bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Structural Disease Burden to Health-related Quality of Life Scores in 264 Adult Spinal Deformity Patients With 2-Year Follow-up
Authors: Bakhsheshian Joshua , Scheer Justin K. , Gum Jeffrey L. , Horner Lance , Hostin Richard , Lafage Virginie , Bess Shay , Protopsaltis Themistocles S. , Burton Douglas C. , Keefe Malla , Hart Robert A. , Mundis Gregory M. , Shaffrey Christopher I. , Schwab Frank , Smith Justin S. , Ames Christopher P. 
Published: March 2018

Study Design:
This is a review of a prospective multicenter database.

Objective:
To investigate the relationship between preoperative disability and sagittal deformity in patients with high Oswestry Disability Index (ODI) and no sagittal malalignment, or low ODI and high sagittal malalignment.

Summary of Background Data:
The relationship between ODI and sagittal malalignment varies between each adult spinal deformity (ASD) patient.

Methods:
A prospective multicenter database of 365 patients with ASD undergoing surgical reconstruction was analyzed. Inclusion criteria entailed: age 18 years or above and the presence of spinal deformity as defined by a coronal Cobb angle≥20 degrees, sagittal vertical axis (SVA)≥5 cm, pelvic tilt (PT) angle≥25 degrees, or thoracic kyphosis≥60 degrees. Radiographic and health-related quality of life (HRQOL) variables were examined and compared, preoperatively and at 2-year postoperative follow-up. Group 1 (low disability high sagittal—LDHS) consisted of ODI<40 and SVA≥5 cm or PT≥25 degrees or pelvic incidence-lumbar lordosis≥11 degrees and group 2 (high disability low sagittal—HDLS) consisted of ODI>40 and SVA<5 cm and PT<25 degrees and pelvic incidence-lumbar lordosis<11 degrees.

Results:
Of 264 patients with follow-up, 58 (22.0%) patients were included in LDHS and 30 (11.4%) were included in HDLS. Both groups had similar demographics and preoperative coronal angles. HDLS had worse baseline HRQOL for all measures (P<0.05) except leg and back pain. HDLS had a higher rate of self-reported leg weakness, arthritis, depression and neurological disorder. Both groups had similar 2-year improvements in HRQOL (P>0.05), except only HDLS had a significant Scoliosis Research Society Mental improvement and a significantly higher rate of reaching minimal clinically important differences in Scoliosis Research Society Mental scores (P<0.05).

Conclusions:
There is an association of worse baseline HRQOL measures, weakness, arthritis, and mental disease in HDLS. Furthermore, HDLS patients demonstrated similar improvements to LDHS. However, HDLS had greater improvements in the mental domains, perhaps indicating the responsiveness of the mental disability to surgical treatment.

Level of Evidence:
Level III.
BMP Use and the Risk of Revision Surgery After Long Posterolateral Fusions in the Elderly
Authors: Puvanesarajah Varun , Jain Amit , Cancienne Jourdan M. , Stein Benjamin E. , Novicoff Wendy M. , Shimer Adam L. , Shen Francis , Hassanzadeh Hamid 
Published: March 2018

Study Design:
Retrospective database review.

Objective of the Study:
The objective of the study was to assess whether bone morphogenetic protein (BMP) decreases the risk of revision surgery in elderly patients treated with 3–7 level or 8 or greater level fusions.

Summary of Background Data:
Revision spine surgery in the elderly is a complex undertaking, highlighting the importance of discovering methods to decrease the risk of repeat procedures. The role of BMP in modulating risk of future revision surgery is not well studied in the elderly.

Materials and Methods:
The PearlDiver database (2005–2012) was queried for elderly adult spinal deformity patients treated with a primary thoracolumbar posterolateral fusion of 3 or more levels. To compare how BMP modifies revision surgery rates in 3–7 level versus 8 level or greater fusions, 4 mutually exclusive cohorts were created and matched to one another: 1043 patients treated with 8 or greater level fusions with BMP; 1111 patients with 8 or greater level fusions without BMP; 2813 patients with 3–7 level fusions with BMP; and 4770 patients with 3–7 level fusions without BMP. Revision and complication rates were compared. Complications included seroma formation, heterotopic ossification, and postoperative neuritis within 90 days.

Results:
Patients treated with BMP during an 8 or greater level fusion were significantly less likely to require a revision surgery than matched controls (relative risk, 0.75, P=0.015). BMP use was not associated with a decreased risk of revision surgery in 3–7 level fusions (relative risk, 0.89, P=0.20). Patients treated with BMP during 3–7 level fusions were significantly less likely to develop any of the assessed complications (P=0.02). There were no other significant differences in pairwise comparisons of subcohorts of each of the fusion lengths.

Conclusions:
BMP use decreases revision rates in elderly adult spinal deformity patients treated with 8 or greater level fusions, but not in those treated with 3–7 level fusions.

Level of Evidence:
Level III.
Correlation Analysis Between Modic Change of Cervical Vertebrae and Intramedullary High Signal Intensity
Authors: Zhou Hao , Fan Jin , Sun Peng , Zhou Wei , Li Qingqing , Yu Lipeng , Yin Guoyong 
Published: March 2018

Purpose:
Clinical studies have shown that endplate Modic change in the cervical spine and intramedullary high signal intensity often occurs simultaneously. We aimed to investigate whether there is a correlation between Modic change and intramedullary high signal intensity, and to explore the possible risk factors.

Materials and Methods:
In total, 133 patients with cervical spondylotic myelopathy treated at the First Affiliated Hospital of Nanjing Medical University between May 2009 and March 2013 were enrolled in the study. Preoperative cervical magnetic resonance imaging and radiographs in hyperextension and hyperflexion were analyzed. With regard to magnetic resonance imaging, all patients were classified into groups according to Modic change types and intramedullary high signal intensity; the ratio of spinal cord compression reflected the degree of spinal stenosis. For plain radiographs, total range of motion (ROM) and segmental ROM of the cervical vertebrae were measured.

Results:
Modic change of the cervical vertebral endplate and intramedullary high signal intensity demonstrated a significantly positive correlation. In patients with Modic change and intramedullary high signal intensity, the segmental angle of motion of the cervical vertebrae in hyperextension, cervical segmental ROM, and ratio of spinal cord compression were significantly higher than in patients without Modic change and intramedullary high signal intensity.

Conclusions:
The occurrence of Modic change and intramedullary high signal intensity are related to cervical instability and spinal canal stenosis. Severe disc protrusion may cause an increase of ROM in cervical hyperextension. Such patients are more prone to Modic change of the cervical vertebral endplate and intramedullary high signal intensity.
Narcotic Consumption Following Anterior and Lateral Lumbar Interbody Fusion Procedures
Authors: Bohl Daniel D. , Narain Ankur S. , Hijji Fady Y. , Ahn Junyoung , Mayo Benjamin C. , Massel Dustin H. , Long William W. , Modi Krishna D. , Singh Kern 
Published: March 2018

Study Design/Setting:
This is a retrospective analysis of a prospectively maintained surgical registry.

Objective:
To characterize postoperative narcotic consumption in patients undergoing either an anterior lumbar interbody fusion (ALIF) or a lateral lumbar interbody fusion (LLIF).

Background Context:
There is substantial interest in evaluating the safety, efficacy, and outcomes following minimally invasive techniques for lumbar fusion procedures. However, few studies have characterized postoperative narcotic consumption in patients undergoing ALIF or LLIF procedures.

Methods:
Consecutive patients who underwent either an ALIF or LLIF during 2007–2014 were identified. Inpatient narcotic consumption was recorded in oral morphine equivalents and dichotomized as greater or less than the 75th percentile total consumption (elevated or normal inpatient consumption). Demographic, comorbidity, and perioperative characteristics were tested for independent association with inpatient narcotic consumption and with continued narcotic usage during the months following surgery.

Results:
A total of 169 patients met inclusion criteria. Of these, 118 (69.8%) underwent ALIF and 51 (30.2%) underwent LLIF procedures. The risk for elevated inpatient narcotic consumption was greater in patients whose body mass index was≥30 kg/m2 [relative risk (RR), 2.8; 95% confidence interval (CI), 1.6–4.8; P<0.001). The risk for continued narcotic usage at the first postoperative visit was elevated in patients with worker’s compensation payment status (RR, 2.0; 95% CI, 1.5–2.7; P<0.001). The risk for continued narcotic usage at the second postoperative visit was elevated in patients with worker’s compensation payment status (RR, 2.6; 95% CI, 1.7–4.1; P<0.001) and in patients with preoperative narcotic utilization (RR, 2.2; 95% CI, 1.4–3.5; P<0.001).

Conclusions:
The present study suggests that while patients with greater body mass index have increased narcotic consumption as inpatients, preoperative narcotic consumption and worker’s compensation payment status are the best predictors of continued narcotics usage during the months following surgery. Worker’s compensation patients and patients who utilize narcotics preoperatively should be the targets of efforts to reduce continued postoperative narcotic usage.
The Safe Correction Angle of Osteotomy at T12 and L1 for Ankylosing Spondylitis Kyphosis
Authors: Liu Chao , Yu Wen , Zheng Guoquan , Guo Yue , Song Kai , Tang Xiangyu , Wang Zheng , Wang Yan , Zhang Yonggang 
Published: March 2018

Study Design:
This is a retrospective clinical study.

Objective:
To investigate the correction angle and safety of the spinal osteotomy at the T12 or L1 vertebra.

Summary of Background Date:
Monosegment subtraction osteotomy cannot effectively correct severe kyphosis in ankylosing spondylitis (AS), generally 2-level spinal osteotomy was taken for achieving expected correction. According to literature, the T12 or L1 were usually taken as the upper spinal osteotomy vertebra. Because of the canalis vertebralis at the T12 and L1 were spinal cord and medullary cone, so the spinal osteotomy at the T12 or L1 vertebra were more dangerous than at lower level. The correction angle and safety of the spinal osteotomy at the T12 or L1 vertebra have not yet been reported.

Materials and Methods:
From July 2009 to 2014, 33 patients in our department with severe AS kyphosis underwent 2-level pedicle subtraction osteotomy were studied. Preoperative and postoperative relevant parameters and complications were recorded.

Results:
The upper spinal osteotomy was taken at the T12 vertebra for 10 patients. The upper spinal osteotomy was taken at the L1 vertebra for 23 patients. The mean amount of correction of T12 and L1 was 26.230 and 27.952 degrees, respectively. All patients could walk with orthophoria and lie horizontally postoperatively. No deadly vascular and neurological lesion occurred.

Conclusions:
Performing pedicle subtraction osteotomy at T12 and L1 can safely achieve a mean correction of 26.230 and 27.952 degrees, respectively. Two-level osteotomy was safely and advocated for correcting severe AS kyphosis.

Level of Evidence:
Level III.
Initial Experience With Real-Time Continuous Physical Activity Monitoring in Patients Undergoing Spine Surgery
Authors: Scheer Justin K. , Bakhsheshian Joshua , Keefe Malla K. , Lafage Virginie , Bess Shay , Protopsaltis Themistocles S. , Burton Douglas C. , Hart Robert A. , Shaffrey Christopher I. , Schwab Frank , Smith Justin S. , Smith Zachary A. , Koski Tyler R. , Ames Christopher P. 
Published: March 2018

Study Design:
Multicenter prospective pilot study.

Objective:
To evaluate if continuous physical activity monitoring by a personal electronic 3-dimensional accelerometer device is feasible and can provide objective data that correlates with patient-reported outcomes following spine surgery.

Summary of Background Data:
Self-reported health-related quality-of-life (HRQOL) metrics are inherently limited by being very subjective, having a low frequency of data collection, and inconsistent follow-up.

Methods:
Inclusion criteria: adults (18+), thoracolumbar deformity or degenerative disease, and regular access to a computer with internet connection. Physical activity parameters included: number of daily steps, maximum hourly steps, and activity intensity. Patients completed the Oswestry Disability Index (ODI), the Short-Form Health Survey 36 (SF-36), and the Scoliosis Research Society-22r (SRS22) preoperatively and postoperatively at 6 weeks, 3 months, and 6 months.

Results:
Thirty-two patients were enrolled, 8 (25%) withdrew, 1 (3.1%) died, and 1 (3.1%) did not end up undergoing surgery resulting in 22 (68.8%) available patients. Mean preoperative and postoperative step ranges were 1278±767 to 17,800±6464 and 891±587 to 12,655±7038, respectively. Eleven patients improved in mean total daily steps at the final postoperative month with 2 having significant improvements (P<0.05). Five patients did not significantly change (P>0.05) and 6 patients had significantly lower mean total daily steps at 6 months (P<0.05). The entire cohort significantly improved in ODI, SF-36 Physical Component Summary, SRS Activity, SRS Appearance, SRS Mental, SRS Satisfaction, and SRS Total score at 6 months postoperative (P<0.05 for all). Both ODI and Physical Component Summary were significantly correlated with preoperative average total daily steps (r=−0.61, P=0.0058 and r=0.60, P=0.0114, respectively). No other HRQOL metrics were significantly correlated at baseline or at 6 months postoperative (P>0.05).

Conclusions:
A prospective pilot study for continuous real-time physical activity monitoring was successfully completed. This is the first study of its kind and demonstrates a foundation to continuous physical activity monitoring following spine surgery. A larger and longer prospective study is needed to confirm long-term results and its relationship with HRQOL scores.
Metastatic Spinal Cord Compression and Steroid Treatment
Authors: Kumar Abhishek , Weber Michael H. , Gokaslan Ziya , Wolinsky Jean-Paul , Schmidt Meic , Rhines Laurence , Fehlings Michael G. , Laufer Ilya , Sciubba Daniel M. , Clarke Michelle J. , Sundaresan Narayan , Verlaan Jorrit-Jan , Sahgal Arjun , Chou Dean , Fisher Charles G. 
Published: March 2018

Study Design:
Systematic review.

Objectives:
We conducted a systematic review of the literature to answer the following questions regarding the use of steroid therapy in metastatic spinal cord compression (MSCC): 1. In cases of MSCC, what is the effect of steroid administration before definitive radiotherapy or surgery on ambulatory status, bowel and bladder function and survival? 2. What steroid dosing regimens are associated with the best outcomes concerning neurological symptoms and complication prevention in cases of MSCC?

Summary of Background Data:
Currently, there is significant variation in the initial bolus dose, daily maintenance dose and duration of treatment when steroids are used as a bridge to definitive therapy for MSCC.

Methods:
A literature search following PRISMA guidelines was conducted in June 2016, using Medline via Ovid SP, Medline via PubMed, Embase, Biosis Previews and the Cochrane Library. Search terms used in each database varied slightly to optimize results. All generic steroid formulations were included along with spinal cord compression or myelopathy combined with metastatic or malignant tumors. Papers discussing acute traumatic causes of spinal cord compression were excluded, as were papers discussing cord compression from nonmetastatic tumors or epidural lipomatosis. Subjects were limited to adult humans undergoing definitive treatment with radiotherapy or surgery.

Results:
Of the 309 papers retrieved, 66 full text studies were reviewed and 6 papers were found to address the stated questions.

Conclusions:
There is a paucity of high quality literature evaluating the use of steroids in MSCC. On the basis of the evidence available an initial 10 mg intravenous bolus of dexamethasone followed by 16 mg PO QD has been associated with fewer complications compared with 100 mg bolus and 96 mg QD. Weaning of steroids should occur rapidly after definitive treatment. Risk of gastric bleeding or perforation can be managed with the routine use of proton-pump inhibitors.

Level of Evidence:
Level IIIa.
Cryopreserved Amniotic Membrane Improves Clinical Outcomes Following Microdiscectomy
Authors: Anderson D. Greg , Popov Victor , Raines Andrew L. , O’Connell Julie 
Published: March 2018

Study Design:
Prospective, randomized controlled trial.

Objective:
To compare pain, physical/mental functional recovery and recurrent herniation for patients following lumbar microdiscectomy with and without the use of a cryopreserved amniotic tissue graft.

Summary of Background Data:
Although microdiscectomy procedures are routinely successful for patients with lumbar radiculopathy due to herniated disc disease, residual low back pain, and recurrent herniation remain unsolved clinical problems.

Methods:
Following Investigated Review Board approval, 80 subjects were randomized in a 1:1 ratio to either receive cryopreserved amniotic (cAM) tissue or no tissue following elective lumbar microdiscectomy surgery. cAM grafts were applied to the annular defect at the conclusion of the procedure. Patients provided preoperative and postoperative clinical assessment data out to 24 months using the Oswestry Disability Index (ODI), Short Form-12 (SF-12) Health Survey, and Visual Analog Pain Scale for back and leg pain. Patients with symptomatic recurrent disc herniation were recorded.

Results:
In total, 48 males and 32 females with an average age of 47.2 years were included. Mean ODI scores for subjects treated with cAM graft demonstrated statistically greater improvement at 6 weeks (14.49 vs. 21.82; P=0.05) and 24 months (6.62 vs. 14.40; P=0.02) compared with controls. Similarly, SF-12 Physical Component Scores demonstrated statistically greater gains in the cAM group at both the 6 weeks and 24 months. None of the subjects in the cAM graft group sustained a recurrent herniation at the same surgical level, whereas 3 patients in the control group sustained a recurrent herniation at the same surgical level, with 2 requiring fusion to manage persistent pain.

Conclusions:
The data demonstrate statistically superior clinical outcomes following lumbar microdiscectomy as measured by ODI and SF-12 (physical composite scale) and a lower rate of recurrent herniation with the use of a cAM tissue graft compared with traditional microdiscectomy.
Functional Recovery Following Early Kyphoplasty Versus Conservative Management in Stable Thoracuolumbar Fractures in Parachute Jumpers
Authors: Masoudi Mohammad S. , Haghnegahdar Ali , Ghaffarpasand Fariborz , Ilami Ghazal 
Published: March 2018

Study Design:
A randomized clinical trial.

Objective:
To compare the functional recovery between early kyphoplasty and conservative care in paratroopers with stable thoracolumbar fractures.

Summary of Background Data:
Treatment of traumatic stable thoracolumbar fractures in young individuals is still a debate. Conservative management and kyphoplasty are options of therapy. But enough data are not available for supporting each.

Methods:
We included 70 paratroopers with stable thoracolumbar fractures (A1 and A2 classification according to AOSpine thoracolumbar spine injury classification system) presenting <60 days after trauma and hyperintensity in T2-weighted magnetic resonance imaging. Old fractures and those requiring fixation were excluded. Patients were randomly assigned to 2 study groups to undergo percutaneous balloon kyphoplasty (n=34) or conservative care (n=36) by applying orthosis for 2 months. Patients were followed for 12 months and were evaluated clinically using visual analogue scale (VAS) and Oswestry disability index (ODI).

Results:
The baseline characteristics were comparable between 2 study groups. The VAS score and ODI decreased significantly in both study groups after 12 months of treatment. The VAS score was significantly lower in kyphoplasty group after the intervention (P<0.001), 1 month (P<0.001), 3 months (P<0.001), 6 months (P<0.001), and 12 months (P<0.001) after the intervention. In addition, the ODI was significantly lower after the intervention (P<0.001), 1 month (P<0.001), 3 months (P<0.001), 6 months (P<0.001), and 12 months (P<0.001) after the intervention. Kyphoplasty was associated with shorter duration of returning to parachuting (P<0.001) and shorter duration of absence from work (P<0.001).

Conclusions:
Early kyphoplasty in stable thoracolumbar fractures after parachute jumping is associated with less pain, better functional recovery, less days of absence from work, and shorter duration of returning to parachuting.
Radiographic and Clinical Outcomes of Anterior and Transforaminal Lumbar Interbody Fusions
Authors: Ajiboye Remi M. , Alas Haddy , Mosich Gina M. , Sharma Akshay , Pourtaheri Sina 
Published: March 2018

Study Design:
Systematic review and meta-analysis.

Objective:
Compare the radiographic and clinical outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF).

Summary of Background Data:
ALIF and TLIF are 2 methods of achieving spinal arthrodesis. There are conflicting reports with no consensus on the optimal interbody technique to achieve successful radiographic and clinical outcomes. The goal of this systematic review and meta-analysis was to compare the radiographic and clinical outcomes of ALIF to TLIF.

Materials and Methods:
A systematic search of multiple medical reference databases was conducted for studies comparing ALIF to TLIF. Studies that included stand-alone ALIFs were excluded. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcome measures included segmental and overall lumbar lordosis, and fusion rates. Clinical outcomes measures included Oswestry disability index (ODI) and visual analog scale (VAS) score for back pain.

Results:
The search yielded 7 studies totaling 811 patients (ALIF=448, TLIF=363). ALIF was superior to TLIF in restoring segmental lumbar lordosis at L4–L5 and L5–S1 (L4–L5; P=0.013, L5–S1; P<0.001). ALIF was also superior to TLIF in restoring overall lumbar lordosis (P<0.001). However, no significant differences in fusion rates were noted between both techniques [odds ratio=0.905; 95% confidence interval, 0.458–1.789; P=0.775]. In addition, ALIF and TLIF were comparable with regards to ODI and VAS scores (ODI; P=0.184, VAS; P=0.983).

Conclusions:
For the restoration of lumbar lordosis, ALIF is superior to TLIF. However, TLIF is comparable to ALIF with regards to fusion rate and clinical outcomes.