDq,α. The shielded electrostatic potential falls off as a function of distance more slowly as α increases, a result somewhat analogous to the dynamical shielding decrease (albeit in a different context) of a free charge as it begins to move. Moreover, smaller pertinent values of q along with relatively higher values of α are found to involve higher ion drift speed vi0 for proper sheath formation. As α increases, the sheath electrostatic potential-gradient dΨs/dξ becomes abruptly steep slowing down the energetic electrons leakage to the wall. Moreover, the sheath thickness broadens as the electron nonthermality strengthens.
Stability and migration of small copper clusters in amorphous dielectrics
Authors: Guzman David M. , Onofrio Nicolas , Strachan Alejandro
Published: May 2015

We use density functional theory (DFT) to study the thermodynamic stability and migration of copper ions and small clusters embedded in amorphous silicon dioxide. We perform the calculations over an ensemble of statistically independent structures to quantify the role of the intrinsic atomic-level variability in the amorphous matrix affect the properties. The predicted formation energy of a Cu ion in the silica matrix is 2.7 ± 2.4 eV, significantly lower the value for crystalline SiO2. Interestingly, we find that Cu clusters of any size are energetically favorable as compared to isolated ions; showing that the formation of metallic clusters does not require overcoming a nucleation barrier as is often assumed. We also find a broad distribution of activation energies for Cu migration, from 0.4 to 1.1 eV. This study provides insights into the stability of nanoscale metallic clusters in silica of interest in electrochemical metallization cell memories and optoelectronics.