bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Cage Dimensions, Positioning, and Side of Approach in Extreme Lateral Interbody Fusion
Authors: Alimi Marjan , Lang Gernot , Navarro-Ramirez Rodrigo , Perrech Moritz , Berlin Connor , Hofstetter Christoph P. , Moriguchi Yu , Elowitz Eric , Härtl Roger 
Published: March 2018

Study Design:
This is a retrospective single-center study.

Objective:
The aim of the study was to evaluate the impact of cage characteristics and position toward clinical and radiographic outcome measures in patients undergoing extreme lateral interbody fusion (ELIF).

Summary of Background Data:
ELIF is utilized for indirect decompression and minimally invasive surgical treatment for various degenerative spinal disorders. However, evidence regarding the influence of cage characteristics in patient outcome is minimal.

Materials and Methods:
Patients undergoing ELIF between 2007 and 2011 were included in a retrospective study. Demographic and perioperative data, as well as cage characteristics and side of approach were extracted. Radiographic parameters including lumbar lordosis, foraminal height, and disc height as well as clinical outcome parameters (Oswestry Disability Index and Visual Analog Scale) were measured preoperatively, postoperatively, and at the latest follow-up examination. Cage dimensions, in situ position, and type were correlated with radiographic and clinical outcome parameters.

Results:
In total, 84 patients with a total of 145 functional spinal units were analyzed. At the last follow-up of 17.7 months, radiographic and clinical outcome measures revealed significant improvement compared with before surgery with both, 18 and 22 mm cage anterior-posterior diameter subgroups (P≤0.05). Among cage characteristics, 22 mm cages presented superior restoration of foraminal and disc heights compared with 18 mm cages (P≤0.05). Neither position of the cage (anterior vs. posterior), nor the type (parallel vs. lordotic) had a significant impact on restoration of foraminal height and lumbar lordosis. Moreover, the side of surgical approach did not influence the amount of foraminal height increase.

Conclusions:
Cage anterior-posterior diameter is the determining factor in restoration of foraminal height in ELIF. Cage height, type, positioning, and side of approach do not have a determining role in radiographic outcome in the present study. Sustainable foraminal height restoration is achieved by implantation of wider cages.

Level of Evidence:
Level 3.
Vancomycin Powder Regimen for Prevention of Surgical Site Infection in Complex Spine Surgeries
Authors: Van Hal Michael , Lee Joon , Laudermilch Dann , Nwasike Chinedu , Kang James 
Published: March 2018

Study Design:
In total, 496 patients of a single surgeon cohort examining the surgical-site infection (SSI) rates with the addition of vancomycin powder in both diabetic and revision spine surgery cases. A historical control group of 652 patients were compared from the same surgeon over an earlier time period before the inception of using vancomycin powder prophylaxis.

Objective:
The objective of this study was to describe and compare the rates of infection in high-risk patient populations while using vancomycin powder.

Summary of Background Data:
Vancomycin powder may not decrease an already low rate of infection. Therefore, use of vancomycin powder in high-risk patients with a higher rate of infection would potentially show benefit of vancomycin powder.

Materials and Methods:
In total, 496 patient charts were collected from a database of cases. Patients were included in the cohort if they had revision spinal operation or if they were diabetic. Patients in the time period July 2010 to August 2013 were included in the vancomycin protocol where 1 g of vancomycin powder was added to the wound before wound closure. Cases were considered positive if there was a positive culture or if there was sufficient clinical suspicion to treat. As a control to this cohort, 692 charts were reviewed from a earlier time period of the same surgeon and institution.

Results:
In total, 28 patients of 496 (5.6%) patients in the cohort returned to the operating room for seroma, hematoma, draining wound, or infection. Sixteen of these patients (16/496, 3.2%) had a culture positive infection or were treated as an infection. This rate was significantly lower than the historical rate before the protocol.

Conclusions:
Although vancomycin does seem to be useful in decreasing SSIs, it is not a panacea. SSIs in high-risk patients were not completely eliminated by the vancomycin protocol.
Minimally Invasive Posterior Cervical Foraminotomy
Authors: Peto Ivo , Scheiwe Christian , Kogias Evangelos , Hubbe Ulrich 
Published: March 2018

Study Design:
Retrospective cohort study.

Objective:
Assessment of outcome after minimally invasive posterior cervical foraminotomy (MI-PCF).

Summary of Background Data:
Surgical management of cervical radiculopathy represents a controversial area in spinal surgery. Preferred approaches include both anterior cervical discectomy and posterior cervical foraminotomy (PCF). Numerous studies showed comparable results. Employing PCF eliminates risks associated with anterior approach. PCF as originally described by Spurling and Scoville necessitates extensive stripping of cervical muscles to expose the cervical spine, resulting in muscle injury, impaired muscle function, prolonged postoperative neck pain, and increased use of narcotics. There are only few studies investigating outcome after employing MI-PCF.

Materials and Methods:
Retrospective review of 34 patients who underwent MI-PCF for presenting complaints, postoperative and follow-up outcome.

Results:
In the last follow-up the weakness resolved completely in 62.6% of patients, in 4.1% improved and in 16.5% remained unchanged. In the last follow-up 76.7% of patients originally presenting with pain reported complete resolution of pain and 10% reported partial improvement of pain. In total, 23.5% of patients were lost during follow-up as far as pain was concerned. In the last follow-up, 75% of patients achieved relative neck-pain-freedom (Visual Analog Scale≤3) at rest and 62.5% of patients under strain. The mean neck pain on Visual Analog Scale at rest was 2.13 (SD=2.42) and 3.34 (SD=3.01) under strain. In total, 93.8% (n=15) of patients would undergo the same procedure for the same achieved result.

Conclusions:
Minimally invasive cervical foraminotomy is an effective procedure for decompression of cervical nerve roots regardless the type of the stenosis. Even employing minimally invasive technique still causes neck pain in the long term affecting up to 25% of patients. More randomized control studies are required to clarify the benefits of minimally invasive PCF.
Radiographic and Clinical Results of Freehand S2 Alar-Iliac Screw Placement for Spinopelvic Fixation
Authors: Park Young-Seop , Hyun Seung-Jae , Park Jong-Hwa , Kim Ki-Jeong , Jahng Tae-Ahn , Kim Hyun-Jib 
Published: March 2018

Study Design:
This was a retrospective clinical case series.

Objective:
The purpose of this study was to evaluate mid-term outcomes of S2 ala-iliac (S2AI) screw fixation in patients who underwent multilevel posterior spinal fusion surgery.

Summary of Background Data:
There have been few reports on radiographic and clinical outcomes in patients who underwent spinopelvic reconstruction surgery using S2AI screw installation.

Materials and Methods:
Twenty-three patients were treated by a single spinal surgeon between September 2013 and June 2014 utilizing segmental instrumentation with pedicle and S2AI screw. Instrumentation including S2AI screw was performed by a freehand technique. Surgical, radiographic, clinical outcomes and complications were evaluated to determine surgical results of S2AI screw fixation.

Results:
The mean follow-up period was 16.9 months (ranged, 13–22 mo). The average number of fusion levels was 7.9 vertebral bodies. There were no cases of neurological deficit and violation of acetabulum or sciatic notch. A peri-screw halo was found in 1 patient and cortical wall violation was observed in 4 patients. The number of lateral and medial breaches was 2 and 3, respectively. All of them were asymptomatic. One patient experienced sacroiliac joint pain after S2AI screw installation. There was no case of screw/rod fracture and revision surgery for S2AI screw.

Conclusions:
Radiographic and clinical outcomes of freehand S2AI screw fixation was acceptable. Sacroiliac joint irritation symptoms after S2AI screw fixation were rare. S2AI screw instrumentation can be a good alternative for spinopelvic fixation.

Level of Evidence:
Level 4.
Spinopelvic Parameters in Asymptomatic Subjects Without Spine Disease and Deformity
Authors: Noshchenko Andriy , Hoffecker Lilian , Cain Christopher M.J. , Patel Vikas V. , Burger Evalina L. 
Published: March 2018

Study Design:
A systematic review with meta-analysis.

Objective:
To combine published data, focusing on the development of optimal spinopelvic parameters in adult asymptomatic subjects without spine deformity while taking into consideration the impact of potential confounders.

Summary of Background Data:
A well-grounded approach to define the optimal spinopelvic parameters is necessary for planning surgical correction of spine deformity.

Materials:
Selection criteria: (1) randomized and nonrandomized prospective, cross-sectional, and retrospective studies; (2) participants: asymptomatic subjects without spine deformity aged above 18 years; (3) studied parameters: lumbar lordosis (LL), pelvic incidence, sacral slope, and pelvic tilt; (4) potential confounders: method of measurement, sex, age, ethnicity, weight, height, and body mass index. Search method: Ovid MEDLINE (1946-current) and EMBASE (1980-current), all years through October 2015 were included. Data were collected: number of enrolled subjects, means of the studied characteristics, SD, SE of the means, 95% confidence intervals. A meta-analysis was performed to evaluate the pooled means and range of optimal values (pooled mean±pooled SD) taking into consideration the impact of confounders. The GRADE approach was applied to evaluate the level of evidence.

Results:
Seventeen of 1018 studies were included (2926 subjects from 9 countries). The pooled means and the optimal ranges were: LL (L1–S1), 54.6 (42–67) degrees; LL (L1–L5), 37.0 (22–53) degrees; pelvic incidence, 50.6 (39–62) degrees; sacral slope, 37.7 (28–48) degrees; pelvic tilt, 12.6 (3–22) degrees. The pooled results were statistically significant (P<0.001), but heterogeneous. Impact of the following confounders was revealed: method of measurement, ethnicity, age, and body mass index. A methodology was created to define an individualized optimal value and range of each studied parameter taking into consideration the influence of confounders.

Conclusions:
The pooled results and developed methodology can be used as diagnostic criteria for evaluation of the spinopelvic parameters, planning of surgical interventions and evaluation of the treatment effect.
The Impact of L5 Sacralization on Fusion Rates and Clinical Outcomes After Single-level Posterior Lumbar Interbody Fusion (PLIF) at L4–L5 Level
Authors: Lee Gun Woo , Shin Ji-Hoon , Ryu Seung Min , Ahn Myun-Whan 
Published: March 2018

Study Design:
Retrospective review of prospectively collected data.

Objective:
To determine the impact of L5 sacralization on fusion rates and clinical outcomes after single-level posterior lumbar interbody fusion (PLIF) surgery at the L4–L5 level.

Summary of Background Data:
L5 sacralization can produce greater stress concentration at the adjacent segment (L4–L5); therefore, L4–L5 PLIF surgery in patients with L5 sacralization may negatively affect fusion rate and be associated with poor clinical outcomes. However, no study has examined the impact of L5 sacralization on fusion rates and clinical outcomes of patients who undergo L4–L5 PLIF surgery.

Materials and Methods:
Of 153 patients who underwent L4–L5 PLIF, data of 145 who met the study criteria were retrospectively reviewed. Among them, 31 patients had L5 sacralization (group A), whereas the remaining 114 patients did not (group B). The primary study endpoint was fusion rate evaluated using dynamic radiographs and computed tomographic scans. Secondary endpoints included (1) pain intensity in the lower back and radiating to the lower extremities on the visual analog scale; (2) clinical outcomes assessed using the Oswestry Disability Index and 12-item Short Form Health Survey; (3) surgical outcomes; and (4) complications.

Results:
Fusion rate evaluated using dynamic radiographs and computed tomographic scans at 6 months after surgery did not differ significantly between patients with and without sacralization (P=0.70 and 0.81, respectively), whereas fusion rate at 1 year after surgery did (P=0.04 and 0.04, respectively). In particular, patients with type II or III L5 sacralization had significantly lower fusion rates than those with other types of or no L5 sacralization. Pain intensity, clinical and surgical outcomes, and complications did not differ significantly between groups.

Conclusions:
Patients with type II or III L5 sacralization may have worse fusion rates after L4–L5 PLIF surgery than those with type I or no sacralization.
Association Between Allogeneic Blood Transfusion and Postoperative Infection in Major Spine Surgery
Authors: Fisahn Christian , Jeyamohan Shiveindra , Norvell Daniel C. , Tubbs Richard S. , Moisi Marc , Chapman Jens R. , Page Jeni , Oskouian Rod J. 
Published: March 2018

Study Design:
Retrospective cohort study.

Objective:
The objective of this study is to compare the incidence of infection in patients who do and do not receive blood transfusions in major deformity surgery (>8 levels).

Summary of Background Data:
Postoperative infections increase morbidity and mortality rates in spine surgery and generate additional costs for the health care system. It has been proposed that blood transfusions increase the risk of wound infection, urinary tract infection, pneumonia, and sepsis.

Methods:
A total of 56 patients met the study criteria, receiving spine surgery involving the fusion of 8 levels or more. Patient-specific characteristics, starting and ending hematocrits, number of units transfused and infections including urinary tract infection, wound infection, pneumonia, and sepsis were documented. Differences in infection risk between those who did and did not undergo a transfusion and their 95% confidence intervals were calculated.

Results:
Groups were similar with respect to baseline and surgical characteristics except for smoking status, operative time, estimated blood loss, and ending hematocrit. The overall infection rate was greater in patients who underwent transfusion than those who did not (36% vs. 10%; P=0.03). Wound infections (n=5) were only observed in those who underwent a transfusion. Smokers were more likely to receive a transfusion and more likely to experience infection. A stratified analysis demonstrated an increased risk of infection associated with transfusion; however, the risk was greater in smokers, suggesting the effect of transfusion on infection could be modified by smoking. Patients undergoing transfusion experienced a significantly longer hospital stay (P=0.01).

Conclusions:
Allogeneic red blood cell transfusion in major spine surgery could be a risk factor for postoperative infection. This increased risk seems to be magnified in those who smoke. Further studies are warranted, and risks of blood loss and transfusion-related complications in smokers also potentially merit exploration.

Level of Evidence:
Level 3.
A Comprehensive Meta-Analysis of the Adjacent Segment Parameters in Cervical Disk Arthroplasty Versus Anterior Cervical Discectomy and Fusion
Authors: Dong Liang , Wang Dongqi , Chen Xiujin , Liu Tuanjing , Xu Zhengwei , Tan Mingsheng , Hao Dingjun 
Published: March 2018

Study Design:
This is a meta-analysis of controlled trials.

Objective:
To assess the overall condition of adjacent segment of cervical disk arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:
With the increase in CDA and ACDF, surgeons are taking more attention to adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). There are more and more meta-analyses comparing the efficacy of CDA with ACDF, however, there are few meta-analyses referring to adjacent segment parameters, and investigators are still unable to arrive at the same conclusion.

Methods:
Several important databases were searched for controlled trials comparing CDA and ACDF before February 2016 according to PRISMA guidelines. The analysis parameters included follow-up time, operative segments, cervical range of motion (ROM), adjacent segment motion, ASDeg, ASDis and adjacent segment reoperation. The risk of bias scale and Newcastle-Ottawa Scale were used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity.

Results:
Forty-one controlled trials fulfilled the inclusion criteria, including 36 English papers and 5 Chinese. The average follow-up time of all included patients was 39 months. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (P<0.01), and the advantage of CDA group increased with the increasing of follow-up time according to subgroup analysis. The rate of ASDeg in CDA was significantly lower than that of ACDF (P<0.01). There was no statistical difference between upper and lower ASDeg using the same surgical method (P>0.05). CDA provided a greater cervical ROM than did ACDF (P<0.01). There was a lower adjacent segment ROM and the rate of ASDis in CDA compared with ACDF (P<0.05).

Conclusions:
Compared with ACDF, the advantages of CDA were lower ASDeg, ASDis, adjacent segment reoperation and adjacent segment motion; and higher cervical ROM. However, there was no statistical difference between upper and lower adjacent segment ROM/ASDeg using the same surgery.
Diagnostic Utility of Intraoperative Neurophysiological Monitoring for Intramedullary Spinal Cord Tumors
Authors: Azad Tej D. , Pendharkar Arjun V. , Nguyen Viet , Pan James , Connolly Ian D. , Veeravagu Anand , Popat Rita , Ratliff John K. , Grant Gerald A. 
Published: March 2018

Study Design:
Systematic review and meta-analysis.

Objective:
The aim of this study was to systematically evaluate the diagnostic utility of intraoperative neurophysiological monitoring (IONM) for detecting postoperative injury in resection of intramedullary spinal cord tumors (IMSCT).

Summary of Background Data:
Surgical management of IMSCT can involve key neurological and vascular structures. IONM aims to assess the functional integrity of susceptible elements in real time. The diagnostic value of IONM for ISMCT has not been systematically evaluated.

Methods:
We performed a systematic review of the PubMed and MEDLINE databases for studies investigating the use of IONM for IMSCT and conducted a meta-analysis of diagnostic capability.

Results:
Our search produced 257 citations. After application of exclusion criteria, 21 studies remained, 10 American Academy of Neurology grade III and 11 American Academy of Neurology grade IV. We found that a strong pooled mean sensitivity of 90% [95% confidence interval (CI), 84–94] and a weaker pooled mean specificity of 82% (95% CI, 70–90) for motor-evoked potential (MEP) recording changes. Somatosensory-evoked potential (SSEP) recording changes yielded pooled sensitivity of 85% (95% CI, 75–91) and pooled specificity of 72% (95% CI, 57–83). The pooled diagnostic odds ratio for MEP was 55.7 (95% CI, 26.3–119.1) and 14.3 (95% CI, 5.47–37.3) for SSEP. Bivariate analysis yielded summary receiver operative characteristic curves with area under the curve of 91.8% for MEPs and 86.3% for SSEPs.

Conclusions:
MEPs and SSEPs appear to be more sensitive than specific for detection of postoperative injury. Patients with perioperative neurological deficits are 56 times more likely to have had changes in MEPs during the procedure. We observed considerable variability in alarm criteria and interventions in response to IONM changes, indicating the need for prospective studies capable of defining standardized alarm criteria and responses.
Efficacy of Conical Laminoplasty After Thoracic Laminectomy
Authors: Kobayashi Kazuyoshi , Imagama Shiro , Ando Kei , Nishida Yoshihiro , Ishiguro Naoki 
Published: March 2018

Study Design:
Retrospective clinical study.

Objective:
To evaluate the results of a new method of laminoplasty, referred to as conical laminoplasty.

Summary of Background Data:
In surgery for a thoracic intradural tumor, laminectomy is frequently used for tumor resection. However, laminoplasty may be more effective due to prevention of damage to the posterior elements. This method can be performed as recapping T-saw laminoplasty and conical laminoplasty which we refer.

Materials and Methods:
After en bloc laminectomy, conical laminoplasty (group C; 21 cases) or recapping T-saw laminoplasty (group R; 17 cases) was performed for patients with thoracic spinal cord tumors. If neither was possible, laminectomy (group L; 16 cases) was performed.

Result:
The number of laminae removed and Japanese Orthopedic Association recovery rates did not differ significantly among the 3 groups. Sagittal kyphosis significantly worsened at final follow-up in group L, but did not change significantly in groups C and R.

Conclusions:
Conical laminoplasty is particularly useful in a case in which T-saw laminoplasty cannot be performed due to tumor expansion in the canal and ossification of the ligamentum flavum. Conical laminoplasty also preserves the posterior elements, which reduces the risk of worsening of kyphosis postoperatively.
Treatment of Degenerative Lumbar Spondylolisthesis With Fusion or Decompression Alone Results in Similar Rates of Reoperation at 5 Years
Authors: Vorhies John S. , Hernandez-Boussard Tina , Alamin Todd 
Published: March 2018

Study Design:
Population-based analysis of administrative discharge records from California, Florida, and New York inpatient, ambulatory, and emergency department settings between 2005 and 2011, utilizing Healthcare Cost and Utilization Project data.

Objective:
We aimed to compare, and characterize rates of reoperation and readmission among patients with degenerative spondylolisthesis treated with surgical decompression alone versus fusion.

Summary of Background Data:
Degenerative lumbar spondylolisthesis with stenosis can be treated by decompression with or without fusion. Fusion has traditionally been preferred. We hypothesized that rates of reoperation after decompression alone would be higher than after fusion.

Materials and Methods:
We undertook a population-based analysis of administrative discharge records from California, Florida, and New York inpatient, ambulatory, and emergency department settings between 2005 and 2011, with Healthcare Cost and Utilization Project data. We identified all patients who had degenerative spondylolisthesis who were treated with decompression alone or with fusion and compared their rates of reoperation at 1, 3, and 5 years from the index operation. We used descriptive statistics and a hierarchical logistic regression model to generate risk-adjusted odds of all-cause readmissions.

Results:
Our study consisted of 75,024 patients with spondylolisthesis; 6712 (8.95%) of them underwent decompression alone and 68,312 (91.05%) of them underwent fusion. Rates of reoperation were higher for decompression versus fusion at 1 year; 6.87% versus 5.53% (P≤0.001), but at 3 years; 13.86% versus 12.91% (P=0.18) and 5 years; 16.9% versus 17.7% (P=0.398) years rates of reoperation were not statistically different. Patients treated with decompression alone that had a second operation tended to have the operation sooner 512.6 versus 567.4 days (P=0.008).

Conclusions:
Our study suggests that treatment of degenerative spondylolisthesis with fusion or decompression alone results in similar rates of reoperation at 5 years. This medium term data indicate that decompression alone may be a viable treatment for some patients with degenerative spondylolisthesis.