bluuebunny/crossref_metadata_2025 huggingface dataset:
Now Hear This: Auditory Sense may be an Undervalued Component of Effective Modeling and Imagery Interventions in Sport
Authors: O Jenny , Law Barbi , Rymal Amanda
Published: January 2016

One of the most important goals of behavioral research in sport psychology and motor learning is to increase
our understanding of how to more effectively manipulate structural elements of psychological skills so as to optimize
learning and performance. Imagery and modeling research have long-held parallel trajectories; advancements in the understanding
of one construct has often informed subsequent research on the other. Preliminary research examining the effect
of auditory modeling has indicated that deliberate manipulation of sounds employed during modeled actions can positively
impact motor skill learning, performance, and consistency. The imagery research has yet to directly examine the
auditory sense, and thus examination of this imagery component would represent a meaningful contribution to our understanding
of how to further optimize athletes’ imagery practice. The current paper reviews current knowledge regarding effective
imagery and modeling structure, and provides theoretical and evidence-based rationales for the examination of the
auditory sense in imagery research.
Audio-Based Interventions in Sport
Authors: Sors Fabrizio , Murgia Mauro , Santoro Ilaria , Agostini Tiziano
Published: January 2016

In common practice, sports-perceptual interventions are mainly based on vision. However, research demonstrates
that sporting performance can also be improved through the use of sounds, showing the relevance of the auditory
channel to convey sports-related information, which can positively affect athletes’ motor outcomes. This review examines
the potential of audio-based interventions in sport. The relevant concepts are defined, a brief overview of the techniques
based on vision is given and laboratory studies demonstrating the effectiveness of sounds in improving the execution of
simple rhythmic motor tasks are reviewed. Subsequently, neurophysiological evidence of the influence of sounds on the
motor regions of the brain is provided and different kinds of audio-based interventions, emphasising their methodological
details and the effects of their application to specific sporting performances are described. Finally, recommendations for
further research in this field, aimed both at maximizing the potential of audio-based interventions and their implementation
at applied sporting contexts, are suggested.
Rhythmic Auditory Stimulation (RAS) and Motor Rehabilitation in Parkinson’s Disease: New Frontiers in Assessment and Intervention Protocols
Authors: Murgia Mauro , Corona Federica , Pili Roberta , Sors Fabrizio , Agostini Tiziano , Casula Carlo , Pau Massimiliano , Guicciardi Marco
Published: January 2016

Previous studies have demonstrated that physical therapy accompanied by Rhythmic Auditory Stimulation
(RAS) can improve the motor skills of patients with Parkinson’s disease and, in particular, their gait disturbances. In the
present work we describe the neurological bases and perceptual-motor deficits generally associated with Parkinson’s disease,
with a specific focus on gait disturbances. Within this framework, we review the role of auditory cueing in the
modulation of patients’ gait, addressing this issue from the cognitive, neurological and biomechanical perspectives. In
particular, we focus on the new frontiers of both assessment and intervention. With regards to the assessment, we describe
the advantages of the three-dimensional quantitative multifactorial gait analysis. As concerns the intervention, we illustrate
the potential impact of the administration of ecological footstep sounds as rhythmic cues.
SoundScript – Supporting the Acquisition of Character Writing by Multisensory Integration
Authors: Oliver Effenberg Alfred , Schmitz Gerd , Baumann Florian , Rosenhahn Bodo , Kroeger Daniela
Published: January 2016

This work is introducing a new movement sonification method called ´SoundScript´ to support the acquisition
of character writing by children. SoundScript creates ´sound traces´ from the writing trace in real-time during the process
of handwriting. The structural correlation of both – optic and acoustic – traces leads to an integrated audio-visual perception
of writing with the expected stimulation of multisensory integration sites of the CNS. Data of a pilot study are introduced
indicating that the writing kinematics is reproduced more adequately if additional sound traces are available during
writing. In the future SoundScript shall be applied to verify if the establishment of internal character representations can
be accelerated, if the conciseness of the specific shape of the particular characters can be made stronger and if thereby the
efficiency of the handwriting learning process can be enhanced.
Malik`s Technique of Single Loop Fixation of Posterior Chamber
Intraocular Lens in Presence of Partial Capsular Support
Authors: Singh Malik Krishan Pal , Goel Ruchi , Kishore Divya , Nagpal Smriti
Published: January 2016

Single loop fixation of posterior chamber intraocular lens in the presence of partial capsular support is usually
performed by creation of additional scleral flap or tunnel. This extra port may expose the suture holding the intraocular
lens or the tucked-in lens haptics to the outside environment thereby increasing the risk of endophthalmitis. We describe a
technique of single loop fixation where the scleral tunnel is created adjacent to the site with the absent capsule, the leading
haptic is placed on the capsular scaffold, the trailing haptic is tied to 9-0 polypropylene, and the suture is then secured to
the inner edge of the scleral lip with enough tension to center the optics and the wound is then closed. The suture knot gets
buried within the scleral tunnel with no external communication and does not require a separate port. It is an easy, safe,
fast and reproducible technique with a lens tilt of less than 2°.
Prevalence of Keratoconus Among a Palestinian Tertiary Student
Population
Authors: Shehadeh Mohammad M. , Diakonis Vasilios F. , Jalil Sara A. , Younis Rania , Qadoumi Jamal , Al-Labadi Liana
Published: January 2016

Purpose:

To screen for keratoconus and potential associated risk factors in a tertiary student population sample.

Population and Methods:

This cross sectional study included 1234 students attending An-Najah National University
(Nablus, West Bank, Palestine), that were randomly selected from a total of 20,000 university students. 634 (51.3%)
student participants responded by completing a self-administered questionnaire and were assessed by means of corneal
topography. Following initial evaluation, participants were referred for Pentacam evaluation if they demonstrated either a
mean keratometry of more than 45 diopters, corneal astigmatism of more than 2 diopters and/or if asymmetric topographic
patterns were present. Pentacam images were analyzed by an experienced ophthalmologist based on a number of indices
and the participants were classified as normal, keratoconus suspects, and keratoconus patients.

Results:

A total of 620 participants (mean age, 20.1±1.6 years) were included in this study, 379 (61.1%) were females and
241 (38.9%) were males. Nine subjects were diagnosed with keratoconus, demonstrating a prevalence of 1.5%. 52 (8.4%)
participants showed at least one abnormal pentacam index, and were considered as KC suspects.

Conclusion:

Keratoconus is a prevalent disease among the tertiary Palestinian student population. This may be related to a
combination of genetic and environmental factors. The results of this study signal the need for public health outreach and
intervention for keratoconus.
Macular Hole Formation After Intravitreal Ranibizumab Injection in Wet
Age-Related Macular Degeneration
Authors: Mukherjee Chandoshi , Mitra Arijit , Kumar N. Ajith , Elsherbiny Samer , Lip Peck Lin
Published: January 2016

Ranibizumab is a monoclonal antibody fragment that inhibits angiogenesis by inhibiting vascular endothelial
growth factor A, used as a treatment for patients with wet aged-related macular degeneration (ARMD). Adverse effects
from intravitreal Ranibizumab injections are well recognised. Macular hole formation following Ranibizumab injection is
a complication that has been recently reported in few case reports. We present a larger case series of five patients, who
developed full thickness macular holes (FTMH) after intravitreal Ranibizumab injections for treatment of wet ARMD that
we were aware of between 2009 and 2013.
Application Of Steel Bar Bracings In Renovation And Modernization Of Historic Buildings
Authors: Kuchta Krzysztof
Published: January 2016

The use of steel bracings is possible in all four stages of engineering activities in the renovation and modernization of historic buildings, i. e.: protecting, repairing, strengthening and rebuilding. Steel bracings are auxiliary structural systems, which, due to their relatively small cross-section dimensions and low weight, provide an efficient way to achieve the required resistance and stability of the original historic building structural systems. The steel structure in most cases is the tissue that differs in style and material of genuine tissue which is present in a renewed historic building, but is also often a rational solution acceptable to the conservation and structural point of view.
The People Behind the Journal: A New Editorial Team for 2016
Authors: Abbott J. Haxby
Published: January 2016

JOSPT's new Editor-in-Chief, J. Haxby Abbott, introduces the 2016 JOSPT Editorial Board, consisting of teams responsible for author-submitted manuscripts and for invited content and special features, such as editorials, invited expert commentaries, and Perspectives for Patients. J Orthop Sports Phys Ther 2016;46(1):1–8. doi:10.2519/jospt.2016.0101
Rupture of the Radial Collateral Ligament and Common Extensor Origin
Authors: Milligan Mark L. , Strickland Colin , Mintken Paul E.
Published: January 2016

The patient was a 46-year-old woman with a 3-month history of left lateral elbow pain who had been treated by her primary care physician for lateral epicondylitis with 2 cortisone injections without significant improvement. Following a new injury, the patient declined a third injection and consulted a physical therapist. Based on his examination, the therapist suspected elbow instability and an extensor tendon tear. Magnetic resonance imaging of the elbow was ordered by a physician and revealed tears of the radial collateral ligament and common extensor origin from the lateral epicondyle. J Orthop Sports Phys Ther 2016;46(1):34. doi:10.2519/jospt.2016.0401
Acetabular Paralabral Cyst: An Unusual Cause of Lower Extremity Pain and Paresthesia
Authors: Reiman Michael P. , Hash Thomas W. , Mather Richard C.
Published: January 2016

The patient was a 41-year-old woman with an 8-month history of insidious sharp right groin pain and paresthesia radiating distally to the medial lower leg and foot with sitting and any activity involving hip extension. She was referred for a collaborative consultation with an orthopaedic surgeon and a physical therapist. Following clinical examination, magnetic resonance imaging of the right hip revealed an anterior labral tear with an associated moderate-sized, multilobulated paralabral cyst compressing the medial femoral neurovascular bundle. J Orthop Sports Phys Ther 2016;46(1):35. doi:10.2519/jospt.2016.0402
Effects of Volitional Spine Stabilization and Lower Extremity Fatigue on Trunk Control During Landing in Individuals With Recurrent Low Back Pain
Authors: Haddas Ram , Sawyer Steven F. , Sizer Phillip S. , Brooks Toby , Chyu Ming-Chien , James C. Roger
Published: January 2016

Study Design

Controlled laboratory study.

Background

Recurrent low back pain (LBP) and neuromuscular fatigue are independently thought to increase the risk of spine injury. Volitional preemptive abdominal contraction (VPAC) is thought to improve lumbar spine and pelvis control in individuals with recurrent LBP. The effects of VPAC on fatigued landing performance in individuals with recurrent LBP are unknown.

Objectives

To determine the effects of VPAC and lower extremity fatigue on trunk control during landing in a population of individuals with recurrent LBP.

Methods

Thirty-two recurrent LBP (mean ± SD age, 21.2 ± 2.7 years) and 33 healthy (age, 20.9 ± 2.3 years) subjects performed 0.30-m drop-jump landings with and without VPAC and fatigue. Trunk, pelvis, and hip biomechanical and electromyographic variables were obtained using 3-D motion capture. Hypotheses were tested using analysis of variance.

Results

Volitional preemptive abdominal contraction resulted in significantly earlier muscle onsets across all muscles, with and without fatigue, in both groups (mean ± SD, 0.058 ± 0.019 seconds earlier; P≤.001) and altered lumbar lateral flexion (1.4° ± 14.8° greater right lateral flexion; P = .002). Fatigue significantly delayed muscle onsets (0.040 ± 0.014 seconds later; P≤.001) and altered pelvic obliquity (1.4° ± 11.0° greater; P≤.001) and trunk side flexion (2.0° ± 14.8° less; P≤.001). The recurrent LBP group exhibited delayed muscle onsets (0.039 ± 0.031 seconds later; P≤.004) and 4.2° less hip abduction at initial contact (P≤.008) in comparison to healthy controls.

Conclusion

Volitional preemptive abdominal contraction decreases some of the detrimental effects of fatigue on landing biomechanics and thus may reduce spine injury risk in individuals with recurrent LBP. J Orthop Sports Phys Ther 2016;46(2):71–78. Epub 1 Jan 2016. doi:10.2519/jospt.2016.6048
Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee
Authors: Courtney Carol A. , Steffen Alana D. , Fernández-de-las-Pñas César , Kim John , Chmell Samuel J.
Published: January 2016

Study Design

An experimental laboratory study with a repeated-measures crossover design.

Background

Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways. Impaired conditioned pain modulation (CPM) has been found experimentally in persons with knee and hip osteoarthritis, indicating impaired inhibition of central nociceptive pathways. We hypothesized increased effectiveness of CPM following application of joint mobilization, determined via measures of deep tissue hyperalgesia.

Objective

To examine the effect of joint mobilization on impaired CPM.

Methods

An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 (73%) with impaired CPM. The subjects were randomized to receive 6 minutes of knee joint mobilization (intervention) or manual cutaneous input only, 1 week apart. Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the hand at baseline, postintervention, and post-CPM testing. Further, vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing.

Results

Joint mobilization, but not cutaneous input intervention, resulted in a global increase in pressure pain threshold, indicated by diminished hyperalgesic responses to pressure stimulus. Further, CPM was significantly enhanced following joint mobilization. Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention, but not at the contralateral knee. Resting pain was also significantly lower following the joint intervention.

Conclusion

Conditioned pain modulation was enhanced following joint mobilization, demonstrated by a global decrease in deep tissue pressure sensitivity. Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis. J Orthop Sports Phys Ther 2016;46(3):168–176. Epub 1 Jan 2016. doi:10.2519/jospt.2016.6259
Does More Therapy in Skilled Nursing Facilities Lead to Better Outcomes in Patients With Hip Fracture?
Authors: Jung Hye-Young , Trivedi Amal N. , Grabowski David C. , Mor Vincent
Published: January 2016

Background

Skilled nursing facilities (SNFs) have increasingly been providing more therapy hours to beneficiaries of Medicare. It is not known whether these increases have improved patient outcomes.

Objective

The study objectives were: (1) to examine temporal trends in therapy hour volumes and (2) to evaluate whether more therapy hours are associated with improved patient outcomes.

Design

This was a retrospective cohort study.

Methods

Data sources included the Minimum Data Set, Medicare inpatient claims, and the Online Survey, Certification, and Reporting System. The study population consisted of 481,908 beneficiaries of Medicare fee-for-service who were admitted to 15,496 SNFs after hip fracture from 2000 to 2009. Linear regression models with facility and time fixed effects were used to estimate the association between the quantity of therapy provided in SNFs and the likelihood of discharge to home.

Results

The average number of therapy hours increased by 52% during the study period, with relatively little change in case mix at SNF admission. An additional hour of therapy per week was associated with a 3.1-percentage-point (95% confidence interval=3.0, 3.1) increase in the likelihood of discharge to home. The effect of additional therapy decreased as the Resource Utilization Group category increased, and additional therapy did not benefit patients in the highest Resource Utilization Group category.

Limitations

Minimum Data Set assessments did not cover details of therapeutic interventions throughout the entire SNF stay and captured only a 7-day retrospective period for measures of the quantity of therapy provided.

Conclusions

Increases in the quantity of therapy during the study period cannot be explained by changes in case mix at SNF admission. More therapy hours in SNFs appear to improve outcomes, except for patients with the greatest need.
Dynesys dynamic stabilization–related facet arthrodesis
Authors: Fay Li-Yu , Chang Peng-Yuan , Wu Jau-Ching , Huang Wen-Cheng , Wang Chun-Hao , Tsai Tzu-Yun , Tu Tsung-Hsi , Chang Hsuan-Kan , Wu Ching-Lan , Cheng Henrich
Published: January 2016

OBJECTIVE

Dynamic stabilization devices are designed to stabilize the spine while preserving some motion. However, there have been reports demonstrating limited motion at the instrumented level of the lumbar spine after Dynesys dynamic stabilization (DDS). The causes of this limited motion and its actual effects on outcomes after DDS remain elusive. In this study, the authors investigate the incidence of unintended facet arthrodesis after DDS and clinical outcomes.

METHODS

This retrospective study included 80 consecutive patients with 1- or 2-level lumbar spinal stenosis who underwent laminectomy and DDS. All medical records, radiological data, and clinical evaluations were analyzed. Imaging studies included pre- and postoperative radiographs, MR images, and CT scans. Clinical outcomes were measured by a visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Furthermore, all patients had undergone postoperative CT for the detection of unintended arthrodesis of the facets at the indexed level, and range of motion was measured on standing dynamic radiographs.

RESULTS

A total of 70 patients (87.5%) with a mean age of 64.0 years completed the minimum 24-month postoperative follow-up (mean duration 29.9 months). Unintended facet arthrodesis at the DDS instrumented level was demonstrated by CT in 38 (54.3%) of the 70 patients. The mean age of patients who had facet arthrodesis was 9.8 years greater than that of the patients who did not (68.3 vs 58.5 years, p = 0.009). There were no significant differences in clinical outcomes, including VAS back and leg pain, ODI, and JOA scores between patients with and without the unintended facet arthrodesis. Furthermore, those patients older than 60 years were more likely to have unintended facet arthrodesis (OR 12.42) and immobile spinal segments (OR 2.96) after DDS. Regardless of whether unintended facet arthrodesis was present or not, clinical evaluations demonstrated improvement in all patients (all p < 0.05).

CONCLUSIONS

During the follow-up of more than 2 years, unintended facet arthrodesis was demonstrated in 54.3% of the patients who underwent 1- or 2-level DDS. Older patients (age > 60 years) were more likely to have unintended facet arthrodesis and subsequent immobile spinal segments. However, unintended facet arthrodesis did not affect the clinical outcomes during the study period. Further evaluations are needed to clarify the actual significance of this phenomenon.
Posterior lumbar dynamic stabilization instead of arthrodesis for symptomatic adjacent-segment degenerative stenosis: description of a novel technique
Authors: Mashaly Hazem , Paschel Erin E. , Khattar Nicolas K. , Goldschmidt Ezequiel , Gerszten Peter C.
Published: January 2016

OBJECTIVE

The development of symptomatic adjacent-segment disease (ASD) is a well-recognized consequence of lumbar fusion surgery. Extension of a fusion to a diseased segment may only lead to subsequent adjacent-segment degeneration. The authors report the use of a novel technique that uses dynamic stabilization instead of arthrodesis for the surgical treatment of symptomatic ASD following a prior lumbar instrumented fusion.

METHODS

A cohort of 28 consecutive patients was evaluated who developed symptomatic stenosis immediately adjacent to a previous lumbar instrumented fusion. All patients had symptoms of neurogenic claudication refractory to nonsurgical treatment and were surgically treated with decompression and dynamic stabilization instead of extending the fusion construct using a posterior lumbar dynamic stabilization system. Preoperative symptoms, visual analog scale (VAS) pain scores, and perioperative complications were recorded. Clinical outcome was gauged by comparing VAS scores prior to surgery and at the time of last follow-up.

RESULTS

The mean follow-up duration was 52 months (range 17–94 months). The mean interval from the time of primary fusion surgery to the dynamic stabilization surgery was 40 months (range 10–96 months). The mean patient age was 51 years (range 29–76 years). There were 19 (68%) men and 9 (32%) women. Twenty-three patients (82%) presented with low-back pain at time of surgery, whereas 24 patients (86%) presented with lower-extremity symptoms only. Twenty-four patients (86%) underwent operations that were performed using single-level dynamic stabilization, 3 patients (11%) were treated at 2 levels, and 1 patient underwent 3-level decompression and dynamic stabilization. The most commonly affected and treated level (46%) was L3–4. The mean preoperative VAS pain score was 8, whereas the mean postoperative score was 3. No patient required surgery for symptomatic degeneration rostral to the level of dynamic stabilization during the follow-up period.

CONCLUSIONS

The use of posterior lumbar dynamic stabilization may offer a valid and safe option for the management of patients who develop ASD rostral to a previously instrumented arthrodesis. The technique may serve as an alternative to multilevel arthrodesis in this patient population. By implanting a dynamic stabilization device instead of an extension of a rigid construct, this might translate into a reduction in the development of yet another level of ASD.
Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature
Authors: Pham Martin H. , Mehta Vivek A. , Patel Neil N. , Jakoi Andre M. , Hsieh Patrick C. , Liu John C. , Wang Jeffrey C. , Acosta Frank L.
Published: January 2016

The Dynesys dynamic stabilization system is an alternative to rigid instrumentation and fusion for the treatment of lumbar degenerative disease. Although many outcomes studies have shown good results, currently lacking is a comprehensive report on complications associated with this system, especially in terms of how it compares with reported complication rates of fusion. For the present study, the authors reviewed the literature to find all studies involving the Dynesys dynamic stabilization system that reported complications or adverse events. Twenty-one studies were included for a total of 1166 patients with a mean age of 55.5 years (range 39–71 years) and a mean follow-up period of 33.7 months (range 12.0–81.6 months). Analysis of these studies demonstrated a surgical-site infection rate of 4.3%, pedicle screw loosening rate of 11.7%, pedicle screw fracture rate of 1.6%, and adjacent-segment disease (ASD) rate of 7.0%. Of studies reporting revision surgeries, 11.3% of patients underwent a reoperation. Of patients who developed ASD, 40.6% underwent a reoperation for treatment. The Dynesys dynamic stabilization system appears to have a fairly similar complication-rate profile compared with published literature on lumbar fusion, and is associated with a slightly lower incidence of ASD.
Dynamic stabilization for L4–5 spondylolisthesis: comparison with minimally invasive transforaminal lumbar interbody fusion with more than 2 years of follow-up
Authors: Kuo Chao-Hung , Chang Peng-Yuan , Wu Jau-Ching , Chang Hsuan-Kan , Fay Li-Yu , Tu Tsung-Hsi , Cheng Henrich , Huang Wen-Cheng
Published: January 2016

OBJECTIVE

In the past decade, dynamic stabilization has been an emerging option of surgical treatment for lumbar spondylosis. However, the application of this dynamic construct for mild spondylolisthesis and its clinical outcomes remain uncertain. This study aimed to compare the outcomes of Dynesys dynamic stabilization (DDS) with minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the management of single-level spondylolisthesis at L4–5.

METHODS

This study retrospectively reviewed 91 consecutive patients with Meyerding Grade I spondylolisthesis at L4–5 who were managed with surgery. Patients were divided into 2 groups: DDS and MI-TLIF. The DDS group was composed of patients who underwent standard laminectomy and the DDS system. The MI-TLIF group was composed of patients who underwent MI-TLIF. Clinical outcomes were evaluated by visual analog scale for back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores at each time point of evaluation. Evaluations included radiographs and CT scans for every patient for 2 years after surgery.

RESULTS

A total of 86 patients with L4–5 spondylolisthesis completed the follow-up of more than 2 years and were included in the analysis (follow-up rate of 94.5%). There were 64 patients in the DDS group and 22 patients in the MI-TLIF group, and the overall mean follow-up was 32.7 months. Between the 2 groups, there were no differences in demographic data (e.g., age, sex, and body mass index) or preoperative clinical evaluations (e.g., visual analog scale back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores). The mean estimated blood loss of the MI-TLIF group was lower, whereas the operation time was longer compared with the DDS group (both p < 0.001). For both groups, clinical outcomes were significantly improved at 6, 12, 18, and 24 months after surgery compared with preoperative clinical status. Moreover, there were no differences between the 2 groups in clinical outcomes at each evaluation time point. Radiological evaluations were also similar and the complication rates were equally low in both groups.

CONCLUSIONS

At 32.7 months postoperation, the clinical and radiological outcomes of DDS were similar to those of MI-TLIF for Grade I degenerative spondylolisthesis at L4–5. DDS might be an alternative to standard arthrodesis in mild lumbar spondylolisthesis. However, unlike fusion, dynamic implants have issues of wearing and loosening in the long term. Thus, the comparable results between the 2 groups in this study require longer follow-up to corroborate.
Facet joint changes after application of lumbar nonfusion dynamic stabilization
Authors: Lee Soo Eon , Jahng Tae-Ahn , Kim Hyun Jib
Published: January 2016

OBJECTIVE

The long-term effects on adjacent-segment pathology after nonfusion dynamic stabilization is unclear, and, in particular, changes at the adjacent facet joints have not been reported in a clinical study. This study aims to compare changes in the adjacent facet joints after lumbar spinal surgery.

METHODS

Patients who underwent monosegmental surgery at L4–5 with nonfusion dynamic stabilization using the Dynesys system (Dynesys group) or transforaminal lumbar interbody fusion with pedicle screw fixation (fusion group) were retrospectively compared. Facet joint degeneration was evaluated at each segment using the CT grading system.

RESULTS

The Dynesys group included 15 patients, while the fusion group included 22 patients. The preoperative facet joint degeneration CT grades were not different between the 2 groups. Compared with the preoperative CT grades, 1 side of the facet joints at L3–4 and L4–5 had significantly more degeneration in the Dynesys group. In the fusion group, significant facet joint degeneration developed on both sides at L2–3, L3–4, and L5–S1. The subjective back and leg pain scores were not different between the 2 groups during follow-up, but functional outcome based on the Oswestry Disability Index improved less in the fusion group than in the Dynesys group.

CONCLUSIONS

Nonfusion dynamic stabilization using the Dynesys system had a greater preventative effect on facet joint degeneration in comparison with that obtained using fusion surgery. The Dynesys system, however, resulted in facet joint degeneration at the instrumented segments and above. An improved physiological nonfusion dynamic stabilization system for lumbar spinal surgery should be developed.
Surgical treatment for irreducible pediatric subaxial cervical unilateral facet dislocation: case report
Authors: Qu Wei , Hao Dingjun , Wu Qining , Song Zongrang , Liu Jijun
Published: January 2016

Unilateral facet dislocation at the subaxial cervical spine (C3–7) in children younger than 8 years of age is rare. The authors describe a surgical approach for irreducible subaxial cervical unilateral facet dislocation (SCUFD) at C3–4 in a 5-year-old boy and present a literature review. A dorsal unilateral approach was applied, and a biodegradable plate was used for postreduction fixation without fusion after failed conservative treatment. There was complete resolution of symptoms and restored cervical stability. Two years after surgery, the patient had recovered range of motion in C3–4. In selected cases of cervical spine injury in young children, a biodegradable plate can maintain reduction until healing occurs, obviate the need to remove an implant, and recover the motion of the injured segment.
The falling rates of hospital admission, case fatality, and population-based mortality for subarachnoid hemorrhage in England, 1999–2010
Authors: Mukhtar Toqir K. , Molyneux Andrew J. , Hall Nick , Yeates David R. G. , Goldacre Raphael , Sneade Mary , Clarke Alison , Goldacre Michael J.
Published: January 2016

OBJECTIVE

In this study, the authors examined trends in population-based hospital admission rates, patient-level case fatality rates (CFRs), and population-based mortality rates for nontraumatic (spontaneous) subarachnoid hemorrhage (SAH) in England.

METHODS

Population-based admission and mortality data (59,599 people admitted to a hospital with SAH, 1999–2010; 37,836 people whose death certificates mentioned SAH, 1995–2010) were analyzed.

RESULTS

Hospital admission rates for SAH per million population declined by 18.3%, from 100.4 (95% CI 97.6−103.1) in 1999 to 82.0 (95% CI 79.7−84.4) in 2010. CFRs at less than 30 days per 100 patients decreased by 18.2%, from 29.7 (95% CI 28.5−31.0) in 1999 to 24.3 (95% CI 23.2−25.5) in 2010. Population-based mortality rates per million population, where SAH was recorded as underlying cause of death on the death certificate, declined by 39.8%, from 41.2 (95% CI 39.5−43.0) in 1999 to 24.8 (95% CI 23.6−26.1) in 2010.

CONCLUSIONS

Population-based hospital admission rates, patient-level CFRs, and population-based mortality rates all declined between 1999 and 2010. Part of the decline in mortality rates for SAH is likely to be attributable to a decline in incidence. It is also, in part, attributable to increased survival after SAH. The available data do not allow us to compare the effects of different treatment methods for SAH on case fatality and mortality. During the period of study, mortality rates declined by almost 40%, and it is likely that there are a number of factors contributing to this substantial improvement in outcomes for SAH patients in England.
Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study
Authors: Conrad Jens , Ayyad Ali , Wüster Christian , Omran Wael , Weber Matthias M. , Konerding Moritz A. , Müller-Forell Wibke , Giese Alf , Oertel Joachim
Published: January 2016

OBJECTIVE

Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved.

METHODS

Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented.

RESULTS

In the clinical evaluation, 0° optics were optimal in the nasal and sphenoidal phase of surgery for both techniques. For detection of tumor remnants, 30° optics were superior. The binostril approach was significantly more time consuming than the mononostril technique. The nasal retractor limited maneuverability of instruments during mononostril approaches in 5 of 20 patients. Endocrinological pituitary function, control of excessive hormone secretion, ophthalmological outcome, residual tumor, and rates of adverse events, such as CSF leaks and diabetes insipidus, were similar in both groups.

In the cadaver study, there was no significant difference in the time required for dissection via the binostril or mononostril technique. The panoramic view was superior in the binostril group; this was due to the possibility of wider opening of the sella in the craniocaudal and horizontal directions, but the need for removal of more of the nasal septum was disadvantageous.

CONCLUSIONS

Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar expansion and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and suprasellar area.
Temporal delays in trauma craniotomies
Authors: Marcoux Judith , Bracco David , Saluja Rajeet S.
Published: January 2016

OBJECTIVE

The Brain Trauma Foundation recommendation regarding the timing of surgical evacuation of epidural hematomas and subdural hematomas is to perform the procedure as soon as possible. Indeed, faster evacuation is associated with better outcome. However, to the authors' knowledge, no study has looked at where delays in intrahospital care occurred for patients suffering from traumatic intracranial mass lesions. The goals of this study were as follows: 1) to characterize the performance of a Level 1 trauma center in terms of delays for emergency trauma craniotomies, 2) to review step by step where delays occurred in patient care, and 3) to propose ways to improve performance.

METHODS

A retrospective review was conducted covering a 5-year period of all emergency trauma craniotomies. Demographic data, injury severity, neurological status, and functional outcome data were collected. The time elapsed between emergency department (ED) arrival and CT imaging, between CT imaging and arrival at the operating room (OR), between ED arrival and OR arrival, between OR arrival and skin incision, and between ED arrival and skin incision were calculated. Patients were also subcategorized as either having immediate life-threatening emergencies (E0) or life-threatening emergencies (E1). The operative technique was also reviewed (standard craniotomy opening vs immediate bur hole decompression followed by craniotomy).

RESULTS

The study included 166 patients. Of these, 58 (35%) were classified into the E0 group and 108 (64.2%) into the E1 group. The median ED-to-CT delay was 54 minutes with no significant difference between the E0 and the E1 groups. The median CT-to-OR time delay was 57 minutes. The median delay for the E0 group was 39 minutes and that for the E1 group was 70 minutes (p = 0.002). The median delay from ED to OR arrival for patients with a CT scanning done at an outside hospital was 75 minutes. The median delay from ED to OR arrival was 85 minutes for the E0 group and 127 minutes for the E1 group (p < 0.0001). The median delay from OR arrival to skin incision was 35 minutes (E0: median 27 minutes; E1: median 39 minutes; p < 0.0001). The median total time elapsed between ED arrival and skin incision was 150 minutes (E0: median 131 minutes; E1: median 180 minutes). Overall, only 17% of patients underwent immediate bur hole decompression, but the proportion climbed to 41% in the E0 group. A lower Glasgow Coma Scale score was associated with a shorter delay (p = 0.0004).

CONCLUSIONS

A long delay until surgery still exists for patients requiring urgent mass lesion evacuation. Many factors contribute to this delay, including performing imaging and transfer to and preparation in the OR. Strategies can be implemented to reduce delays and improve the delivery of care.
Stereotactic radiofrequency thermocoagulation for giant hypothalamic hamartoma
Authors: Shirozu Hiroshi , Masuda Hiroshi , Ito Yosuke , Sonoda Masaki , Kameyama Shigeki
Published: January 2016

OBJECTIVE

The authors undertook this study to validate the feasibility and safety of stereotactic radiofrequency thermocoagulation (SRT) for the surgical treatment of giant hypothalamic hamartoma (HH).

METHODS

Of the 109 patients who underwent SRT for hypothalamic hamartoma (HH) at the authors' institution between 1997 and 2013, 16 patients (9 female, 7 male) had giant HHs (maximum diameter ≥ 30 mm). The clinical records of these 16 patients were retrospectively reviewed.

RESULTS

The patients' age at first SRT ranged from 1 to 22 years (median 5 years). The maximum diameter of their HHs was 30–80 mm (mean 38.5 mm). Eleven HHs had bilateral attachments to the hypothalamus. All patients had gelastic seizures (GS), and 12 had types of seizures other than GS. Some of these patients also had mental retardation (n = 10, 62.5%), behavioral disorders (n = 8, 50.0%), and precocious puberty (n = 11, 68.8%). A total of 22 SRT procedures were performed; 5 patients underwent repeat SRT procedures. There was no mortality or permanent morbidity. After 17 of the 22 procedures, the patients experienced transient complications, including high fever (n = 7), hyperphagia (n = 3), hyponatremia (n = 6), disturbance of consciousness (n = 1), cyst enlargement (n = 1), and epidural hematoma (n = 1). Thirteen patients (81.3%) achieved freedom from GS after the final SRT procedure during a follow-up period ranging from 6 to 60 months (mean 23 months). Twelve patients had nongelastic seizures in addition to GS, and 7 (58.3%) of these 12 patients experienced freedom from their nongelastic seizures.

CONCLUSIONS

SRT provided minimal invasiveness and excellent seizure outcomes even in patients with giant HHs. Repeat SRT is safe for residual GS. SRT is a feasible single surgical strategy for HH regardless of the tumor's size or shape.
Serum biomarkers as predictors of long-term outcome in severe traumatic brain injury: analysis from a randomized placebo-controlled Phase II clinical trial
Authors: Raheja Amol , Sinha Sumit , Samson Neha , Bhoi Sanjeev , Subramanian Arulselvi , Sharma Pushpa , Sharma Bhawani Shankar
Published: January 2016

OBJECTIVE

There has been increased interest in the potential importance of biochemical parameters as predictors of outcome in severe traumatic brain injury (sTBI).

METHODS

Of 107 patients with sTBI (age 18–65 years with a Glasgow Coma Scale score of 4–8 presenting within 8 hours after injury) who were randomized for a placebo-controlled Phase II trial of progesterone with or without hypothermia, the authors serially analyzed serum biomarkers (S100-B, glial fibrillary acidic protein [GFAP], neuron-specific enolase [NSE], tumor necrosis factor–α, interleukin-6 [IL-6], estrogen [Eg], and progesterone [Pg]). This analysis was performed using the sandwich enzyme-linked immunosorbent assay technique at admission and 7 days later for 86 patients, irrespective of assigned group. The long-term predictive values of serum biomarkers for dichotomized Glasgow Outcome Scale (GOS) score, functional independence measure, and survival status at 6 and 12 months were analyzed using an adjusted binary logistic regression model and receiver operating characteristic curve.

RESULTS

A favorable GOS score (4–5) at 1 year was predicted by higher admission IL-6 (above 108.36 pg/ml; area under the curve [AUC] 0.69, sensitivity 52%, and specificity 78.6%) and Day 7 Pg levels (above 3.15 ng/ml; AUC 0.79, sensitivity 70%, and specificity 92.9%). An unfavorable GOS score (1–3) at 1 year was predicted by higher Day 7 GFAP levels (above 9.50 ng/ml; AUC 0.82, sensitivity 78.6%, and specificity 82.4%). Survivors at 1 year had significantly higher Day 7 Pg levels (above 3.15 ng/ml; AUC 0.78, sensitivity 66.7%, and specificity 90.9%). Nonsurvivors at 1 year had significantly higher Day 7 GFAP serum levels (above 11.14 ng/ml; AUC 0.81, sensitivity 81.8%, and specificity 88.9%) and Day 7 IL-6 serum levels (above 71.26 pg/ml; AUC 0.87, sensitivity 81.8%, and specificity 87%). In multivariate logistic regression analysis, independent predictors of outcome at 1 year were serum levels of Day 7 Pg (favorable GOS—OR 3.24, CI 1.5–7, p = 0.003; and favorable survival—OR 2, CI 1.2–3.5, p = 0.01); admission IL-6 (favorable GOS—OR 1.04, CI 1.00–1.08, p = 0.04); and Day 7 GFAP (unfavorable GOS—OR 0.79, CI 0.65–0.95, p = 0.01; and unfavorable survival—OR 0.80, CI 0.66–0.96, p = 0.01).

CONCLUSIONS

Serial Pg, GFAP, and IL-6 monitoring could aid in prognosticating outcomes in patients with acute sTBI. A cause and effect relationship or a mere association of these biomarkers to outcome needs to be further studied for better understanding of the pathophysiology of sTBI and for choosing potential therapeutic targets.

Clinical trial registration no.: CTRI/2009/091/000893 (http://www.ctri.nic.in).
The effect of pregnancy on survival in a low-grade glioma cohort
Authors: Rønning Pål A. , Helseth Eirik , Meling Torstein R. , Johannesen Tom B.
Published: January 2016

OBJECTIVE

The impact of pregnancy on survival in female patients with low-grade glioma (LGG) is unknown and controversial. The authors designed a retrospective cohort study on prospectively collected registry data to assess the influence of pregnancy and child delivery on the survival of female patients with LGG.

METHODS

In Norway, the reporting of all births and cancer diagnoses to the Medical Birth Registry of Norway (MBRN) and the Cancer Registry of Norway (CRN), respectively, is compulsory by law. Furthermore, every individual has a unique 11-digit identification number. The CRN was searched to identify all female patients with a histologically confirmed diagnosis of World Health Organization (WHO) Grade II astrocytoma, oligoastrocytoma, oligodendroglioma, or pilocytic astrocytoma who were 16–40 years of age at the time of diagnosis during the period from January 1, 1970, to December 31, 2008. Obstetrical information was obtained from the MBRN for each patient. The effect of pregnancy on survival was evaluated using a Cox model with parity as a time-dependent variable.

RESULTS

The authors identified 65 patients who gave birth to 95 children after an LGG diagnosis. They also identified 281 patients who did not give birth after an LGG diagnosis. The median survival was 14.3 years (95% CI 11.7–20.6 years) for the entire study population. The effect of pregnancy was insignificant in the multivariate model (HR 0.71, 95% CI 0.35–1.42).

CONCLUSIONS

Pregnancy does not seem to have an impact on the survival of female patients with LGG.
Probabilistic machine learning for the evaluation of presurgical language dominance
Authors: Gazit Tomer , Andelman Fani , Glikmann-Johnston Yifat , Gonen Tal , Solski Aliya , Shapira-Lichter Irit , Ovadia Moran , Kipervasser Svetlana , Neufeld Miriam Y. , Fried Itzhak , Hendler Talma , Perry Daniella
Published: January 2016

OBJECTIVE

Providing a reliable assessment of language lateralization is an important task to be performed prior to neurosurgery in patients with epilepsy. Over the last decade, functional MRI (fMRI) has emerged as a useful noninvasive tool for language lateralization, supplementing or replacing traditional invasive methods. In standard practice, fMRI-based language lateralization is assessed qualitatively by visual inspection of fMRI maps at a specific chosen activation threshold. The purpose of this study was to develop and evaluate a new computational technique for providing the probability of each patient to be left, right, or bilateral dominant in language processing.

METHODS

In 76 patients with epilepsy, a language lateralization index was calculated using the verb-generation fMRI task over a wide range of activation thresholds (from a permissive threshold, analyzing all brain regions, to a harsh threshold, analyzing only the strongest activations). The data were classified using a probabilistic logistic regression method.

RESULTS

Concordant results between fMRI and Wada lateralization were observed in 89% of patients. Bilateral and right-dominant groups showed similar fMRI lateralization patterns differentiating them from the left-dominant group but still allowing classification in 82% of patients.

CONCLUSIONS

These findings present the utility of a semi-supervised probabilistic learning approach for presurgical language-dominance mapping, which may be extended to other cognitive domains such as memory and attention.
A decade of emerging indications: deep brain stimulation in the United States
Authors: Youngerman Brett E. , Chan Andrew K. , Mikell Charles B. , McKhann Guy M. , Sheth Sameer A.
Published: January 2016

OBJECTIVE

Deep brain stimulation (DBS) is an emerging treatment option for an expanding set of neurological and psychiatric diseases. Despite growing enthusiasm, the patterns and implications of this rapid adoption are largely unknown. National trends in DBS surgery performed for all indications between 2002 and 2011 are reported.

METHODS

Using a national database of hospital discharges, admissions for DBS for 14 indications were identified and categorized as either FDA approved, humanitarian device exempt (HDE), or emerging. Trends over time were examined, differences were analyzed by univariate analyses, and outcomes were analyzed by hierarchical regression analyses.

RESULTS

Between 2002 and 2011, there were an estimated 30,490 discharges following DBS for approved indications, 1647 for HDE indications, and 2014 for emerging indications. The volume for HDE and emerging indications grew at 36.1% annually in comparison with 7.0% for approved indications. DBS for emerging indications occurred at hospitals with more neurosurgeons and neurologists locally, but not necessarily at those with the highest DBS caseloads. Patients treated for HDE and emerging indications were younger with lower comorbidity scores. HDE and emerging indications were associated with greater rates of reported complications, longer lengths of stay, and greater total costs.

CONCLUSIONS

DBS for HDE and emerging indications underwent rapid growth in the last decade, and it is not exclusively the most experienced DBS practitioners leading the charge to treat the newest indications. Surgeons may be selecting younger and healthier patients for their early experiences. Differences in reported complication rates warrant further attention and additional costs should be anticipated as surgeons gain experience with new patient populations and targets.