bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior or Single-stage Combined Anterior and Posterior Approach Decompression for Treating Complex Cervical Spondylotic Myelopathy Coincident Multilevel Anterior and Posterior Compression
Authors: Zhou Xiaoxiao , Cai Pan , Li Yuwei , Wang Haijiao , Xia Shengli , Wang Xiuhui 
Published: March 2018

Study Design:
A single-center, retrospective, longitudinal matched cohort clinical study of prospectively collected outcomes.

Objective:
To compare retrospectively the clinical outcomes and complications of the posterior approach laminoplasty and single-stage anterior approach laminoplasty combined with anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion for treating patients with cervical spondylotic myelopathy coincident multilevel anterior and posterior compression, known as complex cervical spondylotic myelopathy (cCSM) here.

Summary of Background Data:
The optimal surgical management of this type of cCSM remains controversial.

Methods:
Sixty-seven patients with multilevel cCSM underwent decompression surgery from 1996 to 2007. Among these patients, 31 underwent a single-stage combined approach with decompression (combined approach group) and 36 underwent laminoplasty for posterior approach (posterior approach group). Average operative duration, operative estimated blood loss, surgical costs, and cervical alignment were measured.

Results:
Average operative duration, operative estimated blood loss, and surgical costs were significantly lower in the posterior approach group than those in the combined approach group (P<0.001). Visual analog scale and modified Japanese Orthopedic Association scale were insignificantly different at each data collection period (P>0.05). No statistical difference was observed in the preoperative Cobb angle (P>0.05), whereas a significant statistical difference was observed for the postoperative Cobb angle (P<0.05) and variation of Cobb angle (P<0.05) between the 2 groups. The surgical incidences of complications were 22.2% and 48.4% in the posterior and combined approach groups (P<0.05), respectively.

Conclusions:
For treating multilevel cCSM, both the posterior approach laminoplasty and single-stage combined approach led to significant neurological improvement and pain reduction in the majority of patients. Both approaches showed similar results in terms of decompression and neurological improvement. The posterior approach was superior to the combined approach in terms of surgical costs, surgical time, blood loss, and complication rate.
The Minimally Important Clinical Difference
Authors: Maltenfort Mitchell G. 
Published: March 2018

The minimally important clinical difference (MCID) is the smallest measureable change in outcome score that will make a difference to the patient. MCID is usually estimated either as the smallest difference that can be detected statistically, or as the difference between patients who respond positively and negatively to an anchor question.
• MCID is the least a surgeon can do which benefits the patient from the patient’s perspective.
• MCID is necessary information in power analyses used to design new studies comparing treatments.
Predictive Factors of the Effectiveness of Caudal Epidural Steroid Injections in Managing Patients With Chronic Low Back Pain and Radiculopathy
Authors: Billy Gregory G. , Lin Ji , Gao Mengzhao , Chow Mosuk X. 
Published: March 2018

Study Design:
Retrospective clinical outcome analysis.

Objective:
To evaluate and determine whether demographic, comorbid factors, or physical examination findings may predict the outcome of caudal epidural steroid injections in managing patients with chronic low back pain and radiculopathy

Summary of Background Data:
The caudal epidural approach is commonly utilized with patients who are on anticoagulation or who have had prior lumbar surgery to treat L5 or S1 radiculopathies.

Methods:
A retrospective review of 136 patients undergoing an initial caudal epidural steroid injection for radiculopathy from January 1, 2006 to August 30, 2013. The patients were assessed before their injections for their pain levels: visual analog scale, presence of lumbar paraspinal and sciatic notch sensitivity, pain with provocative maneuvers, motor weakness, and sensory loss. The patients were then reassessed following their injection for their visual analog scale pain levels, percentage improvement, and duration of pain relief.

Results:
Stepwise regression was used to determine whether demographic, comorbid factors, or physical examination signs were predictive of percentage improvement or length of relief following an injection. Among these variables, duration of symptoms was found to be negatively significantly related with a P-value of 0.032 for percentage of improvement. For each week of the duration of symptoms, the percentage of improvement decreased by 0.07%. Regarding physical examination findings, presence of pain with lumbar extension was negatively and significantly related to length of relief duration with a P-value of 0.0124. The mean length of relief duration is 38.37 weeks for individuals without painful lumbar extension and 14.68 weeks for individuals with painful lumbar extension

Conclusions:
The mean length of relief following a caudal injection is reduced by 62% in patients who exhibit pain with lumbar extension.
Lumbar Spinal Surgery in Patients With Parkinson Disease
Authors: Kimura Hiroaki , Fujibayashi Shunsuke , Otsuki Bungo , Takemoto Mitsuru , Shikata Jitsuhiko , Odate Seiichi , Matsushita Mutsumi , Kusuba Akira , Kim Youngwoo , Sakamoto Takeshi , Watanabe Kei , Ota Masato , Izeki Masanori , Tsubouchi Naoya , Matsuda Shuichi 
Published: March 2018

Study Design:
A multicenter, retrospective study.

Objective:
To identify the factors that affect surgery-related complications and to clarify the surgical strategy for treating lumbar disorders in Parkinson disease (PD).

Summary of Background Data:
Previous studies have reported a high complication rate for spinal surgery in patients with PD. Because of the limited number of studies, there are no guidelines for spinal surgery for PD patients.

Methods:
We retrospectively reviewed the records for 67 PD patients who underwent lumbar spinal surgery. The patients were divided into 3 groups: 12 patients underwent laminectomy (Laminectomy), 24 underwent fusion surgery (Fusion) for lumbar canal stenosis, and 31 underwent corrective surgery for spinal deformity (Deformity). We assessed surgery-related complications in each group. The Cox proportional hazards model was used to identify the factors that predicted surgical failure.

Results:
The percentages of patients who experienced failure of the initial surgery were 33.3% in the Laminectomy group, 45.8% in the Fusion group, and 67.7% in the Deformity group. The rates of implant failure were high in the Fusion and Deformity groups (33.3% and 38.7%, respectively). The Deformity group had a high rate of postoperative fracture (41.9%). These complications occurred at the most caudal site within a year after surgery and resulted in progression of kyphotic deformity. Multivariate analysis revealed that preoperative lumbar lordosis angle (LL) (per −1 degree) was associated with a failure of the initial surgery (hazard ratio, 1.024; 95% confidence interval, 1.008–1.04; P=0.003).

Conclusions:
We have demonstrated that a small preoperative LL increases the risk for failure of the initial surgery. Attaining and maintaining the proper lumbar lordosis with rigid fixation may be necessary in PD patients with a small preoperative LL.
Prospective Cohort Study of Performance Status and Activities of Daily Living After Surgery for Spinal Metastasis
Authors: Kakutani Kenichiro , Sakai Yoshitada , Maeno Koichiro , Takada Toru , Yurube Takashi , Kurakawa Takuto , Miyazaki Shingo , Terashima Yoshiki , Ito Masaaki , Hara Hitomi , Kawamoto Teruya , Ejima Yasuo , Sakashita Akihiro , Kiyota Naomi , Kizawa Yoshiyuki , Sasaki Ryohei , Akisue Toshihro , Minami Hironobu , Kuroda Ryosuke , Kurosaka Masahiro , Nishida Kotaro 
Published: March 2018

Study Design:
A prospective cohort study of performance status (PS) and activities of daily living (ADL) in patients with spinal metastasis.

Objective:
To identify the effect of spinal surgery on PS and ADL in patients with spinal metastasis.

Summary of Background Data:
Spinal metastasis causes severe neurological deficits, resulting in drastic loss of patients’ PS and ADL. However, the effect of spine surgery on PS and ADL is not well known.

Materials and Methods:
Seventy patients with spinal metastasis were enrolled in this study. Forty-six patients desired and underwent spine surgery (“surgery” group) and 24 patients did not desire surgery (“nonsurgery” group). Both groups received optimal treatments, including radiation, chemotherapy, and palliative care services. Evaluation was performed at 1, 3, and 6 months after study enrollment using the Eastern Cooperative Oncology Group PS, the Barthel index (BI) for ADL, and Frankel classification for neurological status.

Results:
There was no significant difference in baseline PS, the BI, or Frankel classification between the groups. The surgery group showed significant improvement in PS, maintaining grade 2 or less throughout the duration of the study, as well as in ADL, exceeding 70 points of the BI, compared with the nonsurgery group (P<0.05). Significantly improved neurological condition was also observed in the surgery group over the following 6 months. More than 95% of patients who underwent surgery improved their PS, the BI, and neurological status. Furthermore, >80% of these patients maintained improvement in PS, the BI, and neurological status for at least 6 months. In contrast, PS, the BI, and neurological status of patients in the “nonsurgery” group deteriorated throughout the study period.

Conclusions:
Spine surgery improves PS, ADL, and neurological status in patients with spinal metastasis for a minimum 6 months. This indicates that these patients can acquire an independent daily life.
A Novel Groove-Entry Technique for Inserting Thoracic Percutaneous Pedicle Screws
Authors: Ishii Ken , Shiono Yuta , Funao Haruki , Singh Kern , Matsumoto Morio 
Published: March 2018

Study Design:
Surgical technique.

Objective:
To evaluate the efficacy of a novel groove-entry technique for thoracic percutaneous pedicle screw (PPS) insertion.

Summary of Background Data:
Minimally invasive spine stabilization (MISt) using posterior thoracolumbar instrumentation has many advantages over open procedures. Because of the variability among PPS entry points, the sloped cortex of the transverse process, and the narrow thoracic pedicle, thoracic PPS placement is technically challenging.

Materials and Methods:
A retrospective review of 24 patients who underwent minimally invasive spine stabilization procedures involving 165 thoracic PPS placements using the novel technique was performed. The thoracic PPS entry is a groove formed by 3 bony elements: the cranial portion of the base of the transverse process, the rib neck, and the posterolateral wall of the pedicle. This groove can be easily identified under fluoroscopy with a Jamshidi needle allowing thoracic PPS insertion in the craniocaudal direction.

Results:
Of the 165 thoracic PPSs placed, “Good” or “Acceptable” PPS placement accuracy was achieved in 152 (92.1%) and 164 (99.4%) placements, respectively. No complications such as organ injury, and screw loosening or breakage were observed with thoracic PPS insertion.

Conclusions:
This novel technique is both safe and reliable, with low misplacement and complication rates. In hospitals in which computer image guidance or navigation is unavailable, this groove-entry technique may become the standard for thoracic PPS insertion.
Sagittal Vertical Axias, Spinosacral Angle, Spinopelvic Angle, and T1 Pelvic Angle
Authors: Zhang Yun-peng , Qian Bang-ping , Qiu Yong , Qu Zhe , Mao Sai-hu , Jiang Jun , Zhu Ze-zhang 
Published: March 2018

Study Design:
This is a retrospective study.

Objective:
To identify the relationship between global sagittal alignment and health-related quality of life (HRQoL) in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis.

Summary of Background Data:
Little data are available on correlation between global sagittal alignment and HRQoL in AS.

Materials and Methods:
A total of 107 AS patients were included in this study. The radiographic parameters were measured on lateral radiographs of the whole spine, including sagittal vertical axias (SVA), spinosacral angle (SSA), spinopelvic angle (SPA), and T1 pelvic angle (TPA). HRQoL was assessed using the oswestry disability index questionnaire, the bath ankylosing spondylitis disease activity index, the bath ankylosing spondylitis functional index, and short form-36 questionnaire. The patients were divided into 2 groups: group A (n=76, global kyphosis≤70 degrees), group B (n=31, global kyphosis>70 degrees). Statistical analysis was performed to identify significant differences between these 2 groups. In addition, correlation analysis and multiple regression analysis between radiologic parameters and clinical questionnaires were conducted.

Results:
With respect to SVA, SSA, SPA, TPA, and HRQoL scores, significant differences were observed between 2 groups (P<0.05). Also, SVA, SSA, SPA, and TPA were significantly related to HRQoL. Multiple regression analysis revealed that SVA, SSA, SPA, and TPA were significant parameters in the prediction of HRQoL in AS patients with thoracolumbar kyphosis. Of note, HRQoL related much more to SSA and SPA than SVA and TPA.

Conclusions:
AS patients with moderate and severe deformity were demonstrated to be significantly different in terms of SVA, SSA, SPA, TPA, and HRQoL. Moreover, SVA, SSA, SPA, and TPA correlated with HRQoL significantly. In particular, SSA and SPA could better predict HRQoL than SVA and TPA in AS patients with thoracolumbar kyphosis.
Preoperative Mental Health is not Predictive of Patient-reported Outcomes Following a Minimally Invasive Lumbar Discectomy
Authors: Mayo Benjamin C. , Massel Dustin H. , Bohl Daniel D. , Long William W. , Modi Krishna D. , Narain Ankur S. , Hijji Fady Y. , Lopez Gregory , Singh Kern 
Published: March 2018

Study Design:
This is a retrospective cohort study.

Objective:
To determine if preoperative mental health is associated with patient-reported outcomes (PROs) following a minimally invasive lumbar discectomy.

Summary of Background Data:
PROs are commonly used to quantify a patient’s perceived health status. Recently, mental health has been theorized to directly affect patients’ perception of their disability and pain after spine surgery.

Materials and Methods:
A registry of patients who underwent a primary, single-level minimally invasive lumbar discectomy was reviewed. The association between preoperative Short-Form Health Survey mental composite score (MCS) and change in PROs [Oswestry Disability Index, back and leg visual analog scale (VAS) pain scores] from preoperative to postoperative (6-week, 12-week, 6-month) timepoints was assessed using multivariate regression controlling for patient demographics and the respective preoperative PRO. Patients in the top and bottom quartiles of preoperative MCS were compared regarding achievement of minimum clinically important difference for each PRO.

Results:
A total of 110 patients were included in the analysis. Better preoperative mental health was associated with lower preoperative disability and decreased preoperative back VAS (P<0.05 for each). Higher preoperative MCS was also associated with greater improvements in back VAS at 6-weeks postoperatively (P<0.05). There was no association between preoperative MCS and change in any PROs at the 12-week or 6-month postoperative visits. Patients in the bottom quartile of preoperative MCS achieved minimum clinically important difference in all PROs at similar rates to patients in the top quartile of preoperative MCS.

Conclusions:
Patients with better preoperative mental health scores are more likely to report decreased disability and pain preoperatively. However, preoperative mental health was not predictive of changes in long-term disability or pain. As a result, patients with a wide range of preoperative mental health scores can achieve satisfactory long-term reductions in disability and pain levels after a lumbar discectomy.

Level of Evidence:
Level IV.
Three-dimensional Cross-Platform Planning for Complex Spinal Procedures
Authors: Kosterhon Michael , Gutenberg Angelika , Kantelhardt Sven R. , Conrad Jens , Nimer Amr Amr , Gawehn Joachim , Giese Alf 
Published: March 2018

Study Design:
A feasibility study.

Objective:
To develop a method based on the DICOM standard which transfers complex 3-dimensional (3D) trajectories and objects from external planning software to any navigation system for planning and intraoperative guidance of complex spinal procedures.

Summary of Background Data:
There have been many reports about navigation systems with embedded planning solutions but only few on how to transfer planning data generated in external software.

Materials and Methods:
Patients computerized tomography and/or magnetic resonance volume data sets of the affected spinal segments were imported to Amira software, reconstructed to 3D images and fused with magnetic resonance data for soft-tissue visualization, resulting in a virtual patient model. Objects needed for surgical plans or surgical procedures such as trajectories, implants or surgical instruments were either digitally constructed or computerized tomography scanned and virtually positioned within the 3D model as required. As crucial step of this method these objects were fused with the patient’s original diagnostic image data, resulting in a single DICOM sequence, containing all preplanned information necessary for the operation. By this step it was possible to import complex surgical plans into any navigation system.

Results:
We applied this method not only to intraoperatively adjustable implants and objects under experimental settings, but also planned and successfully performed surgical procedures, such as the percutaneous lateral approach to the lumbar spine following preplanned trajectories and a thoracic tumor resection including intervertebral body replacement using an optical navigation system. To demonstrate the versatility and compatibility of the method with an entirely different navigation system, virtually preplanned lumbar transpedicular screw placement was performed with a robotic guidance system.

Conclusions:
The presented method not only allows virtual planning of complex surgical procedures, but to export objects and surgical plans to any navigation or guidance system able to read DICOM data sets, expanding the possibilities of embedded planning software.
A New Method of Measuring the Occipitocervical Angle That Could be Applied as an Intraoperative Indicator During Occipitocervical Fusion
Authors: Nagashima Shingo , Nagae Masateru , Arai Yuji , Tonomura Hitoshi , Takatori Ryota , Sukenari Tsuyoshi , Fujiwara Hiroyoshi , Sawada Koshiro , Mikami Yasuo , Kubo Toshikazu 
Published: March 2018

Study Design:
A method for measuring occipitocervical angle.

Objective:
To develop a new method of measurement for assessing the occipitocervical angle using intraoperative fluoroscopic imaging, and to examine its reliability.

Summary of Background Data:
To avoid postoperative complications following occipitocervical fusion, it is vital to obtain a suitable fusion angle between the occipital bone and the upper cervical spine.

Materials and Methods:
The subjects were 30 cases with occipito-atlanto-axial lesions and 30 healthy volunteers. Lateral plain radiographs of the cervical spine in neutral position were used to draw the McGregor line, the line between the external occipital protuberance and the most caudal point on the midline occipital curve (Oc line), the tangential line of the inferior endplate of the C2 vertebra (C2 line), and the posterior longitudinal line of the C2 vertebra (Ax line). The angles formed by these 4 lines and the horizontal line were measured. The O-C2 angle and the Oc-Ax angle, the new indicator, were measured by 3 doctors and reliability was evaluated.

Results:
In the disease group, mean intraobserver variances of the McGregor, Oc, C2, Ax, O-C2, and Oc-Ax angles were 0.7, 1.3, 1.5, 1.2, 1.6, and 1.9 degrees. Mean intraobserver intraclass correlation coefficients were 0.997, 0.994, 0.994, 0.997, 0.989, and 0.988, showing high intraobserver reliability for all angles. Mean interobserver intraclass correlation coefficients were 0.998, 0.996, 0.994, 0.997, 0.988, and 0.990, showing high interobserver reliability for all angles. The same reliability was obtained in the healthy group.

Conclusions:
The Oc-Ax angle is as reliable an indicator as the conventional O-C2 angle, and could be used as a new intraoperative indicator for occipitocervical fusion. It may be particularly useful in cases where it is difficult to identify the McGregor line and/or the inferior endplate of the C2 vertebra.

Level of Evidence:
Level 3—diagnostic study.
Assessment of the Cross-Sectional Areas of the Psoas Major and Multifidus Muscles in Patients With Adult Spinal Deformity
Authors: Banno Tomohiro , Yamato Yu , Hasegawa Tomohiko , Kobayashi Sho , Togawa Daisuke , Oe Shin , Mihara Yuki , Kurosu Kenta , Yamamoto Naoto , Matsuyama Yukihiro 
Published: March 2018

Study Design:
This is a case-control study.

Objective:
The present study aimed to compare the cross-sectional areas of the psoas major and multifidus muscles between elderly patients with adult spinal deformity (ASD) and age-matched and body weight–matched controls, and to evaluate the associations between the cross-sectional areas of these muscles and the severity of spinal deformity.

Summary of Background Data:
The study included 49 female kyphosis patients with mild scoliosis (Cobb angle <20 degrees; mean age, 70.9 y, group D). The control group (group C) included age-matched and body weight–matched female patients who underwent abdominal surgery (n=98; mean age, 71.7 y).

Materials and Methods:
The cross-sectional areas of the bilateral psoas majors and multifidus muscles were calculated using preoperative L4/L5 axial computed tomography images. In group D, the following spinopelvic parameters were assessed: sagittal vertical axis, pelvic tilt, pelvic incidence, lumbar lordosis, and thoracic kyphosis. The relationships between the muscle cross-sectional areas and spinopelvic parameters were evaluated.

Results:
The cross-sectional area of the multifidus muscle was lower in group D than in group C. However, the cross-sectional area of the psoas major muscle was not different between the 2 groups. In multiple regression analysis, the cross-sectional area of the multifidus muscle was significantly associated with all spinopelvic parameters.

Conclusions:
The cross-sectional area of the multifidus muscle might be lower in elderly patients with ASD than in controls. In the elderly population, the severity of sagittal spinal deformity might be correlated with the cross-sectional area of the multifidus muscle. Therefore, muscle imbalances between the flexors and extensors of the spine could participate in the pathology of ASD.