bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Difference in Clinical Outcomes After Anterior Cervical Fusion, Disk Replacement, and Foraminotomy in Professional Athletes
Authors: Mai Harry T. , Chun Danielle S. , Schneider Andrew D. , Hecht Andrew C. , Maroon Joseph C. , Hsu Wellington K. 
Published: March 2018

Study Design:
Retrospective case series.

Object:
To compare postoperative outcomes of professional athletes treated for cervical disk herniation after anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), or total disk replacement (TDR).

Summary of Background Data:
ACDF, PF, and TDR have all led to excellent outcomes in the general population but the unique demands in the professional athlete necessitate specific study.

Methods:
Athletes of 4 major American professional sports leagues—National Football League, Major League Baseball, National Hockey League and National Basketball Association—diagnosed with cervical disk herniation and managed operatively were identified. Athletes were grouped into cohorts based on operation type. Athlete performance outcome measures were calculated based on sport-specific statistics and assessed as a percentage change after surgery to standardize comparison across sports.

Results:
A total of 101 professional athletes were identified (ACDF=86, PF=13, and TDR=2). The PF cohort had a significantly greater return to play rate and shortest time to return after surgery (P=0.03 and P=0.04, respectively). However, the reoperation rate at the index level was significantly higher in PF athletes compared with ACDF (46.2% vs. 5.8%; P<0.001) over the study follow-up period (average, 13.5 y). There was no significant difference in performance score after surgery for all surgical cohorts (P=0.41) and among cohorts (P=0.41). When analyzed by sport only baseball athletes experienced a significant decrease in performance after surgery (P=0.049).

Conclusions:
ACDF and PF are both viable options with excellent outcomes in professional athletes. PF allows a significantly higher rate and quicker return to play but portends a higher risk for reoperation compared with ACDF. TDR results are limited in our cohort and require further study to determine professional athlete outcomes.

Level of Evidence:
Level IV.
Novel Technique for Sacral Alar-Iliac (S2AI) Fixation
Authors: Andrade Nicholas S. , Okafor Louis , Neuman Brian J. 
Published: March 2018

Objective:
To provide reasoning and steps for the placement of sacral alar-iliac (S2AI) screws for pelvic arthrodesis to aid osseous lumbosacral fusion.

Summary of Background Data:
Studies support lower rates of screw breakage and need for revision surgery or hardware removal for S2AI screws compared with traditional iliac bolts, as well as low rates of pseudoarthrosis and arthritis associated with this hardware placement.

Materials and Methods:
A case video of S2AI placement demonstrates our operative technique and is accompanied by procedural description of surgical maneuvers.

Results and Surgical Techniques:
One patient underwent lumbosacral fusion surgery aided by S2AI-mediated pelvic fixation.

Conclusions:
The present technique utilizing S2AI screws provides for successful pelvic fixation to aid in lumbosacral fusion, with no need for subcutaneous tissue dissection and improved outcomes compared with traditional iliac bolts.
Variation in Spine Surgeon Selection Criteria Between Neurosurgery and Orthopedic Surgery Patients
Authors: Hijji Fady Y. , Narain Ankur S. , Haws Brittany E. , Witiw Christopher D. , Kudaravalli Krishna T. , Yom Kelly H. , Deutsch Harel , Singh Kern 
Published: March 2018

Study Design:
A cross-sectional survey study.

Objective:
The objective of this study is to determine if there are any differences in spine surgeon selection criteria between neurosurgery patients and orthopedic patients.

Background Information:
The evolution of the health care delivery system has allowed for increased patient autonomy in provider selection. However, the process and criteria by which patients choose particular spine surgeons is not well understood. Furthermore, differences in physician selection criteria used by patients who present either to a neurosurgery or orthopedic spine surgeon has not been previously established.

Materials and Methods:
An anonymous questionnaire consisting of 26 questions was administered to 644 patients seeking treatment from either a single neurosurgery-trained or orthopedics-trained spine surgeon at an urban institution. Four questions pertained to demographic variables. Sixteen questions asked patients to rate specific spine surgeon selection criteria in terms of importance (scale, 1–10). Six questions were multiple choice, asking patients to select their preferences towards aspects of a spine surgeon. Patient responses were compared using χ2 analysis or Fisher exact test for categorical variables.

Results:
The 3 most important factors for selecting a spine surgeon were the same for neurosurgery and orthopedic surgery patients: board certification (neurosurgery, orthopedic surgery) (9.07±2.35, 9.22±1.79), in-network provider status (8.01±3.15, 8.09±3.03), and surgeon bedside manner (7.88±2.52, 8.07±2.29). When listing their preference regarding surgeon specialty training, 82.74% of neurosurgery patients and 48.81% of orthopedic surgery patients preferred a surgeon who was trained in neurosurgery.

Conclusions:
The growth in patient autonomy within the current health care system has emphasized the importance of identifying patient preferences in the physician selection process.
Board certification, in-network insurance status, and bedside manner may be the most influential factors for patients in spine surgeon selection irrespective of surgical subspecialty. Patients may also be more likely to seek spine surgeons with neurosurgery training over orthopedic surgery training. The present study provides spine surgeons a framework to improve both patient recruitment and patient satisfaction.
Heterogeneity of Reporting Outcomes in the Spine Surgery Literature
Authors: Cooper Maxwell E. , Torre-Healy Luke A. , Alentado Vincent J. , Cho Samuel , Steinmetz Michael P. , Benzel Edward C. , Mroz Thomas E. 
Published: March 2018

Study Design:
Review of spine surgery literature between 2005 and 2014 to assess the reporting of patient outcomes by determining the variability of use of patient outcomes metrics in the following categories: pain and disability, patient satisfaction, readmission, and depression.

Objective:
Expose the heterogeneity of outcomes reporting and discuss current initiatives to create more homogenous outcomes databases.

Summary of Background Data:
There has been a recent focus on the reporting of quality metrics associated with spine surgery outcomes. However, little consensus exists on the optimal metrics that should be used to measure spine surgery outcomes.

Materials and Methods:
A PubMed search of all spine surgery manuscripts from January 2005 through December 2014 was performed. Linear regression analyses were performed on individual metrics as well as outcomes categories as a fraction of total papers reviewing surgical outcomes.

Results:
Outcomes reporting has increased significantly between January 1, 2005 and December 31, 2014 [175/2871 (6.1%) vs. 764/5603 (13.6%), respectively; P<0.001; R
2=98.1%]. For the category of pain and disability reporting, Visual Analog Score demonstrated a statistically significant decrease in use from 2005 through 2014 [56/76 (73.7%) vs. 300/520 (57.7%), respectively; P<0.001], whereas Oswestry Disability Index increased significantly in use [19/76 (25.0%) vs. 182/520 (35.0%), respectively; P<0.001]. For quality of life, EuroQOL-5 Dimensions increased significantly in use between 2005 and 2014 [4/23 (17.4%) vs. 30/87 (34.5%), respectively; P<0.01]. In contrast, use of 36 Item Short Form Survey significantly decreased [19/23 (82.6%) vs. 57/87 (65.5%), respectively; P<0.01]. For depression, only the Zung Depression Scale underwent a significant increase in usage between 2005 and 2014 [0/0 (0%) vs. 7/13 (53.8%), respectively; P<0.01].

Conclusions:
Although spine surgery outcome reporting has increased significantly over the past 10 years, there remains considerable heterogeneity in regards to individual outcomes metrics utilized. This heterogeneity makes it difficult to compare outcomes across studies and to accurately extrapolate outcomes to clinical practice.
Mini-open Lateral Retropleural Approach for Symptomatic Thoracic Disk Herniations
Authors: Yen Chun-Po , Uribe Juan S. 
Published: March 2018

Background:
Surgeries for symptomatic thoracic disk herniations (TDH) remain challenging.

Objective:
A mini-open lateral retropleural approach is described and the clinical outcomes are reported.

Materials and Methods:
A total of 23 patients underwent mini-open lateral retropleural diskectomy. Patients were placed in a lateral position. A 5-cm lateral incision was made followed by resection of the rib after careful dissection of its undersurface from the endothoracic fascia. The fascia was incised and separated from parietal pleura to widen the retropleural space. The rib head was removed followed by a pedicle resection below the TDH to expose the dura. A posterior partial corpectomy above and below the disk was performed to create a space ventral to the TDH, which was later dissected away from the dura and removed.

Results:
Fourteen males and 9 females comprised the clinical cohort. Five presented with axial back pain, 7 with radicular pain and 11 with myelopathy. All but 2 disks were successfully removed. The mean blood loss was 214cc and the mean hospital stay was 5.3 days. There was no mortality or new neurological deficits. The mean follow-up was 15.4 months.

Conclusions:
Mini-open lateral retropleural approach is safe and effective to remove symptomatic TDH with minimal morbidities and fast patient recovery.
Effectiveness of Surgical Treatment for Tarlov Cysts
Authors: Dowsett Laura E. , Clement Fiona , Coward Stephanie , Lorenzetti Diane L. , Noseworthy Tom , Sevick Laura , Spackman and Eldon 
Published: March 2018

Summary of Background Data:
In the general population, it has been estimated that 1.5% of people have ≥1 Tarlov cysts, with about 13% of those being symptomatic. Despite a range of options for treatment, there is debate about when, and how to optimally treat individuals with Tarlov cysts among clinicians, and among policy decision makers.

Objective:
To summarize the current evidence on surgical treatment of Tarlov cysts.

Study Design:
A systematic review was completed.

Methods:
Nine databases were searched. Abstracts and full-texts were assessed by 2 reviewers. To be included, studies had to assess safety, efficacy, or effectiveness of treating Tarlov cysts, had to be written in English or French, and had to be a randomized, quasi-randomized, observational cohort, case control, or case series design including ≥2 participants. Logistic regression analysis was undertaken on the patient-level data collected to assess the association of patient and cyst characteristics on treatment success.

Results:
In total, 31 studies were included in this systematic review; all were case series. Among the 646 participants included in these 31 studies, 210 experienced complete resolution of symptoms (32%), 327 had partial resolution (50%), 106 did not have any improvement or worsening of symptoms (16%), and 3 had their symptoms worsen after surgery (0.4%). A number of adverse events were reported after surgery; however, all were temporary. The analysis of 49 patients with data on cyst size resulted in the odds of complete resolution of symptoms being lower for patients with larger cysts (odds ratio=0.53, P-value=0.107) although this finding is not statistically significant. For those with a cyst >1.5 cm the odds of complete resolution were (odds ratio=0.36, P-value=0.190) compared with those with a cyst <1.5 cm.

Conclusions:
The evidence suggests that surgery for symptomatic Tarlov cysts may be an effective option for partially or completely relieving symptoms. Contrary to previous findings larger cysts were not associated with completely relieving symptoms.
The Effect of Severity of Illness on Spine Surgery Costs Across New York State Hospitals
Authors: Kaye I. David , Adrados Murillo , Karia Raj J. , Protopsaltis Themistocles S. , Bosco Joseph A. 
Published: March 2018

Study Design:
Observational database review.

Objective:
To determine the effect of patient severity of illness (SOI) on the cost of spine surgery among New York state hospitals.

Summary of Background Data:
National health care spending has risen at an unsustainable rate with musculoskeletal care, and spine surgery in particular, accounting for a significant portion of this expenditure. In an effort towards cost-containment, health care payers are exploring novel payment models some of which reward cost savings but penalize excessive spending. To mitigate risk to health care institutions, accurate cost forecasting is essential. No studies have evaluated the effect of SOI on costs within spine surgery.

Materials and Methods:
The New York State Hospital Inpatient Cost Transparency Database was reviewed to determine the costs of 69,831 hospital discharges between 2009 and 2011 comprising the 3 most commonly performed spine surgeries in the state. These costs were then analyzed in the context of the specific all patient refined diagnosis-related group (DRG) SOI modifier to determine this index’s effect on overall costs.

Results:
Overall, hospital-reported cost increases with the patient’s SOI class and patients with worse baseline health incur greater hospital costs (P<0.001). Moreover, these costs are increasingly variable for each worsening SOI class (P<0.001). This trend of increasing costs is persistent for all 3 DRGs across all 3 years studied (2009–2011), within each of the 7 New York state regions, and occurs irrespective of the hospital’s teaching status or size.

Conclusions:
Using the 3M all patient refined-DRG SOI index as a measure of patient’s health status, a significant increase in cost for spine surgery for patients with higher SOI index was found. This study confirms the greater cost and variability of spine surgery for sicker patients and illustrates the inherent unpredictability in cost forecasting and budgeting for these same patients.
The Epidemiology of Vertebral Osteomyelitis in the United States From 1998 to 2013
Authors: Issa Kimona , Diebo Bassel G. , Faloon Michael , Naziri Qais , Pourtaheri Sina , Paulino Carl B. , Emami Arash 
Published: March 2018

Study Design:
This is a epidemiological database analysis.

Objectives:
The objectives of this article are to assess the following characteristics of vertebral osteomyelitis (VO): (1) incidence and patient demographics, (2) mortality rate, (3) length-of-stay (LOS), and (4) admission costs.

Summary of Background:
VO is a serious disease with potentially devastating clinical consequences. At present, there is limited data on the epidemiology of VO in the United States as previous reports are based on older studies with small sample sizes.

Methods:
We used the Nationwide Inpatient Sample database and estimated that 228,044 patients were admitted for VO in the United States between 1998 and 2013. Data were extracted on patient demographics, comorbidities, inpatient mortality, LOS, and inflation-adjusted hospitalization charges. Multivariable regression analyses were performed.

Results:
The incidence of VO admission was 4.8 per 100,000, increasing from 8021 cases (2.9/ 100,000) in 1998 to 16,917 cases (5.4/100,000) in 2013. Majority of patients were white (74%), male (51%), younger than 59 years of age (49.5%), and carried Medicare insurance (50%). The increase in incidence for male and females was similar. The mortality rate during hospital stay was 2.1%, decreasing from 2% in 1998 to 1.7% in 2006 and increasing to 2.2% in 2013. Risk factors for mortality included increased age, male sex, and higher comorbidity score. History of congestive heart failure [odds ratio (OR)=2.45], cerebrovascular disease (OR=1.92), liver disease (OR=2.33), hepatitis C (OR=2.36), and renal disease (OR=1.88) was associated with higher mortality rate. Mean LOS was 9.2 days, decreasing from 9.1 days in 1998 to 8.8 days in 2013. The mean estimated hospital charges for admission were $54,599, however, this increased from $24,102 in 1998 (total of $188.8 millions) to $80,786 in 2013 (total of $1.3 billions).

Conclusion:
This condition is associated with lengthy and expensive hospital stays resulting in a significant burden to patients and the health care system.
Adjacent Level Degeneration
Authors: Miller Justin , Sasso Rick , Anderson Paul , Riew K. Daniel , McPhilamy Austin , Gianaris Thomas 
Published: March 2018

Study Design:
Prospective randomized, 2-center, clinical trial.

Objective:
To prospectively compare adjacent level degeneration between the Bryan Cervical Disc Prosthesis and anterior cervical discectomy and fusion (ACDF), and assess the reliability of our measurements utilizing a method not previously described.

Summary of Background Data:
ACDF is a reliable and proven procedure for the treatment of radiculopathy and/or myelopathy. Despite a successful track record several limitations including adjacent segment degeneration/disease, loss of viscoelastic disc properties, perioperative immobilization, graft site morbidity, pseudarthrosis, and plating complications have been identified. An original driving force and theoretical basis for total disc arthroplasty was prevention of adjacent level degeneration.

Materials and Methods:
Seventy-nine patients were enrolled and followed prospectively at 2 centers in a multicenter, Food and Drug Administration Investigational Device Exemption trial for the Bryan Cervical Disc arthroplasty. Neutral lateral radiographs were obtained preoperatively and postoperatively, and at 1-, 2-, 4-, and out to 7-year follow-up after surgery. The cephalad, adjacent level above the blinded procedure level was analyzed for all patients and time points by measuring the anteroposterior distance and the vertical disc height. A ratio was created using disc height/anteroposterior distance.

Results:
Seventy patients (Bryan Cervical Disc N=34 and ACDF N=36) met inclusion criteria. Both fusion and arthroplasty groups showed a significant (P=0.001) decrease in disc height over time, indicative of adjacent level degeneration. Overall change in disc height between groups was not significantly different. Using our measurement technique, the overall interreviewer reliability was good [intrareviewer correlation coefficients (95% confidence interval)=0.77 (0.55–0.85)] and intrareviewer reliability was excellent [0.93 (0.91–0.94) and 0.85 (0.81–0.87)].

Conclusions:
Adjacent level degeneration occurs in a similar manner in both the ACDF and total disc arthroplasty group. Our measurement technique is reliable and to the best of our knowledge not previously reported in the literature.
Genetic Variant of SOCS3 Gene is Functionally Associated With Lumbar Adolescent Idiopathic Scoliosis
Authors: Qiao Jun , Xiao Lingyan , Xu Leilei , Qian Bangping , Zhu Zezhang , Qiu Yong 
Published: March 2018

Study Design:
This is a genetic association study.

Objective:
To investigate association between suppressor of cytokine signaling-3 (SOCS3) gene polymorphisms and the onset and progression of lumbar adolescent idiopathic scoliosis (AIS) and to further clarify its role in the regulation of SOCS3 expression in AIS patients.

Summary of Background Data:
Some studies showed that muscle development imbalance may be responsible for onset and progression of lumbar AIS. SOCS3 is one of the significant regulators of skeletal muscle development, and in vitro study showed that SOCS3 influences myoblast differentiation.

Materials and Methods:
Rs4969198 was genotyped in 476 lumbar AIS patients and 672 controls. The differences of genotype and allele distributions between patients and controls were calculated using the χ2 test. Paravertebral muscles were collected from 53 AIS, 23 congenital scoliosis, and 18 lumbar disk herniation patients. AIS patients were classified into 3 groups according to the genotypes of each single nucleotide polymorphisms, and 1-way analysis of variance test was used to compare SOCS3 expression among different groups and genotypes.

Results:
Patients were found to have a significantly higher frequency of GG than the controls (40.8% vs. 29.9%, odds ratio=1.36; P=0.000), and the frequency of allele G was found to be remarkably higher in the patients than the controls (65.3% vs. 56.7%, odds ratio=1.15; P=0.000). AIS patients had significantly less muscle expression of the SOCS3 than the congenital scoliosis patients (2.73±2.17 vs. 4.62±2.41; P=0.006) and the lumbar disk herniation patients (2.73±2.17 vs. 4.12±2.93; P=0.009). The SOCS3 expression was significantly correlated with the curve severity (r=0.472; P=0.014).

Conclusions:
The SOCS3 gene is significantly associated with the development of lumbar AIS in Chinese population. Decreased expression of SOCS3 is associated with larger severity of lumbar AIS.

Level of Evidence:
Level III.
A Meta-analysis of the Association Between Physical Activity and Breast Cancer Mortality
Authors: Lee Junga 
Published: March 2018

Background
There are conflicting data on the association between physical activity (PA) intensity and amount and prognosis of breast cancer. It is unknown whether increasing or decreasing PA is associated with all-cause mortality.

Objective
The purpose of this study was to estimate the associations between PA and the risk of mortality.

Methods
MEDLINE and EMBASE were used to find eligible studies published from January 1970 to March 2017 for this meta-analysis. We included 24 studies, with a total of 144 224 patients and follow-up periods ranging from 1.9 to 12.7 years. We categorized the amount of PA as low (<300 min/wk), moderate (300–500 min/wk), and high (>500 min/wk).

Results
We found that high amounts of PA had an inverse relationship with breast-cancer–specific mortality and all-cause morality. Patients who decreased PA after diagnosis showed poorer all-cause mortality, whereas patients who increased PA postdiagnosis had a favorable association with all-cause mortality. Last, patients who met PA guidelines after diagnosis had a lower breast-cancer–specific mortality and all-cause mortality.

Conclusion
Physical activity may play a pivotal role in reducing the risk of death. Getting at least 300 min/wk of moderate-intensity PA will help improve the risk of breast cancer death.

Implications for Practice
Participating in PA is an essential factor in breast cancer care that extends throughout the life span of cancer survivors. Higher levels of PA than current PA guidelines should be recommended to cancer patients.