bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlations Between the SF-36, the Oswestry-Disability Index and Rolland-Morris Disability Questionnaire in Patients Undergoing Lumbar Decompression According to Types of Spine Origin Pain
Authors: Ko Sangbong , Chae Seungbum 
Published: March 2018

Study Design:
Cross-sectional study.

Objective:
To determine the correlation between SF-36 (a measure for overall health status in patients) and Oswestry-Disability Index (ODI) or Rolland-Morris Disability Questionnaire (RMDQ) confined to spine according to the type of pain from the spine.

Summary of Background Data:
Data showed moderate correlation between ODI and SF-36 Physical Component Score (PCS), Physical Functioning (PF) (r=−0.46), Physical Role Functioning (RP) (r=−0.284), Bodily Pain (BP) (r=−0.327), and Mental Component Score (MCS), Emotional Role Functioning (r=−0.250), Social Role Functioning (r=0.254), Vitality (r=0.296).

Materials and Methods:
Between January 1, 2008 and December 31, 2013, a total of 69 patients were enrolled in this study. They were diagnosed with lumbar spinal stenosis and underwent decompression surgery such as laminotomy in this hospital. The 3 standardized questionnaires (ODI, RMDQ, and SF-36) were given to these patients, at least 1 year after the surgery.

Results:
ODI and SF-36 had a statistically significant (P=0.001) and moderate correlation. Small correlations were also seen between Physical Functioning (r=−0.46), Physical Role Functioning (r=−0.284), and Bodily Pain (r=−0.327) of SF-36 PCS and ODI, and between Emotional Role Functioning (r=−0.250), Social Role Functioning (r=−0.254), and Vitality (r=−0.296) of SF-36 Mental Component Score and ODI. Items in ODI for the level of pain while standing and traveling were mostly related to axial back pain, while item of lifting was related to referred buttock pain. Sleeping disturbance section in the ODI was mainly caused by radiated leg pain. In addition, RMDQ was also associated to the 3 types of pain.

Conclusions:
Moderate correlation was found between ODI or RMDQ as a condition-specific outcome and the SF-36, indicating overall health status. ODI was found to be a more adequate measure to evaluate axial back pain rather than referred pain or radiating pain. RMDQ was adequate to measure the health status and to evaluate the 3 types of spine pain. These 3 instruments could therefore provide the clinician with complementary information about the patient’s status.
Can an Anchored Cage be Substituted for an Anterior Cervical Plate and Screw for Single-Level Anterior Cervical Fusion Surgery?
Authors: Seo Dong Kwang , Kim Moon Kyu , Choi Soo Jung , Sohn Jun Young , Kim Young Ki , Jeong Eui Kyun , Ha Jung-Ki , Kim Chung Hwan , Park Jin Hoon 
Published: March 2018

Study Design:
This is a case series of device failure patients.

Objective:
To identify poor candidates for anterior cervical discectomy and fusion (ACDF) using an anchored cage.

Summary of Background Data:
An anchored cage has been used as an alternative implant for ACDF surgery because of ease of use, relatively acceptable fusion rate, and lower risk of plate-related complications, including dysphagia.

Materials and Methods:
We retrospectively reviewed the outcomes of 36 patients who underwent ACDF using an anchored cage between January 2012 and December 2013. The initial diagnoses included 8 traumatic soft disk herniations without posterior ligamentous complex injury, 25 degenerative soft disk herniations, 1 degenerative foraminal stenosis, 1 traumatic soft disk herniation after reducing a unilaterally dislocated facet joint, and 1 subluxation of a previously implanted cervical artificial disk. We encountered 5 cases with poor outcomes and performed 3 revisions on the index level. We reviewed the clinical and radiologic data for 31 patients with reasonable outcomes and reviewed the failed 5 cases separately.

Results:
Among the 31 patients with reasonable outcomes, all the clinical parameters improved. For the radiologic outcomes, 10 cases of cage subsidence occurred and no patient experienced instability.
Among the 5 patients with poor outcomes, 1 patient had traumatic soft disk herniation and a reduced unilaterally dislocated facet joint, 1 patient had subluxation of a previously implanted cervical artificial disk, and 3 patients had degenerative soft disk herniation and poor bone quality. Although 3 patients required revision surgeries, 2 patients showed only radiologic failures without revision.

Conclusions:
We analyzed the short-term outcomes of ACDF using an anchored cage and observed 5 patients with poor outcomes among 36 patients. We recommend the use of a single anchored cage for patients with definite evidence of posterior column stability and healthy bone.

Level of Evidence:
Level 3.
A Posterior Oblique Approach to the Lumbar Disk Spaces, Vertebral Bodies, and Lumbar Plexus
Authors: Spiessberger Alexander , Baumann Fabian , Häusler Martin , Rühli Frank , Fandino Javier , Muroi Carl 
Published: March 2018

Study Design:
A laboratory cadaveric study.

Objective:
We aimed to demonstrate the feasibility of a posterior oblique approach, sharing the same advantages as the transpsoas technique while minimizing the risk of lumbar plexus or psoas muscle injuries.

Summary of Background Data:
The transpsoas approach for interbody fusion and corpectomy offers advantages over posterior and anterior approaches. However, possible risks include traumatization of the psoas muscle or lumbar plexus.

Methods:
All lumbar disk spaces and vertebral bodies were exposed by a posterior oblique approach from left and right on a human cadaveric specimen. The exposure obtained and a step-by-step documentation of the procedure is outlined in detail.

Results:
We were able to achieve wide exposure of all lumbar disk spaces and vertebral bodies above the L5/S1 disk space. Only the psoas muscle was retracted, and the lumbar plexus nerves were easily visualized and gently retracted. Sharp dissection was only required around the tip of the transverse processes.

Conclusions:
A posterior oblique approach seems to be less invasive than the transpsoas approach. Exposure of the anterior column structures above the iliac crest is comparable. The oblique approach offers direct access to the lumbar plexus and the extraforaminal segments of the nerve roots.
Five-Year Reoperation Rates of 2-Level Lumbar Total Disk Replacement Versus Fusion
Authors: Radcliff Kris , Spivak Jeffrey , Darden Bruce , Janssen Michael , Bernard Thierry , Zigler Jack 
Published: March 2018

Study Design:
Long-term analysis of prospective randomized clinical trial data.

Summary of Background Data:
Lumbar total disk replacement (TDR) has been found to have equivalent or superior clinical outcomes compared with fusion and decreased radiographic incidence of adjacent level degeneration in single-level cases.

Objective:
The purpose of this particular analysis was to determine the incidence and risk factors for secondary surgery in patients treated with TDR or circumferential fusion at 2 contiguous levels of the lumbar spine.

Methods:
A total of 229 patients were treated and randomized to receive either TDR or circumferential fusion to treat degenerative disk disease at 2 contiguous levels between L3 and S1 (TDR, n=161; fusion, n=68).

Results:
Overall, at final 5-year follow-up, 9.6% of subjects underwent a secondary surgery in this study. The overall rate of adjacent segment disease was 3.5% (8/229). At 5 years, the percentage of subjects undergoing secondary surgeries was significantly lower in the TDR group versus fusion (5.6% vs. 19.1%, P=0.0027).
Most secondary surgeries (65%, 17/26) occurred at the index levels. Index level secondary surgeries were most common in the fusion cohort (16.2%, 11/68 subjects) versus TDR (3.1%, 5/161 subjects, P=0.0009). There no statistically significant difference in the adjacent level reoperation rate between TDR (2.5%, 4/161) and fusion (5.9%, 4/68). The most common reason for index levels reoperation was instrumentation removal (n=9). Excluding the instrumentation removals, there was not a significant difference between the treatments in index level reoperations or in reoperations overall.

Conclusions:
There were significantly fewer reoperations in TDR patients compared with fusion patients. However, most of the secondary surgeries were instrumentation removal in the fusion cohort. Discounting the instrumentation removals, there was no significant difference in reoperations between TDR and fusion. These results are indicative that lumbar TDR is noninferior to fusion.
Halo-Vest Immobilization in Elderly Odontoid Fracture Patients
Authors: DePasse J. Mason , Palumbo Mark A. , Ahmed Abdul-Kareem , Adams Charles A. , Daniels Alan H. 
Published: March 2018

Study Design:
Retrospective cohort study.

Objective:
To evaluate the utilization and effectiveness of halo-vest (HV) immobilization for type II odontoid fractures from 2004 to 2014.

Summary of Background Data:
Controversy persists regarding the optimal treatment method for odontoid fractures in the elderly. Management options include immobilization in a cervical orthosis, HV immobilization, and operative intervention. Over the past decade, high mortality and morbidity rates have been reported following HV immobilization in this patient population.

Materials and Methods:
In a retrospective study, patient demographics, presentation, Charlson comorbidity index, treatment method, and outcome data for patients over 65 who had suffered type II odontoid fractures from 2004 to 2014 were compared with a historical cohort from 1997 to 2004.

Results:
One hundred twenty-six patients met inclusion criteria. The mean age was 82.7±8.8 compared with 80.7±0.9 in the 1997–2004 cohort. The in-hospital mortality rate from 2004 to 2014 was 11.1% (14/126) compared with 31% in the historical cohort, and 10 (7.9%) patients were treated with HV compared with 49%. Mortality in the HV group was higher than the surgical group (P=0.01) but no different from the orthosis group (P=0.63).There were no differences in injury severity score, Charlson comorbidity index, or complications between treatment groups.

Conclusions:
Over the past decade, HV use for elderly odontoid fractures has decreased at our institution. Mortality and morbidity of elderly patients treated with HV has also decreased. These findings are likely the result of improved patient selection and greater attention to respiratory care. This study demonstrates that HV immobilization of odontoid fractures in elderly patients can be as safe as cervical orthosis treatment in select patients.
Lateral Extracavitary Approach Versus Posterior Extensive Circumferential Decompression in the Treatment of Complicated Thoracic and Lumbar Tuberculous Spondylitis
Authors: Omran Khaled , Abdel-Fattah Ahmed S. , Othman Ahmed M.A. , Youssef Ahmed O. , Solimen Amr , ElRefai Mohamed A. , Saleh Ahmed N. , Ali Mohammed 
Published: March 2018

Objectives and Study Design:
The aim of this study was to retrospectively evaluate 45 patients operated upon either by posterior extensive circumferential decompression (PECD) or by the lateral extracavitary (LEC) technique and compare the clinical, radiologic, laboratory, and functional outcomes.

Summary of Background:
The debate continues on the best decompression-fusion technique for treating complicated spinal tuberculosis. In recent times, the advantages of combined surgery have been successfully achieved using the 1-stage salvage technique, with enough accessibility to all 3 spinal columns.

Materials and Methods:
From January 2011 to December 2013, 51 patients with complicated spinal tuberculous were surgically treated at our department. After gaining the approval of the local ethics committee, 45 patients and their records were available for evaluation. The patients were divided into 2 groups. Group I included 23 patients treated with PECD and group II included 22 patients treated with LEC. Two authors and an independent observer performed the final clinical assessment by means of clinical examination and by using the Visual Analog Scale and Oswestery Disability Index for determining pain, disability, and quality of life. The radiographs were reviewed independently by 3 authors and a radiologist for fusion, kyphotic angle, and angle loss rate. Neurological assessment using the American Spinal Injury Association motor index was performed by 2 authors and a neurologist independently.

Results:
The mean follow-up period was 36±5.5 months. In all patients, local symptoms were relieved significantly postoperatively. There were no major complications in this series. Three patients contracted superficial wound infection and 2 developed intercostal neuralgia. Both complications resolved uneventfully and did not influence the outcome. Solid interbody fusion was diagnosed in 43 cases (95.6%). Deformity correction and neurological recovery were significantly improved in both groups (P<0.001). PECD showed better results than LEC.

Conclusions:
Both procedures attained good results for maintained deformity correction, bony fusion, spinal cord decompression, and neurological improvement in complicated tuberculous spondylitis. However, PECD may be superior to LEC.
Is Preexisting Cervical Disk Degeneration a Prognostic Factor in Whiplash-associated Disorders?
Authors: Chung Nam-Su , Jeon Chang-Hoon , Lee Yu-Sang , Park Jang-Ho , Lee Han-Dong 
Published: March 2018

Study Design:
This is a retrospective control study.

Objective:
We aimed to determine whether preexisting cervical disk degeneration is a prognostic factor in Whiplash-associated disorder (WAD).

Summary of Background Data:
WAD is a common injury of traffic accident and has a broad range of prognoses. Although numerous studies have investigated prognostic factors in WAD, few have evaluated the effect of preexisting disk degeneration.

Materials and Methods:
This study involved 45 consecutive patients with grade I or II WAD having advanced disk degeneration (at least 1 disk of Miyazaki grade≥III on magnetic resonance imaging) and a control cohort of 52 patients with no or mild disk degeneration (all disks having Miyazaki grades≤II). Clinical assessment included pain severity (assessed by the visual analog scale), neck pain-related disability (assessed by the neck disability index), and physical and mental health condition [assessed by the short-form 36 (SF-36) physical composite score and SF-36 mental composite score, respectively]. Changes in each parameter were evaluated at baseline and at 3-month, 6-month, and 1-year follow-ups and compared between the 2 groups.

Results:
There were no differences between the 2 groups regarding demographics and baseline outcome parameters (all P>0.05). There were also no differences in improvement in visual analog scale for neck pain, neck disability index, SF-36 physical composite score, or SF-36 mental composite score between the 2 groups (all P>0.05) for each visit. The number of claim closures was significantly lower among patients with advanced degeneration than among controls at 6-month and 1-year follow-ups (P=0.004 and 0.006, respectively).

Conclusions:
In the present study, the clinical presentation and prognosis of WAD were not affected by preexisting disk degeneration. However, claim closure was delayed in patients with preexisting disk degeneration. These results suggest that misunderstanding of disk degeneration on magnetic resonance imaging may create persistent illness and lead to continued compensation in WAD.
Reliability of Sagittal Spinopelvic Alignment Measurements After Total Hip Arthroplasty
Authors: Pernaa Katri , Seppänen Matti , Mäkelä Keijo , Saltychev Mikhail 
Published: March 2018

Study design:
This is a observational study.

Objective:
To evaluate the reliability of measuring sagittal spinopelvic alignment after hip arthroplasty.

Summary of Background Data:
Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and lumbar lordosis (LL) are widely used in planning the treatment of people with spinal and hip disorders. Previously, these measures have proved reliable when hip heads are intact. Thus far, it is not known whether they are also reliable after total hip replacement.

Materials and Methods:
Two observers assessed PI, SS, PT, and LL in the radiographs of 97 patients who had undergone total hip replacement. Test-retest (intraobserver) and interobserver reliability were estimated.

Results:
The intraclass correlation coefficient ranged from 0.92 to 0.97 and 0.85 to 0.94 for the intraobserver and interobserver settings, respectively, indicating an almost perfect correlation between observers or observations. The absolute intrarater measurement errors were 1.41 [95% confidence interval (CI), 0.98–2.03) for PI, 1.16 (95% CI, 0.78–1.74) for SS, 0.49 (95% CI, 0.31–0.76) for PT, and 1.75 (95% CI, 1.22–2.51) degrees for LL. The respective interrater figures were 2.82 (95% CI, 2.04–3.9), 2.44 (95% CI, 1.78–3.35), 0.73 (95% CI, 0.48–1.13), and 2.28 (95% CI, 1.55–3.34) degrees.

Conclusions:
It seems that total hip arthroplasty does not affect the reliability of spinopelvic sagittal alignment measurements.

Level of evidence:
Level II.
Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB
Authors: D’souza Areena R. , Mohapatra Bibhudendu , Bansal Murari L. , Das Kalidutta 
Published: March 2018

Study Design:
A retrospective study.

Objective:
To evaluate the results of posterior pedicle-screw fixation with transpedicular decompression in 21 cases of thoracic and thoracolumbar spinal tuberculosis (TB) in terms of functional, neurological, and radiologic outcomes.

Summary of Background Data:
Spinal TB is predominantly an anterior disease that can lead to kyphotic deformity. Hence, anterior debridement and fusion was considered as the gold standard. However, with remarkable improvements in chemotherapy regimens and diagnostic tools, it is possible to detect the disease process early and treat them with less radical approaches. In the present study, authors have shown the results of posterior pedicle-screw fixation with transpedicular decompression in thoracic and thoracolumbar spinal TB.

Materials and Methods:
The study reviewed 21 patients with thoracic or thoracolumbar TB with kyphotic deformity who were operated with posterior pedicle-screw fixation and transpedicular decompression (pus aspiration through a Jamshidi needle) with kyphosis correction for either neurological deficits (11) or intractable pain (10), not responding to at least 4–6 weeks of chemotherapy. Patients with <3 spinal segment involvement, <30 degrees kyphosis, and <50% vertebral body destruction were included in the study.

Results:
The mean age of patients was 43.9 years and the mean kyphosis angle at the level of involvement was 21.61±3.72 degrees. Kyphosis improved postoperatively to 5.79±3.48 degrees. The mean follow-up period was 24.09 months, and final kyphosis correction was maintained at 8.74±3.65 degrees. Bony fusion was achieved in 80.5% cases. Eleven patients had neurological deficits, and all of them recovered. All patients had a Visual Analog score improvement from 9.52 to 2.57 postoperatively.

Conclusions:
Posterior stabilization with transpedicular decompression can be considered as a good treatment option for the management of thoracic and thoracolumbar TB in patients with <50% vertebral body destruction and <30-degree kyphosis. It provides rapid relief of instability pain, improvement of neurological deficit, and prevents progression of deformity.
Value in Single-level Lumbar Discectomy
Authors: Rosenbaum Benjamin P. , Modic Michael T. , Krishnaney Ajit A. 
Published: March 2018

Study Design:
This is a retrospective study.

Objective:
Compare improvements in health status measures (HSMs) and surgical costs to determine whether use of more costly items has any relationship to clinical outcome and value in lumbar disc surgery.

Summary of Background Data:
Association between cost, outcomes, and value in spine surgery, including lumbar discectomy is poorly understood. Outcomes were calculated as difference in mean HSM scores between preoperative and postoperative timeframes. Prospective validated patient-reported HSMs studied were EuroQol quality of life index score (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire (PHQ-9). Surgical costs consisted of disposable items and implants used in operating room.

Methods:
We retrospectively identified all adult patients at Cleveland Clinic main campus between October 2009 and August 2013 who underwent lumbar discectomy (652) using administrative billing data, Current Procedural Terminology (CPT) code 63030. HSMs were obtained from Cleveland Clinic Knowledge Program Data Registry.

Results:
In total, 67% of operations performed in the outpatient or ambulatory setting, 33% in the inpatient setting. Among 9 surgeons who performed >10 lumbar discectomies, there were 72.4 operations per surgeon, on average. Mean surgical costs of each surgeon differed (P<0.0001). In a multivariable regression, only the surgeon and surgery type (outpatient or inpatient) were statistically correlated with surgical costs (P<0.0001 and 0.046, respectively). Changes in EQ-5D, PDQ, and PHQ-9 were not correlated with surgical costs (P=0.76, 0.07, 0.76, respectively). In multivariable regression, only surgical cost was significantly correlated to mean difference in PDQ (P=0.030). More costly surgeries resulted in worse PDQ outcomes.

Conclusions:
Mean surgical costs varied statistically among 9 surgeons; costs were not shown to be positively correlated with patient outcomes. Performing an operation using more costly disposable supplies/implants does not seem to improve patient outcomes and should be considered when constructing preference cards and during an operation.