bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Carriers for Growth Factors for Enhancing Spinal Fusion
Authors: Li Xudong Joshua , Jin Li , Shen Francis
Published: April 2016

Spinal fusion is a well-accepted surgical treatment for many spinal diseases; the costs amount to ~34 billion annually in the US alone, with significant increases projected due to an aging population. Non-unions are a notable complication of spinal fusion surgery. To promote bone regeneration, the FDA has approved rhBMP-2 with a rebsorbable collagen sponge as an alternative to the standard bone graft for spinal fusion. However, adverse events associated with supraphysiological doses, and burst release of rhBMP-2 is a recurring problem for clinicians. Formulations that help regulate the delivery and release profile of growth factors are needed to achieve consistent clinical outcomes. Numerous approaches have been tested, and some of them have shown promising results. Strategies tested for achieving this endeavor include: 1) optimization of cytokine kinetics, 2) combination of different growth factors, 3) utilization of osteoinductive and osteoconductive scaffolds, 4) incorporation of progenitor cells, 5) augmentation of biological activity with tropic bone factors, and, 6) reduction of the endogenous BMP antagonists.

Disclosures: None
Bone Healing through Synthetic Scaffolds
Authors: Hsu Wellington K.
Published: April 2016

Patients who undergo spine surgery can have suboptimal outcomes postoperatively from pseudarthrosis. Historically, iliac crest bone graft, which provides all of the critical elements of bone repair, has been the gold standard for spine fusion, however, recent studies suggest that less than 6% of the U.S. spine surgeon population utilizes this procedure. Several bone graft substitutes are now available worldwide that obviate the need for the complications from iliac crest harvesting such as growth factors, stem cells, and allograft-based products. Recent developments in the production of biomaterials have highlighted the potential for synthetic scaffolds in providing graft options for surgeons in the future. With novel 3D printing methods, use of peptide amphiphiles, and formulation modifications, we will review the promising technologies that may revolutionize spinal biologics.
A Nanotechnology-Based Therapy to Target Inflammation in Degenerated Intervertebral Disc: First Results from an ex vivo Disc Organ Culture
Authors: Teixeira Graciosa Q. , Boldt Antje , Nagl Ines , Molinos Maria , Pereira Catarina Leite , Benz Karin , Wilke Hans-Joachim , Ignatius Anita , Barbosa Mário A. , Neidlinger-Wilke Cornelia , Gonçalves Raquel M.
Published: April 2016

Introduction

Resolution of intervertebral disc (IVD) degeneration-associated inflammation is a pre-requisite for tissue regeneration. Here, a pro-inflammatory disc organ culture model from bovine origin was established,1 and a therapy based on the intra-discal delivery of an anti-inflammatory drug (diclofenac).

Material and Methods

Bovine caudal IVD punches were needle-punctured and additionally stimulated with lipopolysaccharide (10 µg/mL) or interleukin-1β (IL-1β, 10–100 ng/mL) for 48 hours. An intradiscal therapeutic approach was tested based on a non-steroidal anti-inflammatory drug, diclofenac (Df), alone or incorporated into nanoparticles, previously developed.2

Results

IL-1β-treated IVD organ cultures showed a statistically significant up-regulation of pro-inflammatory markers (IL-6, IL-8, PGE2) and metalloproteases (MMP1, MMP3) expression while ECM proteins (Collagen II, Aggrecan) were significantly down-regulated. The injection of the anti-inflammatory drug was able to reduce the levels of pro-inflammatory cytokines and MMPs and surprisingly increased ECM protein levels.

Conclusion

These results point the intradiscal application of anti-inflammatory drugs as promising therapeutics for disc degeneration. Moreover, the organ culture model established could be used to address cellular/molecular mechanisms that regulate inflammation and IVD degeneration, and moreover to test novel therapeutic drugs, thus reducing the number of animals in in vivo experimentation.

Acknowledgments

This work was supported by European funds from FP7-EU-project GENODISC (HEALTH-F2–2008–201626), by German funds from the German Spine Foundation (Deutsche Wirbelsäulenstitung), by the Luso-German Integrated Actions Program (DAAD/CRUP, ref. A20/12), by FEDER funds through the Programa Operacional Factores de Competitividade – COMPETE, by Portuguese funds through QREN (project NORTE-07–0124-FEDER-000005) co-financed by North Portugal Regional Operational (ON.2-O Novo Norte). Graciosa Q. Teixeira and Catarina L. Pereira also acknowledge FCT for their PhD grants (SFRH/BD/88429/2012 and SFRH/BD/85779/2012, respectively). References Teixeira GQ, et al. Tissue Eng 2015; (Part C). Accepted for publication Gonçalves RM, et al. J Mater Sci Mater Med 2015
The Effect of Iodixanol on Human Intervertebral Disc Cells in vitro
Authors: Gradisnik Lidija , Maver Uros , Bunc Gorazd , Velnar Tomaz
Published: April 2016

Introduction

The diagnostics of discogenic low back pain may employ also radioopaque contrast agents, such as iodixanol, which may cause cytotoxicity to intervertebral disc cells following the intradiscal injections, provoking or accelerating the degeneration process. As many studies so far have been accomplished on animal cells, the potential effects of these agents in humans still remain unclear. The study aim was to evaluate the effect of iodixanol on human intervertebral disc cells in vitro and to compare its cytotoxicity to saline solution control.

Material and Methods

From human lumbar intervertebral disc fragments obtained during discectomis, annulus fibrosus and nucleus pulposus cells were isolated, cultured on the microtiter plates and exposed to various concentrations of iodixanol. Saline was used as a control. Three different dilutions (undiluted, 1:2 and 1:4) of iodixanol were tested. After 6, 24 and 48 hours, viability was determined.

Results

A time and dose depended response to iodixanol exposure was observed. The nulceus pulposus cells were more susceptible than annulus fibrosus cells to its toxic effects. Iodixanol was cytotoxic in all three tested concentrations (undiluted, 1:2 and 1:4) with the cell survival of 0%, 8% and 14%, respectively. Necrosis, rather than apoptosis, was the main reason for such devastating effects.

Conclusion

In iodixanol, commonly used for discography, the cytotoxic effects were observed in a dose- and time-dependent manner. According to our study, concentrated iodixanol is best avoided due to its high toxicity. Although 1:4 dilution was least toxic and may be thus recommended for the intradiscal diagnostics, the high dilutions are questionable due to loss of resolution yield. We assume the toxic effects of the contrast agents used may also contribute to disc degeneration, culminating to progressive tissue damage after the diagnostic measures.
Radiological, Histological and Biochemical Characterization of a Novel Ovine Lumbar Intervertebral Disc Injury Model
Authors: Daly Christopher , Goldschlager Tony , Ghosh Peter , Jenkin Graham , Cooper-White Justin , Naidoo Taryn
Published: April 2016

Introduction

Numerous animal models of degenerative disc disease exist. Debate exists as to the ideal animal model and optimal method of inducing degeneration. The ovine lumbar spine is one accepted animal model of degenerative intervertebral disc disease. The goal of this study is to describe and characterize a novel, simple, reproducible ovine disc-injury model utilizing a drill bit inserted into the lumbar intervertebral disc to mimic disc degeneration.

Material and Methods

Six female sheep underwent pre-operative MRI followed by lumbar intervertebral disc injury at two levels via insertion of a 3.5mm diameter drill bit to a depth of 12 mm via a lateral retroperitoneal approach. Necropsies were performed two months following injury. Lumbar spines were explanted and underwent 9.4T MRI, radiographic imaging, gross morphological, histological and biochemical analysis. Gross morphologic assessment consisted of horizontal section of the intervertebral disc, digital photography of the surfaces. Biochemical analysis was performed for sulphated glycosaminoglycans, type I and type II collagen and DNA. Histological analysis utilized a semiquantitative grading system.

Results

There was no evidence of disc degeneration on pre-operative MRI. Drill bit injured discs demonstrated increased Pfirrmann degenerative scores relative to controls and pre-operative scores. Injured levels demonstrated significantly greater reductions in Disc Height Index than control levels. Gross morphological assessment similarly revealed significantly higher degenerative morphological scores in injured disc relative to pre-operative scores and controls. On biochemical analysis the annulus fibrosus (AF) at the entry point in injured discs contained less type II collagen and proteoglycans than the AF of non-injured control discs. Histological assessment demonstrated increased degenerative scores in injured disc on semiquantitative scoring.

Conclusion

These finding demonstrate that the 3.5mm drill bit ovine lumbar intervertebral-disc injury model produced macroscopic, radiological, biochemical and histological changes consistent with disc degeneration.
Analysis of Serum C-reactive Protein in Patients with Lumbar Disc Herniation
Authors: Dewan Aarti
Published: April 2016

Introduction

We measured the serum concentration of C-reactive protein (CRP) by a high-sensitive method in patients with lumbar disc herniation. The level and type of herniation were evaluated. Inflammatory cytokines, such as interleukins are produced at the site of disc herniation and are now considered responsible for the pain perceived by the patient. Thus, purpose of this study is to test whether HSCRP can stand as an objective tool to predict postoperative recovery in patients undergoing lumbar discectomy. That is, to study association between preoperative HSCRP blood level and postoperative recovery with the help of modified Oswestry Back Disability Score.

Materials and Methods

A study group consisting of 50 cases of established lumbar disc disease and control group of 50 normal subjects, matched with the study group. Both the study and control groups were subjected to detailed evaluation with the help of modified Oswestry Low Back Pain Scale both pre andpostoperatively at 4 months, 8 months and 1-year. The preoperative blood samples were analyzed to assess the HSCRP concentration. All the cases underwent surgery over a period.

Results

The level of HSCRP in the study group was between 0.050– and 0.710 mg/dL and in the control group, 0.005–0.020 mg/dL. There was highly significant positive correlation between preoperative HSCRP level and postoperative score at p < 0.005. Cases with HSCRP level in the range of 0.1820 ± 0.079 mg/dL, showed better recovery (score improved > 10 points), while those with HSCRP level in the range of 0.470 ± 0.163 mg/dL, showed poor recovery (score improved < 10 points).

Conclusion

The significantly high concentration of serum hs-CRP might indicate a systemic inflammatory response to impingement of the nerve root caused by disc herniation and might be a predictor of recovery after operation.
Proteomic Analysis of Degenerated Intervertebral Disc- identification of Biomarkers of Degenerative Disc Disease and Development of Proteome Database
Authors: Ranjani Veera , Sreemol G. , Muthurajan Raveendran , Natesan Senthil , Gnanam R. , Kanna Rishi M. , Rajasekaran S.
Published: April 2016

Introduction

Low back pain (LBP) is a leading cause of disability resulting from musculoskeletal disorders among general population. The life time prevalence of single episode of low back pain in general population is reported to be around 80%. It is a leading cause of loss of productivity and the resulting economic burden due to loss of productivity is enormous. Degenerative disc disease (DDD) is a leading cause for LBP however, molecular mechanism underlying DDD are largely unknown. To date, there are few reports available on Intervertebral Disc (IVD) proteomics. Hence, weundertook the analysis of the intervertebral disc using a proteomic based approach to develop a database which may be helpful to isolate probable biomarkers and better understand the molecular basis of DDD.

Methods

Sample for proteomic analysis was obtained during lumbar discectomy in a case of intervertebral disc prolapse from a 50 year old female. IVD tissue sample was pulverizedusing liquid nitrogen and proteins were extracted. Extracted proteins were subjected to Two-Dimensional Polyacrylamide Gel Electrophoresis (2D-PAGE) analysis. Reproducible and abundantly expressed proteins were analyzed using Matrix Assisted Laser Desorption/Ionisation- Time of Flight (MALDI-TOF)Mass Spectrometry. The peptide mass fingerprinting data from the MALDI-TOF were analyzed by MASCOT online tool for the identification of proteins. Database was developed based on the results obtained from the MASCOT analysis.

Results

Thirty protein spots were identified from the degenerated IVD tissue by proteomic profiling techniques. Out of these 30 proteins, 25 proteins showed significant matches against human proteins in the NCBI database; remaining 5 spots did not generate any significant matches. The proteins which showed a significant match provide authentic evidence of the presence of these proteins in the IVD. The database was developed based on a three layer architecture model which could help investigator identify target proteins consisting of presentation layer, application layer and the data storage layer. This database would prove useful in future proteomic research into DDD.

Conclusion

Following the genomic era, molecular analysis at the proteomic level is a developing technology. This technology has the scope to identify the functions of the differently expressed proteins, from control and degenerated discs and may provide an opportunity to design novel strategies to treat degenerative disc disease in the future. Our study provides early data in the field of proteomic profiling in the clinical disease scenario of DDD.
Outcome and Differences in the Clinical Results of Three Different Surgical Methods for Lumbar Disk Herniation
Authors: Haghnegahdar Ali , Sedighi Mahsa
Published: April 2016

Introduction

We aimed to study the following gaps in the literature. (1) Clinical results of spinous process osteotomy for the treatment of LDH is scarce in the literature. (2) Studies comparing clinical outcomes between laminectomy and osteotomy have not been reported. (3) Results of MAPN with open techniques have not been compared. We sought to study the outcome of surgery for LDH by conducting a comparative study between three different surgical techniques; we aimed to find whether any of these approaches were more efficacious in reducing pain or improving patients' quality of life. In addition, factors that could predict the outcome of LDH surgery were assessed.

Materials and Methods

We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption.

Results

Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation.

Conclusion

Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population.
Microdiscectomy Results using the Caspar Technique
Authors: Velnar Tomaz , Bunc Gorazd
Published: April 2016

Introduction

The degenerative disease of the intervertebral disc and back pain are chronic conditions and represent an important cause of morbidity and mortality. Treatment of lumbar radicular compressive syndromes is described, as well as the success of microsurgical procedure according to the Caspar technique.

Material and Methods

In the prospective study, 100 patients were included. All suffered from the radiculopathy due to the nerve compression. Conservative treatment was not successful and operation was then performed. The follow up of patients was evaluated from 1 to 3 years after the operation, the average time was 17 months.

Results

The results showed excellent outcome in 67%, good outcome in 28%, fair in 1% and poor in 3% of patients. One patient died one month after the operation due to unrelated reasons and was not included in the final assessment. Thus, the total result was satisfactory in 95%.

Conclusion

The results of microsurgical approach showed that the efficiency of such operation in this series can be compared with similar results elsewhere according to the international criteria (88% to 98%). The successfulness of the microsurgical method is due to gentle tissue handling, especially with respect to the nerve structures in the spinal canal and considerably smaller injury if muscles and bone. This is achieved by better visibility and field magnification with the operative microscope.
The Role of Caveolin-1 in Intervertebral Disc Degeneration and Regeneration
Authors: Bach Frances , Zhang Ying , Verdondschot Lucy , Bedate Alberto Miranda , Creemers Laura , Ito Keita , Meij Björn , Sakai Daisuke , Chan Danny , Tryfonidou Marianna
Published: April 2016

Introduction

During intervertebral disc (IVD) degeneration, the main cell type in the nucleus pulposus (NP) shifts from notochordal cells (NCs) to chondrocyte-like cells (CLCs). Microarray analysis revealed that caveolin-1 expression was correlated with IVD degeneration. The aim of this study was to determine the role of caveolin-1 in NC and CLC physiology to assess its potential role in IVD regeneration.

Material and Methods

Protein expression (caveolin-1, apoptosis, progenitor cell markers, extracellular matrix, TGF-β-signaling pathway) was determined in IVDs of wild type (WT) and caveolin-1 knockout (KO) mice and canine IVDs of different degeneration grades (immunofluorescence, immunohistochemistry, TUNEL assay). Micro-aggregate cultures of CLCs from canine and human degenerated IVDs (Thompson grade III) were treated with chondrogenic medium (incl. TGF-β1) alone or in combination with (a) caveolin-1 scaffolding domain peptide (CSD) and/or (b) siRNA against caveolin-1. DNA, glycosaminoglycan (GAG) content, collagen type I and II immunohistochemistry and gene expression profiling (RT-qPCR) for extracellular matrix production/degradation-, cell proliferation- and apoptosis markers was performed.

Results

The NP of WT mice was rich in viable NCs, whereas the NP of caveolin-1 KO mice contained more collagen type II-rich matrix and less cells together with an increased progenitor cell surface marker (Tie2+/GD2+) expression and a higher apoptotic activity. Caveolin-1 expression increased in the later stages of canine IVD degeneration, together with a significantly increased apoptotic activity. Caveolin-1 knockdown significantly decreased GAG deposition in the CLC aggregates (6–14%), whereas CSD treatment significantly rescued and increased GAG deposition (11–16%).

Conclusion

Caveolin-1 plays a crucial role in preservation of NCs, underscored by the NP phenotype of caveolin-1 KO mice. Caveolin-1 may be related with cell senescence given its increased expression in degenerated IVDs. However, caveolin-1 knockdown decreased extracellular matrix production, while CSD supplementation rescued this effect. The latter implies that CSD may be a useful disease modifying agent since it is known to influence degeneration-related signaling pathways (incl. TGF-β signaling). Altogether, this indicates that the increased caveolin-1 expression during IVD degeneration may also be a repair mechanism rather than being merely a senescence marker.

Acknowledgment

This work was supported by AOSpine Research Network grants (SRN2011_11, AOSPINE 106540) and the Dutch Arthritis Foundation (LLP22).
New 5-Grade Scale for Anterior Fusion Estimation: Validation for Infectious Spondylitis
Authors: Mushkin Alexander , Baulin Ivan , Pavel Gavrilov , Nina Sovetova , Naumov Denis
Published: April 2016

Introduction

Fusion status assessed using plain radiograph or CTs, according to the 4-grade scale published by Bridwell et al (1995). Unfortunately, this method is based on the measuring of bone density and bone sclerosis and it's not completely definite for dynamic analysis, especially for early post-op period.

Methods

5–grade scale based on the quantities evaluation characterized by implant's position between vertebral bodies and descriptive characteristic of the zone between transplant(implant) and implant site. 1 grade – dislocation of the transplant (implant): one or both ends are dislocated from the vertebral end plate(s); 2 grade – transplant (implant) is located between vertebral bodies, the size between blocked vertebra and end of transplant ≥ 3 mm; 3 grade – transplant (implant) is located between vertebral bodies, the size between blocked vertebra and end of transplant 1 ≤…≤ 3 mm; 4 grade – the diastasis between vertebra and transplant (implant) is not visualized; non-clear bone structure of fusion zone; with local sclerosis (similar to the grade 2 according Bridwell's scale); 5 grade – structural bone block with a clear bone trabeculars between transplant (implant) and contacted vertebral body (similar to the grade 1 according Bridwell's scale).

Results

109 patients aged from 21 till 76 years (average - 59,2 years) were included into prospective CT-study 3, 6, 12 months post-op. All patients were consequently operated between 2010 – 2013 in one clinic. Indications for surgery was chronic spinal infections (TB or osteomyelitis) with un-effective previous course of conservative treatment. According to the variant of anterior fusion patients were divided into 2 groups: group 1 ( n = 40) - autologous bone graft; group 2 ( n = 69) – autologous bone graft inserted into the titanium mesh cage. Fusion was estimated separately for cranial and caudal contact zone. Statistically confirmed differences between compared groups in fusion status in early post-op (3 and 6 month) evaluation. The results were more differential in compare with Bridwell's scale. The differences completely disappeared till 12 month after surgery.

Conclusions

New 5-grade scale for anterior fusion estimation doesn't depend on the technical characteristic of CT-images; it is more objective for estimation of early results of spinal reconstruction. The proposed method could be more informative for comparative studies of the different spine pathologies.
A Study of Sacral Anthropometry to Determine S1 Sacral Screw Placement for Spinal Lumbosacral Fixation in the Korean Population
Authors: Ha Kee-Yong , Oh In-Soo
Published: April 2016

Introduction

There are various methods of S1 pedicular screw fixation, and every method has its own advantages and disadvantages. But, anatomical variation of the posterior superior iliac spine (PSIS) was not considered in any method. Therefore, little is known about the safe angle for screw fixation in the Asian population.

Material and Methods

We performed our study in 160 sacra including the pelvic ring obtained from 80 Korean cadavers. The bony measurements were obtained by performing 1 mm computed tomography (CT) cuts from the L5 lumbar vertebra to the pelvic ring and excluding other structures. We evaluated the incidence of anatomic variation of the PSIS and measured the safe marginal length and angle for screw fixation considering the PSIS and course of the external iliac vein, using a Korean sacrum model.

Results

Our study showed that the closed type of PSIS is more frequent in males than in females. The optimal angle for screw fixation is 16.91 ± 6.85 (°), while the Lt. side S1 pedicle insertion angle (SPIA) is 16.00 ± 6.20 (°). The average Korean optimal screw length is 58.35 ± 14.90 (cm) for the Rt. Side and 55.89 ± 16.16 (cm) for the Lt. side.

Conclusion

With reference to these parameters, the optimal screw length and angle can be chosen and bicortical anteromedial screw fixation can be easily and safely performed.
New Motor Deficit after Adult Spinal Deformity Surgery Leads to Worsened Early HRQOL: Subanalysis of 273 Patients from Scoli Risk 1 Prospective Study
Authors: Saigal Rajiv , Berven Sigurd , Lafage Virginie , Kelly Michael , Kopjar Branko , Smith Justin , Dahl Benny , Cheung Kenneth M. C. , Carreon Leah Y. , Schwab Frank , Rebmann Kathrin , Shaffrey Christopher , Fehlings Michael , Lenke Lawrence , Ames Christopher
Published: April 2016

Introduction

An International, ambispective, multi-center observational cohort study (Scoli-Risk-1) was completed to determine the impact of neural injury on Health-related Quality of Life scores (HRQOLs). 30.9% of patients suffered any ASIA lower extremity motor score (LEMS) worsening during the first 6 months after surgery. The purpose of this analysis is to define the impact of new LEMS deficit on HRQOL metrics and recovery of those measures after surgery in the first 6 months. We hypothesized that new motor deficits (defined by LEMS worsening) will lead to worsened HRQOL scores, after correction of adult spinal deformity.

Material and Methods

Patients aged 18–80 years with a diagnosis of adult spinal deformity were eligible for enrollment at 15 sites worldwide. Other inclusion criteria included major Cobb > 80 degrees, C7-L2 curve apex, and any patient undergoing 3 column osteotomy. ASIA scores and standard HRQOL scores (ODI, SRS, SF-36 mental, and SF-36 physical) were recorded pre-op, 6 weeks and 6 months. Patients were subdivided into three subcategories of LEMS change (≥2 points worsening, 1 pt worsening to no change, or LEMS improvement).

Results

273 complex adult spinal deformity (ASD) patients enrolled, with 184 female (67%) and 89 male (33%) patients. Mean age was 56.9 years (SD 15.3, range 18–81). 30.9% of patients suffered a worsening of LEMS within the first 6 months post-surgery. HRQOL scores worsened as LEMS worsened. The 6 week HRQOL changes for LEMS ≤2 patients vs LEMS −1 to 0 vs improved LEMS patients were: ODI (11.6 vs 0.7 vs −0.6), SF-36 physical (−3.9 vs −1.6 vs 1.0), SF-36 mental (−1.5 vs 1.4 vs 0.6), and SRS total change (0 vs 0.4 vs 0.5), respectively. The 6 month HRQOL changes for LEMS < =2 patients vs LEMS −1 to 0 vs improved LEMS were: ODI (−6.8 vs −9.5 vs −14), SF-36 physical (0.6 vs 2.6 vs 6.2), SF-36 mental (−1.1 vs 3.8 vs 5.9), and SRS total change (0.3 vs 0.7 vs 0.8), respectively. Table 1 shows these data. While the database is not yet locked, these data are subject to minor changes.

Conclusion

In the subgroup of patients who developed a new lower extremity motor deficit after adult spinal deformity surgery, total HRQOLs and HRQOL changes were negatively impacted. Patients with 2 or more points of LEMS worsening had the worst HRQOL changes. However, even these patients showed overall improvement in ODI, SF-36 physical and SRS total scores at 6 months compared with pre-op baseline.
Efficacy of En Bloc Direct Vertebral Body Derotation (Dvbd) in Idiopathic Scoliosis Treatment
Authors: Urbanski Wiktor , Wolanczyk Michal , Dragan Szymon
Published: April 2016

Introduction

Vertebral axial rotation in horizontal plane is a component of spinal deformity in scoliosis. Greater axial rotation is related with inclination to curve progression, contributes to rib hump development. Therefore the correction of axial deformity appears as an obvious component of scoliosis correction. However clinical efficiency and complication risk of derotation maneuvers is still not established. The object of the study was to assess horizontal correction obtained with en bloc direct vertebral body derotation (DVBD) and the influence of the maneuver on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis correction.

Material and Methods

36 patients after surgical correction of idiopathic scoliosis were included into study. Authors analyzed two groups; adolescents and adults. All patients underwent posterior fusion with pedicle screws only instrumentation. 15 (20 curves) patients were corrected by rod derotation only and 21 (26 curves) underwent rod derotation and direct en bloc vertebral derotation (DVBD). Measurements according to Cobb method were performed on X-rays obtained before and post surgery - coronal plane curves, sagittal profile (T2-T12, T5-T12, L1-S1). Spine flexibility was assessed of prone bending X-rays. Axial rotation was determined on CT scans obtained intraoperatively (O-Arm, Medtronic) and postoperative CT scan. Rotation assessment was done according to the method described by Aaro and Dahlborn.

Results

The comparison of axial rotation prior to correction and post correction revealed decrease of axial apical vertebral rotation in both DVBD and non DVBD groups. However in DVBD group vertebral derotation was greater than in non DVBD group and it was confirmed in statistic analysis. Amount of axial derotation was similar in both adults and adolescents. Analysis of coronal curves showed statistically significant better correction in (DVBD) group and obviously better correction was possible in flexible than stiff curves. DVBD did not improve but also did not decrease kyphosis comparing to pre op measurements and results from non DVBD group. This statement concerned both T2-T12, T5-T12 measurements. Neither flexibility nor stiffness of the curves influenced kyphosis results.

Conclusion

Direct vertebral body derotation is a relevant maneuver to improve correction in idiopathic scoliosis, either in coronal or sagittal plane. It may be useful technique in adolescent as well as adult patients.
The Rib Construct (RC) has Provided Secure Proximal Fixation for Management of Patients with EOS and Severe Thoracic Hyperkyphosis
Authors: Ahmad Alaaeldin
Published: April 2016

Introduction

Thoracic hyperkyphosis, described as greater than 20 degrees of kyphosis from T1–5, and/or 40 degrees from T5–12, or greater than 50 degrees of maximum total kyphosis, has been associated with poor outcomes when treating EOS. For such patients, decision making between spine based and rib based proximal fixation has been graded as being among the areas of greatest clinical uncertainty at present for surgeons treating EOS. We address this uncertainty by reporting our results of rib based fixation in patients with EOS and thoracic hyperkyphosis. We chose a minimum of 70 degrees of kyphosis between T5–12 for inclusion, rather than 50, to focus further on the management of severe hyperkyphosis.

Material and Methods

Ongoing data collection of surgical management of 13 children with EOS and greater than 20 degrees of kyphosis between T1–5 and/or 70 degrees between T5–12, and at least 24 months of followup was compiled. The (RC) was used for proximal fixation in all cases.

Results

5 syndromic,5 congenital/structural, 1 idiopathic. 9 had prior spine surgery. Average age at initial surgery 84 months; followup averaged 47 months (24–77). 5 had T1–5 kyphosis, average 29 degrees, postop 26. 9 had T5–12 kyphosis, average 96 degrees, postop 56. Average preop thoracic scoliosis 68 postop 44; preop lumbar scoliosis 39, postop 38. Average preop spine length 22.9 cm, postop 29.2. Average preop coronal balance 11.3 cm, postop 13.1. Average preop sagittal balance 39, postop 27. Complications included 3 proximal hook dislodgments, 5 distal anchors, 1 delayed deep wound infection with removal and subsequent replacement of instrumentation, 3 rod failures, 1 PJK. As a group, there were 63 subsequent planned procedures, and 18 unplanned.

Conclusion

The RC provides reliable proximal fixation for EOS patients with severe thoracic hyperkyphosis, especially for those with hyperkyphosis from T5–12.
Radical Debridement and Spinal Reconstruction using Titanium Mesh Cages (TMC's) in Pediatrics Patients with Pott's Disease and Vertebral Osteomyelitis
Authors: Mushkin Alexander , Naumov Denis
Published: April 2016

Introduction

TB spondylitis and vertebral osteomyelitis frequently occur in the patients of early ages. The tendency to the multilevel damage with total or subtotal lesions of several vertebral bodies leads to the spine collapse and early kyphosis. Radical debridement and autogenous strut-graft fusion have become the “gold standard” for surgery. The introduction of the TMC in adult's spinal surgery has opened up a variety of applications that are realizable as a result of the versatility of the implant. But the use of TMC in pediatrics spinal surgery is controversial, and results have not been published to date.

Patients and Methods

Study design: cohort analysis. 74 children aged from 7 months till 17 years underwent spinal reconstruction: 5 (10%) in the cervical spine, 32 (46%) in the thoracic spine and 37 (44%) in the lumbar spine. Clinical series include 18 early age patients under 3 years old. Group 1 (n1 = 25) – tuberculous (TB) spondylitis; group 2 (n2 = 49) – chronic nonspecific spondylitis (CNS) and its consequences, including 16 patients with spondylodiscitis. Disease duration in all patients was at least 4 months prior ineffective antimicrobial therapy. The indications for surgery were destruction with vertebral deformity progression, neurological disorders and ineffective chemotherapy with continuing abscesses. All patients had debridement with anterior column reconstruction, posterior instrumentation and fusion by TMC's with bone auto-grafts. The rate of the fusion was assessed by CT at 6 and 12 months after surgery according to the new rating scale graded from 1 (incorrect implant position) to grade 5 (solid fusion with a structural bone block).

Results

The number of stabilized spinal segments ranged from 2 to 5. Etiology of spondylitis was identified due to bacteriological, molecular genetics and morphological studies of the operational material. No operative complications and no implant-related complications were recorded in the postoperative period. The fusion rate corresponded to grade 3 in 91,1% ( n = 68) at 6 mns post-op and as grade 4 in 93,2% ( n = 69) at the 12 mns post-op. Till the final follow-up (M 36 - mns, min 12 - mns, max – 4 years) a mean segmental loss of correction was 3,7 (0 ÷ 7) degrees. Destabilization of TMC's was detected after surgery only in two cases due to the late infection's reactivation.

Conclusion

The anterior interbody fusion by TMC's with bone auto-grafts in pediatric spine reconstruction provides reliable spinal stability in both the short-term and long-term period and does not increase the risk of infectious complications in cases of infectious spondylitis' surgery. TMC produce the early anterior fusion and provide the possibility to earlier removing of posterior instrumentation before the disk degeneration inside the instrumented zone in growing spine.
Functional Outcome after Anterior Decompression and Stabilization using Locally Made Stand-alone Titanium Cage with Bone Graft in Caries Spine: An Experience of 600+ Cases at Ghurki Hospital
Authors: Khan Ahsan Akhtar , Aziz Amer
Published: April 2016

Introduction

Tuberculosis is the leading cause of death in third world countries, from a single infectious disease. It paralyses the society when it affects the spine due to its residual neurological deficit in the form of Quadriplegia, paraplegia, loss of bladder and bowel control, bedsores, as well as from continuous financial burden it exerts on the affected family and whole society. Early spinal decompression and stabilization with a locally made stand alone cage have dramatic results in terms of improvement in neurology, relief of pain and correction of deformity as well as improvement in the patient's quality of life.

Methods

The objective of the study is to determine the outcome after Anterior Decompression and Stabilization with locally made stand alone Cage & Bone Graft in caries spine in terms of improvement of neurology, relief of pain, improvement of Kyphotic angle as well as quality of life improvement. It is a prospective case series study including 600 cases, which were treated at GTTH from 2005–15. After pre-operative assessment of pain, neurology, measurement of angle of deformity, and QOL analysis using the SF-36®, all patients were treated with Ant. Decompression and then stabilization was achieved using morcellized bone graft with a locally made stand alone cage. After surgery patients were followed at 06 weeks, 03 months, 06 months & 01 year to assess neurology, relief of pain and Kyphotic angle and their SF-36® scores.

Results

Neurology improved in 88% of patients, pain was relieved in 92% of cases and there was mean correction of 18° in Kyphotic angle at the end of 01 year follow up with a significant improvement in the patient's quality of life.

Conclusion

Early diagnosis and early intervention gives excellent results in Tuberculosis of the spine. After anterior decompression, stabilization with cage and bone graft results in significant improvement of neurology, relief of pain and correction of Kyphotic deformity, as well as the patient's quality of life. There is no need for added instrumentation.
Surgical Treatment of Burst Fractures of the Dorsolumbar Spine by Short Segment Posterior Instrumentation. To Fuse or Not to Fuse?
Authors: Koptan Wael , El-Sharkawi Mohammad , ElMiligui Yasser
Published: April 2016

Introduction

The concept of ‘Ligamentotaxis’ using short segment posterior instrumentation and fusion is widely accepted for managing unstable burst fractures of the dorsolumbar spine. The aim of this work is to study the possibility of performing this procedure without fusion.

Materials and Methods

This is prospective randomized study included 54 patients with burst fractures of the dorsolumbar spine treated with short segment posterior instrumentation without fusion (Group 1); compared with a similar group of 47 patients that were treated by the same technique with posterolateral fusion using iliac crest autograft. Patients were followed up for an average of 5y.

Results

In Group 1, all patients with neurological impairment improved 1 to 2 Frankel grades; the VAS improved from an average of 7.8 to 1.3 and the overall complications were 4/54. The kyphotic deformity was corrected from an average of 22.6 degrees to an average of 3.1 degrees; the average anterior height of the fractured vertebrae was corrected from an average of 65% to an average of 92% and the compromise of the spinal canal improved from an average of 42% to 14%. Implant failure occurred in 2 patients. There was no significant difference in these parameters between Groups 1 and 2. In Group 2 there was significantly more operative time, blood loss, hospital stay and 10/47 complications including 2 implant failures.

Conclusion

Short segment posterior instrumentation without fusion is a safe efficient procedure with significantly less operative time, blood loss, hospital stay and complications than when fusion was performed.
Direct Spondylolysis Repair in Young Adults
Authors: Negm Mohammad
Published: April 2016

Introduction

Spondylolysis is a common problem affecting all ages but in adolescent and young adult specially the athletes it represent a significant dilemma as most of them starting their life and need a stable free spine, a minority of old people affected by this disease need medical care, and only a few require surgery but in athletes and young adult surgery usually the role. Reconstruction of the pars interarticularis is an alternative to segmental fusion; this technique has the advantage of preserving segmental motion. Most authors report good results for young patients without intervertebral disc or facet affection

Material and Methods

In this study the fixation of the isthmus was done with a pedicle screw hook system. This stable and strong device is easy to use, allows an anatomic pars interarticularis reconstruction and avoids a postoperative bracing and allow early ambulation. 9 patients were assessed in this study, the mean age at operation was 24 (range 16–32 years) and the average follow-up was for 24 months (range 6–36 months). 7 patients showed no preoperative degenerative disc disease and 2 patients had grade 1 changes. The visual analogical scale, the Oswestry disability index (ODI were used for assessment of pain and clinical outcome before and after surgery.

Results

The results were from “excellent” to “good” for 8 patients and “fair” for one of them. The fusion rate was observed in all cases. Among patients results are from “good,” to “excellent” in all cases and consolidation was always observed. All of them showed normal disc height after the surgery.

Conclusion

Direct spondylolsis repair by pedicle screw hook system is an excellent and reliable method in management of spondylolysis especially in intact disc in young adults
Long Segment Posterior Instrumentation with Interbody Fusion using Locally Harvested Bone Graft for Fracture Dislocations of Thoraco Lumbar Spine: An Outcome Study of 60 Cases
Authors: Farooque Kamran
Published: April 2016

Material and Methods

Sixty (60) cases of Fracture Dislocations of thoraco lumbar spine were treated at JPN Apex level one Trauma Center, A.I.I.M.S., New Delhi, from Jan. 2008 to April 2014. All the cases were treated by long segment pedicle screw constructs, two levels above and below the dislocation level, from a posterior approach. A combined posterior and postero lateral decompression from posterior approach was done in 56 cases. In 3 cases, only posterior decompression by complete laminectomy was done. In one case only, additional anterior decompression from anterior approach was done along with posterior approach. Partial corpectemy and interbody fusion using Harms type mesh cage was done in 20 cases. Complete Discectomy at the dislocation level and Interbody Fusion, using locally harvested bone graft(Spinous process and Lamina) from the posterior decompression was done in 32 cases. A partial corpectemy and interbody fusion using the TLIF banana type cages was done in 4 cases. In Situ postero lateral fusion was done in 3 cases. In one case, additional anterior surgery along with posterior surgery was done to achieve anterior reconstruction with expandable cage.

Results

Follow up of cases ranged from one year to six years. There was no case of implant failure or loss of fixation, in any of the 60 cases. Fusion was achieved in all cases, as evidenced by direct and indirect markers. All patients achieved at least a sitting balance. 20 patients were ambulating on wheel chair, while 40 patients achieved independent mobilization, with or without the help of calipers and braces. Neurologic recovery of one ASIA grade was seen in 15 patients, and two ASIA grades was seen in 20 patients. There was no neurologic recovery seen in 25 patients. There was deep seated infection, in two cases, which resolved with debridement and antibiotics. Sacral bed sores developed in six cases, which were treated by local flaps.

Conclusion

Long segment posterior fixation, two levels above and below the injury from a posterior only approach is sufficient and adequate treatment for fracture dislocation injuries of thoraco lumbar spine. Interbody Fusion using locally harvested bone graft is a novel technique to enhance the fusion rate and minimize instrumentation failures.
Posterior Spinal Fixation with Fusion versus without Fusion in Treatment of Dorsolumbar and Lumbar Fractures
Authors: Elkhateeb Tameem , Mahmoud Abdelrady
Published: April 2016

Introduction

Operative treatment in the form of posterior fixation with or without fusion has moved to the forefront of fracture management as it helps decreasing morbidity and mortality with better return to work and satisfactory functions. The aim of the study is to compare the results of posterior spinal fixation with fusion versus without fusion in cases of dorsolumbar and lumbar fractures both clinically and radiologically.

Material and Methods

A randomized clinical trial conducted on 60 patients in Ain Shams University Hospitals in two groups: Group (A): posterior spinal fixation with fusion (30 patients); Group (B): posterior spinal fixation without fusion (30 patients). All patients have dorsolumbar and/or lumbar spine fractures and are candidates for posterior spinal fixation. Inclusion criteria: Age group (<45 years). Both sexes. Neurologically intact patients with kyphotic angle more than 20° or decreased vertebral body height more than 50% or a canal compromise more than 50%. Single or multilevel spinal injury. Exclusion criteria: Any patient who will need anterior fusion according to load sharing classification (≥7). Incomplete or complete neurological deficit. Advanced spondylosis. Fracture of pars interarticularis. Fracture of facet joints. Preoperative evaluation includes history, examination, and radiological evaluation. All patients were done under general anesthesia in prone position. A standard midline posterior approach was used to expose the desired levels for fixation. Posterior instrumentation using pedicular screws (in non-fusion group, only top loading rod systems were used as side loading and plate systems may damage facet joints). Posterior and intertransverse fusion was used in fusion group.

Results

Operative time was shorter in non-fusion group (107.5 minute) than fusion group (140.83 minute). Intraoperative blood loss was less in non-fusion group (330.33 ml) than fusion group (368.33 ml). The mean of lost correction of vertebral body height % in fusion group was 7.9 while the mean of lost correction of vertebral body height % in non-fusion group was 8.07. This is statistically not significant with P-value  > 0.05 (0.917). The mean of lost correction of Cobb angle in fusion group was 6.7° while the mean of lost correction of Cobb angle in non-fusion group was 8.65°. This is statistically significant with P-value < 0.05. The mean segmental motion after removal in fusion group was 1.73° while the mean segmental motion after removal in non-fusion group was 11.62°. This is statistically significant with P-value < 0.001.

Conclusion

Posterior spinal fixation without fusion yielded satisfactory results similar to those of posterior spinal fixation with fusion in patients with dorsolumbar fractures with a load sharing score < 7.