bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion
Authors: Xi Zhuo , Mummaneni Praveen V. , Wang Minghao , Ruan Huibing , Burch Shane , Deviren Vedat , Clark Aaron J. , Berven Sigurd H. , Chou Dean 
Published: August 2020

OBJECTIVEOne vexing problem after lateral lumbar interbody fusion (LLIF) surgery is cage subsidence. Low bone mineral density (BMD) may contribute to subsidence, and BMD is correlated with Hounsfield units (HUs) on CT. The authors investigated if lower HU values correlated with subsidence after LLIF.METHODSA retrospective study of patients undergoing single-level LLIF with pedicle screw fixation for degenerative conditions at the University of California, San Francisco, by 6 spine surgeons was performed. Data on demographics, cage parameters, preoperative HUs on CT, and postoperative subsidence were collected. Thirty-six–inch standing radiographs were used to measure segmental lordosis, disc space height, and subsidence; data were collected immediately postoperatively and at 1 year. Subsidence was graded using a published grade of disc height loss: grade 0, 0%–24%; grade I, 25%–49%; grade II, 50%–74%; and grade III, 75%–100%. HU values were measured on preoperative CT from L1 to L5, and each lumbar vertebral body HU was measured 4 separate times.RESULTSAfter identifying 138 patients who underwent LLIF, 68 met the study inclusion criteria. All patients had single-level LLIF with pedicle screw fixation. The mean follow-up duration was 25.3 ± 10.4 months. There were 40 patients who had grade 0 subsidence, 15 grade I, 9 grade II, and 4 grade III. There were no significant differences in age, sex, BMI, or smoking. There were no significant differences in cage sizes, cage lordosis, and preoperative disc height. The mean segmental HU (the average HU value of the two vertebrae above and below the LLIF) was 169.5 ± 45 for grade 0, 130.3 ± 56.2 for grade I, 100.7 ± 30.2 for grade II, and 119.9 ± 52.9 for grade III (p < 0.001). After using a receiver operating characteristic curve to establish separation criteria between mild and severe subsidence, the most appropriate threshold of HU value was 135.02 between mild and severe subsidence (sensitivity 60%, specificity 92.3%). After univariate and multivariate analysis, preoperative segmental HU value was an independent risk factor for severe cage subsidence (p = 0.017, OR 15.694, 95% CI 1.621–151.961).CONCLUSIONSLower HU values on preoperative CT are associated with cage subsidence after LLIF. Measurement of preoperative HU values on CT may be useful when planning LLIF surgery.
The association between lower Hounsfield units of the upper instrumented vertebra and proximal junctional kyphosis in adult spinal deformity surgery with a minimum 2-year follow-up
Authors: Duan Ping-Guo , Mummaneni Praveen V. , Rivera Joshua , Guinn Jeremy M. V. , Wang Minghao , Xi Zhuo , Li Bo , Wu Hao-Hua , Ames Christopher P. , Burch Shane , Berven Sigurd H. , Chou Dean 
Published: August 2020

OBJECTIVEPatients undergoing long-segment fusions from the lower thoracic (LT) spine to the sacrum for adult spinal deformity (ASD) correction are at risk for proximal junctional kyphosis (PJK). One mechanism of PJK is fracture of the upper instrumented vertebra (UIV) or higher (UIV+1), which may be related to bone mineral density (BMD). Because Hounsfield units (HUs) on CT correlate with BMD, the authors evaluated whether HU values were correlated with PJK after long fusions for ASD.METHODSThe authors performed a retrospective study of patients older than 50 years who had undergone ASD correction from the LT spine to the sacrum in the period from October 2007 to January 2018 and had a minimum 2-year follow-up. Demographic and spinopelvic parameters were measured. HU values were measured on preoperative CT at the UIV, UIV+1, and UIV+2 (2 levels above the UIV) levels and were assessed for correlations with PJK.RESULTSThe records of 127 patients were reviewed. Fifty-four patients (19 males and 35 females) with a mean age of 64.91 years and mean follow-up of 3.19 years met the study inclusion criteria; there were 29 patients with PJK and 25 patients without. There was no statistically significant difference in demographics or follow-up between these two groups. Neither was there a difference between the groups with regard to postoperative pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), PI minus LL (PI-LL), thoracic kyphosis (TK), or sagittal vertical axis (SVA; all p > 0.05). Postoperative pelvic tilt (p = 0.003) and T1 pelvic angle (p = 0.014) were significantly higher in patients with PJK than in those without. Preoperative HUs at UIV, UIV+1, and UIV+2 were 120.41, 124.52, and 129.28 in the patients with PJK, respectively, and 152.80, 155.96, and 160.00 in the patients without PJK, respectively (p = 0.011, 0.02, and 0.018). Three receiver operating characteristic (ROC) curves for preoperative HU values at the UIV, UIV+1, and UIV+2 as a predictor for PJK were established, with areas under the ROC curve of 0.710 (95% CI 0.574–0.847), 0.679 (95% CI 0.536–0.821), and 0.681 (95% CI 0.539–0.824), respectively. The optimal HU value by Youden index was 104 HU at the UIV (sensitivity 0.840, specificity 0.517), 113 HU at the UIV+1 (sensitivity 0.720, specificity 0.517), and 110 HU at the UIV+2 (sensitivity 0.880, specificity 0.448).CONCLUSIONSIn patients undergoing long-segment fusions from the LT spine to the sacrum for ASD, PJK was associated with lower HU values on CT at the UIV, UIV+1, and UIV+2. The measurement of HU values on preoperative CTs may be a useful adjunct for ASD surgery planning.
Minimally invasive spinal fixation in an aging population with osteoporosis: clinical and radiological outcomes and safety of expandable screws versus fenestrated screws augmented with polymethylmethacrylate
Authors: Gazzeri Roberto , Panagiotopoulos Konstantinos , Galarza Marcelo , Bolognini Andrea , Callovini Giorgio 
Published: August 2020

OBJECTIVEThe goal of this study was to compare the clinical and radiological outcomes between fenestrated pedicle screws augmented with cement and expandable pedicle screws in percutaneous vertebral fixation surgical procedures for the treatment of degenerative and traumatic spinal diseases in aging patients with osteoporosis.METHODSThis was a prospective, single-center study. Twenty patients each in the expandable and cement-augmented screw groups were recruited. Clinical outcomes included visual analog scale (VAS), Oswestry Disability Index (ODI), and satisfaction rates. Radiographic outcomes comprised radiological measurements on the vertebral motion segment of the treated levels. Intraoperative data including complications were collected. All patients completed the clinical and radiological outcomes. Outcomes were compared preoperatively and postoperatively.RESULTSAn average shorter operative time was found in procedures in which expandable screws were used versus those in which cement-augmented screws were used (p < 0.001). No differences resulted in perioperative blood loss between the 2 groups. VAS and ODI scores were significantly improved in both groups after surgery. There was no significant difference between the 2 groups with respect to baseline VAS or ODI scores. The satisfaction rate of both groups was more than 85%. Radiographic outcomes also showed no significant difference in segment stability between the 2 groups. No major complications after surgery were seen. There were 4 cases (20%) of approach-related complications, all in fenestrated screw procedures in which asymptomatic cement extravasations were observed. In 1 case the authors detected a radiologically evident osteolysis around a cement-augmented screw 36 months after surgery. In another case they identified a minor loosening of an expandable screw causing local back discomfort at the 3-year follow-up.CONCLUSIONSExpandable pedicle screws and polymethylmethacrylate augmentation of fenestrated screws are both safe and effective techniques to increase the pullout strength of screws placed in osteoporotic spine. In this series, clinical and radiological outcomes were equivalent between the 2 groups. To the authors’ knowledge, this is the first report comparing the cement augmentation technique versus expandable screws in the treatment of aging patients with osteoporosis.
Hounsfield units of the vertebral body and pedicle as predictors of pedicle screw loosening after degenerative lumbar spine surgery
Authors: Xu Fei , Zou Da , Li Weishi , Sun Zhuoran , Jiang Shuai , Zhou Siyu , Li Zhuofu 
Published: August 2020

OBJECTIVEThe authors aimed to compare the efficacy of lumbar vertebral body Hounsfield units (HUs) and pedicle HUs at predicting pedicle screw loosening.METHODSThe authors retrospectively assessed 143 patients with L3–5 instrumentation. The patients were classified into one of two groups based on the status of their L3 screws (a screw loosening group or a control group). The pedicle HUs and vertebral HUs of L3 were measured using preoperative lumbar CT scans, and the pedicle HUs were measured in two ways: by excluding or by including cortical bone.RESULTSThe screw loosening rate was 20.3% (n = 29/143) at the 12-month follow-up. The vertebral body HUs and pedicle HUs in the screw loosening group were lower than those in the control group (vertebral body group: 98.6 HUs vs 121.4 HUs, p < 0.001; pedicle excluding cortical bone: 208.9 HUs vs 290.5 HUs, p = 0.002; pedicle including cortical bone: 249.4 HUs vs 337.5 HUs, p < 0.001). The pedicle HUs tended to have a higher area under the receiver operating characteristic curve value in predicting screw loosening, compared with that of vertebral body HUs, but the difference was not statistically significant (p > 0.05). Among patients with low vertebral body HUs of ≤ 130, the loosening rate was much lower in patients with pedicle HUs of ≤ 340 than in those with pedicle HUs of > 340 (31.0% vs 13.0%, respectively; p < 0.05).CONCLUSIONSVertebral body HUs alone are insufficient to accurately evaluate the risk of pedicle screw loosening. Therefore, it is important to collect both the pedicle HU and vertebral body HU measurements for surgical planning.
Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis?
Authors: Bettag Christoph , Abboud Tammam , von der Brelie Christian , Melich Patrick , Rohde Veit , Schatlo Bawarjan 
Published: August 2020

OBJECTIVEPyogenic spondylodiscitis affects a fragile patient population. Surgical treatment in cases of instability entails instrumentation, and loosening of this instrumentation is a frequent occurrence in pyogenic spondylodiscitis. The authors therefore attempted to investigate whether low bone mineral density (BMD)—which is compatible with the diagnosis of osteoporosis—is underdiagnosed in patients with pyogenic spondylodiscitis. How osteoporosis was treated and how it affected implant stability were further analyzed.METHODSCharts of patients who underwent operations for pyogenic spondylodiscitis were retrospectively reviewed for clinical data, prior medical history of osteoporosis, and preoperative CT scans of the thoracolumbar spine. In accordance with a previously validated high-fidelity opportunistic CT assessment, average Hounsfield units (HUs) in vertebral bodies of L1 and L4 were measured. Based on the validation study, the authors opted for a conservative cutoff value for low BMD, being compatible with osteoporosis ≤ 110 HUs. Baseline and outcome variables, including implant failure and osteoporosis interventions, were entered into a multivariate logistic model for statistical analysis.RESULTSOf 200 consecutive patients who underwent fusion surgery for pyogenic spondylodiscitis, 64% (n = 127) were male and 66% (n = 132) were older than 65 years. Seven percent (n = 14) had previously been diagnosed with osteoporosis. The attenuation analysis revealed HU values compatible with osteoporosis in 48% (95/200). The need for subsequent revision surgery due to implant failure showed a trend toward an association with estimated low BMD (OR 2.11, 95% CI 0.95–4.68, p = 0.067). Estimated low BMD was associated with subsequent implant loosening (p < 0.001). Only 5% of the patients with estimated low BMD received a diagnosis and pharmacological treatment of osteoporosis within 1 year after spinal instrumentation.CONCLUSIONSRelying on past medical history of osteoporosis is insufficient in the management of patients with pyogenic spondylodiscitis. This is the first study to identify a substantially missed opportunity to detect osteoporosis and to start pharmacological treatment after surgery for prevention of implant failure. The authors advocate for routine opportunistic CT evaluation for a better estimation of bone quality to initiate diagnosis and treatment for osteoporosis in these patients.
Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment
Authors: Flanigan Patrick M. , Mikula Anthony L. , Peters Pierce A. , Oushy Soliman , Fogelson Jeremy L. , Bydon Mohamad , Freedman Brett A. , Sebastian Arjun S. , Currier Bradford L. , Nassr Ahmad , Kennel Kurt A. , Anderson Paul A. , Polly David W. , Elder Benjamin D. 
Published: August 2020

OBJECTIVEOpportunistic Hounsfield unit (HU) determination from CT imaging has been increasingly used to estimate bone mineral density (BMD) in conjunction with assessments from dual energy x-ray absorptiometry (DXA). The authors sought to compare the effect of teriparatide on HUs across different regions in the pelvis, sacrum, and lumbar spine, as a surrogate measure for the effects of teriparatide on lumbosacropelvic instrumentation.METHODSA single-institution retrospective review of patients who had been treated with at least 6 months of teriparatide was performed. All patients had at least baseline DXA as well as pre- and post-teriparatide CT imaging. HUs were measured in the pedicle, lamina, and vertebral body of the lumbar spine, in the sciatic notch, and at the S1 and S2 levels at three different points (ilium, sacral body, and sacral ala).RESULTSForty patients with an average age of 67 years underwent a mean of 20 months of teriparatide therapy. Mean HUs of the lumbar lamina, pedicles, and vertebral body were significantly different from each other before teriparatide treatment: 343 ± 114, 219 ± 89.2, and 111 ± 48.1, respectively (p < 0.001). Mean HUs at the S1 level for the ilium, sacral ala, and sacral body were also significantly different from each other: 124 ± 90.1, −10.7 ± 61.9, and 99.1 ± 72.1, respectively (p < 0.001). The mean HUs at the S2 level for the ilium and sacral body were not significantly different from each other, although the mean HU at the sacral ala (−11.9 ± 52.6) was significantly lower than those at the ilium and sacral body (p = 0.003 and 0.006, respectively). HU improvement occurred in most regions following teriparatide treatment. In the lumbar spine, the mean lamina HU increased from 343 to 400 (p < 0.001), the mean pedicle HU increased from 219 to 242 (p = 0.04), and the mean vertebral body HU increased from 111 to 134 (p < 0.001). There were also significant increases in the S1 sacral body (99.1 to 130, p < 0.05), S1 ilium (124 vs 165, p = 0.01), S1 sacral ala (−10.7 vs 3.68, p = 0.04), and S2 sacral body (168 vs 189, p < 0.05).CONCLUSIONSThere was significant regional variation in lumbar and sacropelvic HUs, with most regions significantly increasing following teriparatide treatment. The sacropelvic area had lower HU values than the lumbar spine, more regional variation, and a higher degree of correlation with BMD as measured on DXA. While teriparatide treatment resulted in HUs > 110 in the majority of the lumbosacral spine, the HUs in the sacral ala remained suggestive of severe osteoporosis, which may limit the effectiveness of fixation in this region.
Association of osteopenia and osteoporosis with higher rates of pseudarthrosis and revision surgery in adult patients undergoing single-level lumbar fusion
Authors: Khalid Syed I. , Nunna Ravi S. , Maasarani Samantha , Belmont Erika , Deme Palvasha , Chilakapati Sai , Eldridge Cody , Singh Ravinderjit , Bagley Carlos A. , Adogwa Owoicho 
Published: August 2020

OBJECTIVEPatients with osteopenia or osteoporosis who require surgery for symptomatic degenerative spondylolisthesis may have higher rates of postoperative pseudarthrosis and need for revision surgery than patients with normal bone mineral densities (BMDs). To this end, the authors compared rates of postoperative pseudarthrosis and need for revision surgery following single-level lumbar fusion in patients with normal BMD with those in patients with osteopenia or osteoporosis. The secondary outcome was to investigate the effects of pretreatment with medications that prevent bone loss (e.g., teriparatide, bisphosphonates, and denosumab) on these adverse outcomes in this patient cohort.METHODSPatients undergoing single-level lumbar fusion between 2007 and 2017 were identified. Based on 1:1 propensity matching for baseline demographic characteristics and comorbidities, 3 patient groups were created: osteopenia (n = 1723, 33.3%), osteoporosis (n = 1723, 33.3%), and normal BMD (n = 1723, 33.3%). The rates of postoperative pseudarthrosis and revision surgery were compared between groups.RESULTSThe matched populations analyzed in this study included a total of 5169 patients in 3 groups balanced at baseline, with equal numbers (n = 1723, 33.3%) in each group: patients with a history of osteopenia, those with a history of osteoporosis, and a control group of patients with no history of osteopenia or osteoporosis and with normal BMD. A total of 597 complications were recorded within a 2-year follow-up period, with pseudarthrosis (n = 321, 6.2%) being slightly more common than revision surgery (n = 276, 5.3%). The odds of pseudarthrosis and revision surgery in patients with osteopenia were almost 2-fold (OR 1.7, 95% CI 1.26–2.30) and 3-fold (OR 2.73, 95% CI 1.89–3.94) higher, respectively, than those in patients in the control group. Similarly, the odds of pseudarthrosis and revision surgery in patients with osteoporosis were almost 2-fold (OR 1.92, 95% CI 1.43–2.59) and > 3-fold (OR 3.25, 95% CI 2.27–4.65) higher, respectively, than those in patients in the control group. Pretreatment with medications to prevent bone loss prior to surgery was associated with lower pseudarthrosis and revision surgery rates, although the differences did not reach statistical significance.CONCLUSIONSPostoperative pseudarthrosis and revision surgery rates following single-level lumbar spinal fusion are significantly higher in patients with osteopenia and osteoporosis than in patients with normal BMD. Pretreatment with medications to prevent bone loss prior to surgery decreased these complication rates, although the observed differences did not reach statistical significance.
BUDIDAYA IKAN LELE SANGKURIANG DENGAN SISTEM BIOFLOK DI DESA JERUKLEUEUT KECAMATAN SINDANGWANGI KABUPATEN MAJALENGKA
Authors: Gaffar Aden Arif , Rasyid Abdur , Suryaningsih Yeni 
Published: August 2020

Komodias ikan air tawar seperti ikan lele salah satu permintaan pasar yang cukup ringgi. Budidaya ikan lele dilakukan di desa jerukleueut Sindangwangi Kabupaten Majalengka. Tujuan dari kegiatan ini untuk meningkatkan pengetahuan dan produksi ikan lele dengan menggunakan sistem bioflok. Budidaya ikan lele dengan sistem bioflok merupakan salah satu sistem dengan memanfaatkan mikroorganisme didalmnya yang bermanfaat sebagai makan tambahan berupa gumpalan berbagai jenis organisme seperti jamur, bakteri, algae, protozoa, cacing, dan lain lain. Benih ikan lele dengan metode bioflok bobot awal rata-rata 3,29 gram dan panjang 7,3 cm dan setelah dipelihara 40 hari memiliki berat rata-rata 12,35 gram dan panjang rata-rata 13,1 cm. Peningkatan berat yang dialami yaitu 9,06 gram dan peningkatan panjang 5,8 cm. Sementara itu, pada media tanpa bioflok, benih lele yang memiliki berat awal rata-rata 3,10 gram dan panjang 7,3 cm, setelah 40 hari terjadi peningkatan menjadi 9,75 gram dan panjang 11,5 cm. Dengan demikian terjadi peningkatan berat mencapai 6,65 gram dan peningkatan panjang 4,2 cm.
LITERASI MEDIA ONLINE PADA SISWA MA AN-NAWAWIYAH MAJALENGKA
Authors: Nurhaipah Titih , Erdiyanti Yucky Putri 
Published: August 2020

Mudahnya konsumsi informasi dalam dunia digital seperti saat ini, mengharuskan setiap individu memilah dan memilih informasi. Saat ini dunia tengah menghadapi permasalahan yang sama yaitu, gelombang hoax. Sehingga masyarakat harus melek informasi, melek teknologi dan melek media. Langkah pasti dan menjadi jalan utama untuk mengantisipasi hoax adalah membangun kompetensi publik dalam menghadapi luapan banjir informasi. Upaya membangun kompetensi publik dilakukan melalui literasi media. Upaya melakukan peningkatan literasi adalah melalui kegiatan pengabdian kepada masyarakat dalam bentuk diskusi dan pemberian pengetahuan yang diselenggarakan di MA An Nawawiyah Majalengka. Tujuan ini tentunya untuk meningkatkan kompetensi literasi media oleh generasi muda. Siswa MA An Nawawiyah sebagai sasaran dalam kegiatan pelatihan literasi ini dilakukan dengan metode ceramah dan diskusi yang disertai latihan dan tanya jawab. Kegiatan ini dilaksanakan dengan memberikan pengetahuan yang disertai contoh-contoh kasus terkini dan pemaparan risiko penyebaran hoax. Hasil dari kegiatan ini diharapkan mampu menjadi model edukasi literasi media.
BIMBINGAN KONSELING KARIR UNTUK ANGGOTA KARANG TARUNA KABUPATEN MAJALENGKA
Authors: Putri Erdiyanti Yucky , Nurhaipah Titih 
Published: August 2020

Tujuan pengabdian kepada masyarakat ini adalah untuk memberikan pengetahunan dan arahan mengenai pilihan karir anggota karang taruna. Pengabdian kepada masyarakat ini dilaksanakan di Aula Dinas Sosial Kabupaten Majalengka. Materi yang disampaikan pada pengarahan ini adalah tentang bimbingan konseling karir bagi anggota karang taruna. Jumlah peserta seminar sebanyak 91 peserta.
Orientasi layanan bimbingan konseling karir membantu masyarakat khususnya pemuda dan pemudi dalam kehidupan berkarir atau bekerja. Bimbingan konseling karir merupakan modal landasan konseptual yang dapat dijadikan mediator guna memfasilitasi keberlangsungan masyarakat dalam berkarir atau bekerja sesuai dengan kompetensi yang dimilikinya. Pemuda pemudi yang tergabung dalam kegiatan karang taruna memiliki peran penting dalam memajukan daerah tempat tinggalnya. Pentingnya peran konselor dalam memberikan bimbingan konseling karir berlandaskan kegiatan karang taruna, disesuaikam dengan keadaan masyarakat atau pemuda pemudi yang memiliki cita- cita dan keinginan untuk maju dalam berkarir ataupun bekerja. Konselor harus mampu secara professional dalam memberikan bimbingan konseling karir kepada masyarakat berlandaskan kegiatan karang taruna di Kabupaten Majalengka. Luaran dari kegiatan ini berupa jurnal pengabdian dan publis di media cetak.