bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical Alignment Following Posterior Cervical Fusion Surgery
Authors: Lee Subum , Cho Dae-Chul , Roh Sung Woo , Jeon Sang Ryong , Moon Eun Ji , Lee Jung Jae , Park Jin Hoon 
Published: December 2020

Study Design.
Retrospective comparative study.

Objective.
The aim of this study was to compare cervical sagittal alignment after posterior fusion surgery with lateral mass screw (LMS) and cervical pedicle screw (CPS) fixation.

Summary of Background Data.
LMS fixation in the subaxial cervical spine has become the preferred method of posterior cervical fusion. Although CPS has biomechanical benefits, it also has neurovascular risks. Few studies to date have compared sagittal alignment changes after posterior cervical fusion using CPS and LMS fixation.

Methods.
From 2006 to 2017, 71 consecutive patients underwent posterior cervical fusion using CPS (n = 51) or LMS (n = 20) fixation. Patients who underwent fusion with both types of screws and those who planned to undergo additional anterior fusion surgery were excluded. The minimum follow-up period was 12 months. C2–C7 Cobb angle for cervical lordosis (CL), fusion segmental angle (SA), C2–C7 sagittal vertical axis (SVA), and T1 slope (T1S) were measured.

Results.
Immediate postoperative SA and SVA differed significantly in patients who underwent CPS and LMS fixation. SA changes were more substantial after CPS fixation, with a significant difference maintained until final follow-up. Over time, CL, SVA, and T1S tended to return to their preoperative states regardless of screw type. Two patients who underwent LMS fixation, but none who underwent CPS fixation, required unplanned or additional anterior fusion surgery for revision.

Conclusion.
The present study is the first radiologic comparison of LMS and CPS fixation after posterior-only fusion surgery. CPS resulted in more reliable and well-preserved SA correction, whereas CL and SVA did not differ between the two groups over time due to loss of correction.

Level of Evidence: 4
Comparison of Different Surgical Systems for Treatment of Early-onset Scoliosis in the Context of Release of Titanium Ions
Authors: Danielewicz Anna , Wójciak Magdalena , Sawicki Jan , Dresler Sławomir , Sowa Ireneusz , Latalski Michał 
Published: December 2020

Study Design.
Case–control study.

Objective.
The aim of the study was to compare growth-friendly systems: traditional growing rod, guided growth systems (GGS), and vertical expandable prosthetic titanium rib in the context of titanium release.

Summary of Background Data.
The problem of scoliosis affects even up to 3% of the population, and ca. 0.1% of patients need surgical treatment. Surgical treatment carries the risk of a long-term presence of implants in the organism, which may result in release of metal ions into the tissues and bloodstream.

Methods.
Seventy-one patients (13.5 ± 3.54 years’ old) were treated for spinal deformity using various surgical systems and the samples of paraspinal tissue, blood, nails, and hair were collected before and after treatment. The quantification of titanium was performed using inductively coupled plasma optical emission spectrometry.

Results.
The metallic particles were released into the peri-implant tissue, and the greatest amounts of titanium were detected in patients with GGS. The concentration of soluble titanium forms in subcutaneous tissue (ST) was low and do not statistically differ from control. The average titanium content in the paraspinal tissue in patients with GGS was two- to three-fold higher than the average value in the other investigated groups. A slightly increased level of titanium compared with the control was noted in all studied groups of patients. The highest content of titanium in blood was observed in patients with the GGS system.

Conclusion.
Neverless the system used, the concentration of soluble titanium forms in both ST and blood was only slightly higher than in the control and did not exceed the allowable levels. The increased level of titanium with GGS system is probably associated with the friction between implant components, whereas the components in the other systems are immobile relative to each other.

Level of Evidence: 3
Altered Circulating Cell-free Mitochondrial DNA of Patients with Congenital Scoliosis
Authors: Yang Guanteng , Tang Mingxing , Zhang Hongqi , Li Jiong , Xiao Lige , Guo Chaofeng 
Published: December 2020

Study Design.
Case–control study.

Objective.
The aim of this study was to estimate the relationship between circulating cell-free DNA (ccf DNA) and clinical parameters of patients with congenital scoliosis (CS).

Summary of Background Data.
CS is a complex spinal deformity characteristic of congenital vertebral malformations. Although numerous studies have centered on the etiology of CS, the cause of CS remains unclear. Previously, we reported that circulating cell-free DNA (ccf DNA) is altered in adolescent idiopathic scoliosis (AIS). However, the relationship between ccf DNA and the clinical parameters of patients with CS remains unclear.

Methods.
The plasma of peripheral blood from 35 patients with CS and 32 age-matched controls was collected for ccf DNA analysis. Quantitative PCR was used to detect ccf n-DNA and ccf mt-DNA levels, and correlation analyses between ccf n-DNA and ccf mt-DNA levels were conducted. Receiver-operating characteristic (ROC) curves were used to analyze the sensitivity and specificity of ccf n-DNA and ccf mt-DNA levels to different characteristics.

Results.
The plasma ccf mt-DNA levels of both ND1 and CYTC were significantly decreased in patients with CS compared with levels in controls both in total and by sex, whereas the plasma ccf n-DNA levels showed no significant difference. There is no difference in both ccf mt-DNA and ccf n-DNA between S-SDV and M-SDV according to The International Consortium for Vertebral Anomalies and Scoliosis (ICVAS) classification. The ROC curve analyses showed a reliable sensitivity and specificity of CS predicted by ccf mt-DNA levels in total but failed to distinguish different ICVAS types.

Conclusion.
Significantly decreased plasma ccf mt-DNA levels were observed in patients with CS compared with those in controls. Although this finding has limited significance for clinical practice, it indicates that ccf mt-DNA may predict the onset or development of CS. Further studies should focus on the role of ccf mt-DNA in embryo development and whether ccf mt-DNAs could be considered as a marker for prenatal screening in development disorder like CS.

Level of Evidence: 4
Who Will Require Revision Surgery Among Neurologically Intact Patients with Proximal Junctional Failure After Surgical Correction of Adult Spinal Deformity?
Authors: Park Se-Jun , Park Jin-Sung , Nam Yunjin , Choi Youn-Taek , Lee Chong-Suh 
Published: December 2020

Study Design.
Retrospective study.

Objective.
To identify the risk factors for revision surgery among neurologically intact patients with proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery.

Summary of Background Data.
PJF following long fusion for ASD is a well-recognized complication that negatively affects clinical outcomes. However, revision surgery is not required for every patient with PJF especially if the patient does not present with neurologic deficit. Identifying the risk factors of revision surgery is necessary to determine who will need revision surgery as well as when is the right time for the revision surgery.

Methods.
Sixty-nine neurologically intact patients with PJF following ASD surgery were followed up with more than 2 years after PJF development or until undergoing revision surgery. PJF was divided into ligamentous failure (proximal junctional angle [PJA] of more than 20°) and bony failure. According to the conduct of revision surgery, two groups (revision and no revision) were created. Risk factors for revision surgery were analyzed in univariate and multivariate analysis with regard to patient, surgical and radiographic variables.

Results.
The mean age at the time of PJF development was 70.9 years. There were 45 patients with bony failure and 24 with ligamentous failure. Revision surgery was performed for 23 patients (33.3%). Multivariate analysis revealed that bony failure (odds ratio: 10.465) and PJA (odds ratio: 1.131) were significant risk factors. For those with bony failure, the cutoff value of PJA for performing revision surgery was calculated as 22°. The revision rate was significantly highest in patients (63.6%) with bony failure + PJA 22° or higher followed by patients (26.1%) with bony failure + PJA less than 22° and patients (12.5%) with ligamentous failure (P = 0.002).

Conclusion.
Bony failure with PJA of greater than 22° increased the likelihood for revision surgery. Therefore, early surgical intervention should be considered in these patients.

Level of Evidence: 4
A Comparison of Three Different Positioning Techniques on Surgical Corrections and Postoperative Alignment in Cervical Spinal Deformity (CD) Surgery
Authors: Morse Kyle W. , Lafage Renaud , Passias Peter , Ames Christopher P. , Hart Robert , Shaffrey Christopher I. , Mundis Gregory , Protopsaltis Themistocles , Gupta Munish , Klineberg Eric , Burton Doug , Lafage Virginie , Kim Han Jo. 
Published: December 2020

Study Design.
Retrospective review of a prospective multicenter cervical deformity database.

Objective.
To examine the differences in sagittal alignment correction between three positioning methods in cervical spinal deformity surgery (CD).

Summary of Background Data.
Surgical correction for CD is technically demanding and various techniques are utilized to achieve sagittal alignment objectives. The effect of different patient positioning techniques on sagittal alignment correction following CD remains unknown.

Methods.
Patients with sagittal deformity who underwent a posterior approach (with and without anterior approach) with an upper instrumented vertebra of C6 or above. Patients with Grade 5, 6, or 7 osteotomies were excluded. Positioning groups were Mayfield skull clamp, bivector traction, and halo ring. Preoperative lower surgical sagittal curve (C2–C7), C2–C7 sagittal vertical axis (cSVA), cervical scoliosis, T1 slope minus cervical lordosis (TS–CL), T1 slope (T1S), chin-brow vertebral angle (CBVA), C2–T3 curve, and C2–T3 SVA was assessed and compared with postoperative radiographs. Segmental changes were analyzed using the Fergusson method.

Results.
Eighty patients (58% female) with a mean age of 60.6 ± 10.5 years (range, 31–83) were included. The mean postoperative C2–C7 lordosis was 7.8° ± 14 and C2–C7 SVA was 34.1 mm ± 15. There were overall significant changes in cervical alignment across the entire cohort, with improvements in T1 slope (P < 0.001), C2–C7 (P < 0.001), TS–CL (P < 0.001), and cSVA (P = 0.006). There were no differences postoperatively of any radiographic parameter between positioning groups (P > 0.05). The majority of segmental lordotic correction was achieved at C4–5–6 (mean 6.9° ± 11). Additionally, patients who had bivector traction applied had had significantly more segmental correction at C7–T1–T2 compared with Mayfield and halo traction (4.2° vs. 0.3° vs. –1.7° respectively, P < 0.027).

Conclusion.
Postoperative cervical sagittal correction or alignment was not affected by patient position. The majority of segmental correction occurred at C4–5–6 across all positioning methods, while bivector traction had the largest corrective ability at the cervicothoracic junction.

Level of Evidence: 4
Mental Health Associated With Postoperative Satisfaction in Lumbar Degenerative Surgery Patients
Authors: Rahman Rafa , Zhang Bo , Andrade Nicholas S. , Ibaseta Alvaro , Kebaish Khaled M. , Riley Lee H. , Cohen David B. , Jain Amit , Lee Sang H. , Sciubba Daniel M. , Skolasky Richard L. , Neuman Brian J. 
Published: December 2020

Study Design:
Retrospective review of prospectively collected data

Objective:
To assess the association between preoperative and postoperative mental health status with postoperative satisfaction in lumbar degenerative surgery patients.

Summary of Background Data:
Poor preoperative mental health has been shown to negatively affect postoperative satisfaction among spine surgery patients, but there is limited evidence on the impact of postoperative mental health on satisfaction.

Materials and Methods:
Adult patients undergoing surgery for lumbar degenerative conditions at a single institution were included. Mental health was assessed preoperatively and 12 months postoperatively using Patient-Reported Outcomes Measurement Information System Depression and Anxiety scores. Satisfaction was assessed 12 months postoperatively using North American Spine Society Patient Satisfaction Index. The authors evaluated associations between mental health and satisfaction with univariate and multivariable logistic regression to adjust for confounders. Preoperative depression/anxiety level was corrected for postoperative depression/anxiety level, and vice versa. Statistical significance was assessed at α=0.05.

Results:
A total of 183 patients (47% male individuals; avg. age, 62 y) were included. Depression was present in 27% preoperatively and 29% postoperatively, and anxiety in 50% preoperatively and 31% postoperatively. Ninteen percent reported postoperative dissatisfaction using the North American Spine Society Patient Satisfaction Index. Univariate analysis identified race, family income, relationship status, current smoking status, change in pain interference, and change in physical function as potential confounders. In adjusted analysis, odds of dissatisfaction were increased in those with mild postoperative depression (adjusted odds ratio=6.1; 95% confidence interval, 1.2–32; P=0.03) and moderate or severe postoperative depression (adjusted odds ratio=7.5; 95% confidence interval, 1.3–52; P=0.03). Preoperative and postoperative anxiety and preoperative depression were not associated with postoperative satisfaction.

Conclusions:
Following lumbar degenerative surgery, patients with postoperative depression, irrespective of preoperative depression status, have significantly higher odds of dissatisfaction. These results emphasize the importance of postoperative screening and treatment of depression in spine patients with dissatisfaction.

Level of Evidence:
Level III—nonrandomized cohort study.
Comparing Investigation Between Bilateral Partial Laminectomy and Posterior Lumbar Interbody Fusion for Mild Degenerative Spondylolisthesis
Authors: Sugiura Tsuyoshi , Okuda Shinya , Takenaka Shota , Nagamoto Yukitaka , Matsumoto Tomiya , Takahashi Yoshifumi , Iwasaki Motoki 
Published: December 2020

Study Design:
A retrospective comparative study.

Objective:
The present study aims to compare the surgical outcomes between bilateral partial laminectomy (BPL) and posterior lumbar interbody fusion (PLIF) in patients with mild degree of slippage.

Summary of Background Data:
To date, there have not been established surgical procedures for patients with mild degree of slippage. Moreover, sufficient studies that have compared surgical outcomes between BPL and PLIF are very few.

Materials and Methods:
In this retrospective study, the authors enrolled 202 consecutive patients with degenerative spondylolisthesis with slippage at L3 or L4 of >3% who underwent spine surgery between 2005 and 2015. Patients were grouped into those who underwent single-segment PLIF (n=106) and those who underwent BPL (n=51). To adjust for potential confounders, the inverse probability of treatment weighting based on the propensity score was used. Surgical outcomes were compared between the BPL and PLIF groups. The threshold age for the final recovery rate of >70% was evaluated using receiver operating characteristic curve analyses to assess the limit of age to achieve good outcomes. Patients who underwent reoperation in both groups were also evaluated.

Results:
Operation time and blood loss were significantly lower in the BPL group. The final recovery rate was similar between the groups without age stratification. The cutoff age to achieve a final recovery rate of >70% was 75 years in the PLIF group, and the final recovery rate was significantly higher in the PLIF group than in the BPL group in patients aged less than 75 years but not in patients aged 75 years or older. In addition, the reoperation rate was similar between groups, and all reoperations in the PLIF group were for adjacent segment disease.

Conclusions:
BPL is one of the useful options in patients with mild degenerative spondylolisthesis, particularly in patients aged more than 75 years.
Bariatric Surgery Before Elective Anterior Cervical Discectomy and Fusion (ACDF) in Obese Patients Is Associated With Reduced Risk of 90-Day Postoperative Complications and Readmissions
Authors: Malik Azeem T. , Noria Sabrena , Xu Wendy , Retchin Sheldon , Yu Elizabeth S. , Khan Safdar N. 
Published: December 2020

Study Design:
This was a national database study.

Objective:
The objective of this study was to assess the impact of prior bariatric surgery (BS) on altering 90-day postoperative outcomes following elective anterior cervical discectomy and fusions (ACDFs).

Summary of Background Data:
Though obesity has previously been shown to be linked with adverse outcomes following elective spine surgical procedures, the effectiveness of weight-loss strategies such as BS has not been explored.

Methods:
The PearlDiver program was used to query the 2007–2013 100% Medicare Standard Analytical Files (SAF100) for patients undergoing an elective ACDF. The study cohort was divided into 2 groups—(1) obese ACDF patients (body mass index ≥35 kg/m2) receiving a BS procedure within 2 years before an ACDF and (2) obese ACDF patients (body mass index ≥35 kg/m2) without a known history of a BS procedure within the last 2 years. Multivariate regression analyses were used to assess the impact of a BS procedure on postoperative outcomes following ACDF while adjusting for age, sex, region, and Elixhauser Comorbidity Index.

Results:
A total of 411 ACDF patients underwent BS within the 2 years before an ACDF. Multivariate analysis showed that undergoing BS before an elective ACDF was associated with a significantly reduced risk of pulmonary complications [odds ratio (OR)=0.53; P=0.002], cardiac complications (OR=0.69; P=0.012), sepsis (OR=0.69; P=0.035), renal complications (OR=0.54; P=0.044), and 90-day readmissions (OR=0.53; P=0.015).

Conclusions:
Surgery-induced weight loss before an ACDF in obese patients is associated with reduced 90-day complication and readmission rates. Orthopaedic and bariatric surgeons should counsel obese patients on the benefits of BS following ACDFs.
INTRAOPERATIVE THREE-DIMENSIONAL FLUORESCEIN ANGIOGRAPHY–GUIDED PARS PLANA VITRECTOMY FOR BRANCH RETINAL VEIN OCCLUSION
Authors: Imai Hisanori , Tetsumoto Akira , Yamada Hiroko , Hayashida Mayuka , Otsuka Keiko , Miki Akiko , Nakamura Makoto 
Published: December 2020

Purpose:
To show surgical results of the intraoperative 3D fluorescein angiography–guided pars plana vitrectomy for branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere.

Methods:
The NGENUITY 3D visualization system was used for the digital-assisted vitrectomy. Three-dimensional fluorescein angiography–guided pars plana vitrectomy was performed in three patients with branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere.

Results:
In all eyes, the scatter retinal photocoagulations for a nonperfusion area, depicted as hypofluorescein, and the segmentation and delamination of the perivascular fibrovascular proliferative membrane, depicted as hyperfluorescein, could be safely performed on the same screen while implementing intraoperative 3D fluorescein angiography.

Conclusion:
Three-dimensional fluorescein angiography–guided pars plana vitrectomy, a novel approach that fully uses the advantages of digital-assisted vitrectomy, can be one of the useful techniques for the treatment of branch retinal vein occlusion with vitreous hemorrhage and neovascularization elsewhere.
Frequency of Contact Lens Complications Between Contact Lens Wearers Using Multipurpose Solutions Versus Hydrogen Peroxide in the United States and Canada
Authors: Tichenor Anna A. , Cofield Stacey S. , Gann Drew , Elder Marian , Ng Alison , Walsh Karen , Jones Lyndon W. , Nichols Jason J. 
Published: December 2020

Objectives:
To retrospectively compare frequency of contact lens (CL) complications in soft CL users of hydrogen peroxide (H2O2) and multipurpose solutions (MPS).

Methods:
This was a multicenter, retrospective chart review of CL records from each patient's three most recent eye examinations at academic and private practices. Patients must have used the same solution type for at least 3 years. Univariate analyses were conducted using t tests, and chi-square or Fisher's exact test for categorical measures.

Results:
There were 1,137 patients included, with 670 (59%) using MPS and 467 (41%) H2O2. In total, 706 (62%) experienced at least one complication; 409 used MPS and 297 used H2O2. There was no difference in the proportion of patients experiencing at least one complication between MPS (61%) and H2O2 (64%) (P=0.38). Multipurpose solutions users were more likely to report discomfort compared with H2O2 users (P=0.04). Presumed microbial keratitis was experienced by 16 MPS and nine H2O2 users (P=0.60).

Conclusions:
No significant differences were found in the frequency of CL complications between MPS and H2O2. H2O2 users were less likely to report discomfort and thus switching to a H2O2 system may be an alternative in CL users with discomfort.
A Micro-Computed Tomography Study of Round Window Anatomy and Implications for Atraumatic Cochlear Implant Insertion
Authors: Cornwall Hannah Louisa , Marway Prabhvir Singh , Bance Manohar 
Published: December 2020

Hypothesis:
The goal of this study was to interrogate high-resolution three-dimensional reconstructions of round window anatomy to illustrate and characterize structural variability with implications for atraumatic cochlear implant insertion.

Background:
Cochlear implants are increasingly used to improve sound detection in patients with substantial residual hearing. However, traumatic cochlear implant insertion through the round window involving upward deviation of the electrode into the spiral ligament, basilar membrane, and osseous spiral lamina, medial impaction on the modiolus, or interscalar excursion into the scala vestibuli are associated with lower rates of hearing preservation and poorer speech perception.
Successful atraumatic insertion is dependent on an anatomical understanding of the middle and inner ear. The round window bony niche lacks distinct demonstrable anatomical landmarks for the position of the round window membrane, and there is limited guidance on the amount of bony overhang that can be safely drilled away. A greater understanding of the anatomical variation around the round window could enhance treatment efficacy.

Methods:
Fourteen human cadaver temporal bones were imaged using microcomputed tomography. Resulting scans were digitally reconstructed, segmented, and measured.

Results:
Round window niche walls vary substantially in size and projection. Round window average short diameter measured 1.30 mm (range 1.07–1.44), and is limited by the crista fenestrae at the inferoanterior margin of the round window. Crista fenestrae size and morphology varied considerably. Reconstructions with solid and translucent panels are presented.

Conclusion:
Anatomical heterogeneity should be considered in cochlear implant selection, drilling, and choice of insertion vector.