bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Fundamental Sagittal Pelvic Parameters Based on Age, Sex, and Race
Authors: Merrill Robert K. , Kim Jun S. , Leven Dante M. , Kim Joung Heon , Meaike Joshua J. , Bronheim Rachel S. , Suchman Kelly I. , Nowacki Doug , Gidumal Sunder S. , Cho Samuel K. 
Published: March 2018

Study Design:
This is a retrospective cohort study.

Objective:
To determine whether age, sex, and race have independent effects on sagittal pelvic parameters.

Summary of Background Data:
Pelvic parameters and sagittal balance correlate with health-related quality of life and are important for patient assessment and surgical planning. Age, sex, and race are 3 unalterable patient factors that may influence pelvic morphology.

Methods:
We conducted a retrospective review of consecutive adult patients who presented to our radiology practice between 2010 and 2015 and had a standing, lateral lumbosacral radiograph. Any patients without both femoral heads and L1–S1 visible on the radiograph, and any patients presenting with traumatic injury, coronal deformity, prior instrumentation, spondylolisthesis, or neoplasm of the spine were excluded. Univariate analysis determined differences in measurements among African American, white, and Hispanic races, as well as between male and female sexes. Correlation analysis between age and different measurements was also conducted. Multivariable regression was then used to determine the independent effect of age, sex, and race on pelvic parameters.

Results:
We investigated 1801 adults (older than 18 y) and 1246 had a recorded race. There were 1165 women, 636 men, 525 whites, 404 African Americans, and 317 Hispanics. Multivariable regression demonstrated a statistically significant increase in pelvic tilt (PT), pelvic incidence (PI), and pelvic incidence-lumbar lordosis (PI-LL) with aging, and statistically significant decrease in sacral slope (SS) and LL with aging. Women had a statistically greater LL than men. African Americans had a statistically smaller PT and greater SS and PI-LL relative to whites, while Hispanics had a statistically smaller PT and PI-LL, and a statistically greater SS and LL relative to whites.

Conclusions:
Pelvic parameters were different between sexes, among races, and changed with age. These findings are important for patient assessment and preoperative planning to obtain optimal sagittal balance.

Level of Evidence:
Level 3.
Downward Laminotomy Technique for Hidden Zone Foraminal Disk Herniations
Authors: Naderi Sait , Onen Mehmet R. 
Published: March 2018

Introduction:
Hidden zone foraminal herniations are among the more rare forms of herniations. As exploration is difficult, and there is a close relationship between the nerve root and pedicle, many surgical approaches have been proposed. The aim of this study was to describe downward laminotomy as a new approach to these herniations.

Materials and Methods:
A downward laminotomy technique was used in 5 cases with hidden zone foraminal disk herniation with no extension to the intervertebral disk space.

Results:
The herniated disk fragment was located at L4–L5 in 4 cases and at L3–L4 in 1 case. Mean visual analog scale scores reduced from preoperative 8.2 to 2.1 postoperatively. The allodynia was resolved in two months.

Conclusions:
It was concluded that downward laminotomy provides a safe, less risky, and minimally invasive approach to hidden zone foraminal disk herniations.
Modified Lumbosacral Angle and Modified Pelvic Incidence as New Parameters for Management of Pediatric High-grade Spondylolisthesis
Authors: Ma Zhenjiang , Zhao Changqing , Zhang Kai , Du Lin , Tian Jianping , Sun Xiaojiang , Zhao Jie 
Published: March 2018

Study Design:
Retrospective clinical study.

Objective:
We aimed to introduce new parameters that can better describe the pelvic morphology and lumbosacral segmental deformity in children with high-grade spondylolisthesis of the L5 vertebra: modified pelvic incidence (mPI) and modified lumbosacral angle (mLSA). Also, we aimed to establish the mLSA as a convenient, reliable measurement method and criteria to evaluate the reduction of L5 vertebral slippage.

Summary of Background Data:
Numerous parameters and methods exist to evaluate segmental deformity and reduction of L5 vertebral slippage, but no definitive standard for accurately and conveniently describing lumbosacral kyphosis and degree of reduction exists.

Methods:
A total of 24 children with high-grade spondylolisthesis (S group) and 152 children without spondylolisthesis (non-S group) underwent standard lateral radiography of the spine in our hospital between June 2009 and June 2014. We compared mPI and mLSA between the S and non-S groups. The agreement and repeatability of mPI and mLSA were also assessed. Preoperative and postoperative Japanese Orthopaedic Association (JOA) and Scoliosis Research Society (SRS)-22 scores were compared to assess clinical outcomes in the S group. The correlations between modified parameter applications and clinical outcomes were also assessed.

Results:
While mPI did not differ between groups, mLSA differed significantly. In the non-S group, mLSA was lordotic (25.51±6.41 degrees). In the S group, mLSA was kyphotic (25.85±5.17 degrees) before surgery and lordotic (20.74±7.04 degrees) postoperatively. The agreement and repeatability of mPI and mLSA were good, and clinical outcomes of the S group were satisfactory. Positive correlations were found between modified parameter applications and the improvement rates of JOA scores.

Conclusions:
mPI and mLSA can better describe the pelvic morphology and local deformity of pediatric high-grade L5 spondylolisthesis, and mLSA can serve as a useful index for correcting lumbosacral kyphosis, rebalancing the sagittal spinal profile and predicting clinical outcomes.
Vertebroplasty and Kyphoplasty for Metastatic Spinal Lesions
Authors: Sadeghi-Naini Mohsen , Aarabi Shahram , Shokraneh Farhad , Janani Leila , Vaccaro Alexander R. , Rahimi-Movaghar Vafa 
Published: March 2018

Introduction:
The spine is the most common site of bone metastases. Vertebroplasty (VP) and kyphoplasty (KP) have been proposed as potential minimally invasive therapeutic options for metastatic spinal lesion (MSL) pain. However, the efficacy of VP and KP on MSL pain is currently unclear.

Objective:
The aim of this study was to assess the effects of VP and KP compared with each other, usual care, or other treatments on pain, disability, and quality of life following MSL.

Methods:
We included randomized controlled trials and prospective nonrandomized controlled clinical trials assessing VP or KP for the treatment of pain following MSL without cord compression. We searched MEDLINE, EMBASE, PubMed, and CENTRAL.

Results:
The literature search revealed 387 citations. Of these, 9 trials met all eligibility criteria and were included in the qualitative analysis. In total, there were 622 patients enrolled in the trials and of them 432 were in the surgical treatment group (92 received KP, 97 received VP, 134 received VP and chemotherapy, 68 received VP and radiotherapy, and 41 received Kiva implant) and 190 were in the nonsurgical treatment group (83 received chemotherapy, 46 received radiotherapy, and 61 received other treatment). Using the grading of recommendations assessment, development and evaluation approach, pain (low-quality evidence) and functional scores (very low-quality evidence) improved more with VP plus chemotherapy than with chemotherapy alone (pain: mean difference, −3.01; 95% confidence interval, −3.21 to −2.80; functional score: mean difference, 15.46; 95% confidence interval, 13.58–17.34). KP seemed to lead to significantly greater improvement in pain, disability, and health-related quality of life (HRQoL) compared with nonsurgical management. VP plus Iodine-125 seemed to lead to significantly greater improvement in pain and disability in comparison with VP alone. VP plus radiochemotherapy resulted in better pain relief and HRQoL postoperatively in comparison with routine radiochemotherapy. There was low-quality evidence to prove that surgical treatment significantly decreases pain, and improves functional score and HRQoL following MSL in comparison with nonsurgical management.

Conclusion:
On the basis of the analysis of currently published trial data, it is unclear whether VP for MSL provides benefits over KP.

Level of Evidence:
Level 2.
Minimally Invasive Spine Surgery
Authors: Bryant Jessica , Mohan Rohith , Koottappillil Brian , Wong Kevin , Yi Paul H. 
Published: March 2018

Study Design:
This is a cross-sectional study.

Objective:
The purpose of this study is to evaluate the content of information available on the Internet regarding minimally invasive spine surgery (MISS).

Summary of Background Data:
Patients look to the Internet for quick and accessible information on orthopedic procedures to help guide their personal decision making process regarding the care they receive. However, the quality of internet-based orthopedic education material varies significantly with respect to accuracy and readability.

Materials and Methods:
The top 50 results were generated from each of 3 search engines (Google, Yahoo!, and Bing) using the search term “minimally invasive spine surgery.” Results were categorized by authorship type and evaluated for their description of key factors such as procedural benefits, risks, and techniques. Comparisons between search engines and between authorship types were done using the Freeman-Halton extension for the Fisher exact test. The content of websites certified by Health on the Net Foundation (HONcode) was compared with those not HONcode certified.

Results:
Of the 150 websites and videos, only 26% were authored by a hospital or university, whereas 50% were by a private physician or clinic. Most resources presented some benefits of MISS (84%, 126/150), but only 17% presented risks of the procedure (26/150). Almost half of all resources described the technique of MISS, but only 27% had thorough descriptions that included visual representations while 26% failed to describe the procedure. Only 12 results were HONcode certified, and 10 (83%) of these were authored by a medical industry company.

Conclusions:
Internet-based resources on MISS provide inconsistent content and tend to emphasize benefits of MISS over risks.
Characteristics of Cervical Spine Motion in Different Types of Cervical Alignment
Authors: Sessumpun Kittipong , Paholpak Permsak , Hindoyan Kevork N. , Tamai Koji , Sangkomkamhang Thananit , Buser Zorica , Wang Jeffrey C. 
Published: March 2018

Study Design:
Retrospective study.

Objective:
To evaluate how each type of sagittal cervical alignment affects the motion of the upper and subaxial cervical spine using kinematic magnetic resonance imaging.

Summary of Background Data:
The sagittal malalignment of the cervical spine from degeneration in the subaxial cervical spine reflects a disruption in the kinematic properties of the cervical spine and affects the motion of adjacent segments. Changes in the sagittal parameters and kinematics of the upper cervical spine and upper thoracic spine due to the kyphosis are unknown.

Methods:
Kinematic magnetic resonance imaging of the cervical spine in neutral position from 311 patients, including 90 lordotic, 90 straight, 90 global kyphotic, and 41 segmental kyphotic were analyzed. The lordotic angle at the upper and lower cervical spine, and T1 slope were measured in the neutral position and again in flexion and extension for dynamic analysis.

Results:
The number of levels with significant disk degeneration was higher in the global kyphosis group. In the global kyphosis group, neutral sagittal parameters showed some characteristics of compensation to the malalignment. Compared with the lordotic group, patients with global kyphosis demonstrated significantly higher lordotic angle of the upper cervical spine and more horizontal T1 slope. The dynamic evaluation showed greater range of motion of the entire cervical spine and subaxial cervical spine in younger patients. However, we still found greater range of motion of the occipito-atlanto-axial complex in global kyphosis, even when controlling for age and number of levels with significant disk degeneration.

Conclusion:
Sagittal malalignment of the cervical spine affects all parts of the cervical motion complex. The global kyphotic alignment of subaxial cervical spine affects the kinematic properties of the occipito-atlanto-axial complex and upper thoracic spine to compensate for the alteration of cervical alignment. These differences are not seen in straight and segmental kyphosis.

Level of Evidence:
Level 3.
One-step Minimally Invasive Pedicle Screw Instrumentation Using O-Arm and Stealth Navigation
Authors: Kleck Christopher J. , Johnson Christopher , Akiyama Michelle , Burger Evalina L. , Cain Christopher J. , Patel Vikas V. 
Published: March 2018

Study Design:
Description of a navigated, single-step, minimally invasive technique for the placement of pedicle screws.

Objective:
To describe a new technique for minimally invasive placement of pedicle screws in the lumbar spine using O-arm and StealthStation navigation in combination.

Summary of Background Data:
Minimally invasive surgical techniques are described in the literature as safe and effective methods for pedicle screw instrumentation. These techniques increase radiation exposure and prompt multiple instrument passes through the pedicle.

Materials and Methods:
In total, 35 adult patients (187 screws) underwent lumbar surgery with pedicle screw placement using the 1- (8 patients/48 screws) or 2-step (27 patients/139 screws) technique. Complications associated with instrumentation were noted. Pedicle screw position was evaluated.

Results:
Of 187 screws placed, 181 (96.8%) were found to be fully contained within the pedicle (grade 1) and 4 (2.1%) had a breach of <2 mm. In the 1-step technique, no screws were malpositioned. One screw at S1 with inadequate fixation was replaced with a screw 1 mm larger in diameter. In the 2-step technique, 2 screws (1.06% overall) were revised due to inferior breach of the pedicle. No neurological sequelae were noted. Also, 1 screw was deemed too long at S1 and was replaced with a shorter screw. None of the revised pedicle screws caused neuromonitoring changes and the breaches were found intraoperatively on 3D imaging.

Conclusions:
Using O-arm and StealthStation navigation with minimally invasive surgical technology for placement of posterior spinal instrumentation is safe, effective, and limits radiation exposure.
Validity and Reproducibility of Various Measurement Methods for Craniocervical Sagittal Balance
Authors: Tamai Koji , Suzuki Akinobu , Takahashi Shinji , Hoshino Masatoshi , Toyoda Hiromitsu , Hayashi Kazunori , Ohyama Shoichiro , Kishimura Yuichi , Onode Ema , Umano Masayuki , Terai Hidetomi , Nakamura Hiroaki 
Published: March 2018

Study Design:
A cross-sectional study.

Objective:
To identify the best indicator for reproducible representation of craniocervical sagittal balance (CCSB).

Summary of Background Data:
Spinal sagittal balance is considered one of the most critical factors affecting the health-related quality of life. Although standard indicators of spinopelvic balance have been established, these do not include the craniocervical balance and there is no standard parameter for evaluating the CCSB.

Materials and Methods:
Six kinds of sagittal vertical axis (SVA) were drawn by a total of 9 spine or orthopedic surgeons, from the anterior margin of the external auditory canal: cranial center of gravity (CCG), C1 (center of the anterior arch), C2 (C2vb: center of the vertebral body, C2e: center of the lower endplate), and C7 (C7vb: center of the vertebral body, C7p: posterosuperior corner). Eight SVA distances were measured by using 30 radiographs; CCG–C7vb, C1–C7vb, C2e–C7vb, C2vb–C7vb, CCG–C7p, C1–C7p, C2e–C7p, and C2bv–C7p.The interobserver and intraobserver reliabilities, and the correlations between CCG and C1, C2e, or C2bv were calculated among the main groups or subgroups.

Results:
In the overall analysis, although the intraclass correlation coefficients (ICC) (1, 1) of all parameters were >0.900, the ICC (2, 1) of CCG–C7p and CCG–C7vb were <0.900. The same trends were noted in the subgroups based on observer’s experience. Comparing C7p-related and C7vb-related parameters, ICC (2, 1) showed 0.901 in C7p-related and 0.849 in C7bv-related parameters. In the analysis of the correlation between cranial SVAs, C1–C7p and C2vb–C7p SVAs correlated highly with CCG–C7p SVA (0.905, 0.805, respectively).

Conclusions:
Although the CCG SVA represents the center of the head, the current results revealed its low reproducibility. The low values were notable in those unfamiliar with craniocervical anatomy. The correlation analysis indicated that C1–C7p and C2vb–C7p SVA parameters are suitable for CCG–C7p SVA. Therefore, these 2 are considered as possible standard parameters in evaluating CCSB.

Level of Evidence:
Level III.
Impact of Cervical Sagittal Alignment on Axial Neck Pain and Health-related Quality of Life After Cervical Laminoplasty in Patients With Cervical Spondylotic Myelopathy or Ossification of the Posterior Longitudinal Ligament
Authors: Fujiwara Hiroyasu , Oda Takenori , Makino Takahiro , Moriguchi Yu , Yonenobu Kazuo , Kaito Takashi 
Published: March 2018

Study Design:
This is prospective observational study.

Objective:
To prospectively investigate the correlation among axial neck pain; a newly developed patient-based quality of life outcome measure, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ); and cervical sagittal alignment after open-door laminoplasty for cervical myelopathy.

Summary of Background Data:
Many studies have focused on postoperative axial neck pain after laminoplasty. However, the correlation among cervical sagittal alignment, neck pain, and JOACMEQ has not been investigated.

Materials and Methods:
In total, 57 consecutive patients treated by open-door laminoplasty for cervical myelopathy were included (mean age, 63.7 y; 15 women and 42 men) and divided into 2 groups according to diagnosis [cervical spondylotic myelopathy (CSM) group: 35 patients, and ossification of the posterior longitudinal ligament (OPLL) group: 22 patients]. JOA score, a subdomain of cervical spine function (CSF) in the JOACMEQ, and the visual analog scale for axial neck pain were assessed preoperatively and 12 months postoperatively. Radiographic cervical sagittal parameters were measured by C2 sagittal vertical axis (C2 SVA), C2–C7 lordosis, C7 sagittal slope (C7 slope), and range of motion.

Results:
C2 SVA values in both groups shifted slightly anteriorly between preoperative and 12-month postoperative measurements (CSM: +19.7±10.9 mm; OPLL: +22.1±13.4 mm vs. CSM: +23.2±16.1 mm; OPLL: +28.7±15.4 mm, respectively). Postoperative axial neck pain in the OPLL group showed strong negative correlations with C2 SVA and C7 slope. Strong negative correlations were found between axial neck pain and CSF in both the preoperative CSM and OPLL groups (CSM: r=−0.45, P=0.01; OPLL: r=−0.61, P<0.01) and between axial neck pain and CSF in the postoperative OPLL group (r=−0.51, P=0.05).

Conclusions:
This study demonstrated a significant negative correlation between neck pain and CSF in both the CSM and OPLL groups preoperatively and in the OPLL group postoperatively. Radiographic cervical sagittal alignment did not significantly correlate with preoperative or postoperative axial neck pain.
A Prospective Single-blind Randomized Controlled Trial of Chewing Gum on Bowel Function Recovery After Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis
Authors: Meng Yichen , Lin Tao , Shao Wei , Jiang Heng , Li Tangbo , Gao Rui , Zhou Xuhui 
Published: March 2018

Purpose:
To evaluate the effectiveness of chewing gum on promoting bowel function recovery in adolescent idiopathic scoliosis patients undergoing surgical correction.

Materials and Methods:
Adolescent idiopathic scoliosis patients scheduled for posterior spinal fusion surgery at our institution were randomized to either group 1 (chewing gum) or group 2 (control). The primary endpoints were time to flatus, time to bowel movement, length of hospital stay, and time to liquid or solid. The secondary endpoints were postoperative opioid consumption, incidence of complications, pain scores, and nausea scores. In addition, a meta-analysis of available data from the literature was performed identifying 2 studies with quantitative data on the efficacy of gum chewing after scoliosis correction surgery.

Results:
In total, 125 patients (63 gum; 62 control) were included in our analysis after randomization. There was no significant difference in time to first flatus (P=0.087), time to bowel movement (P=0.307), time to liquid or solid, length of postoperative hospital stay (P=0.954), postoperative complications, opioid consumption, and postoperative nausea scores between the 2 groups. The postoperative pain scores on postoperative day 1 were significantly lower (P=0.027). There was a significant decrease in the time to the first flatus for patients having selective thoracic fusion in both groups than those having fusion to lumbar spine. Meta-analysis also indicated there was no significant difference in outcomes of bowel function between the 2 groups.

Conclusions:
Our institutional data and meta-analysis collaboratively suggested that chewing gum did not hasten the return of bowel function.
Incidence and Risk Factors for Proximal Junctional Kyphosis
Authors: Sebaaly Amer , Sylvestre Clément , El Quehtani Yehya , Riouallon Guillaume , Larrieu Daniel , Boussiere Louis , Steib Jean Paul , Roussouly Pierre , Wolff Stéphane , Obeid Ibrahim 
Published: March 2018

Study Design:
This was a retrospective multicentric study.

Objective:
The objective of this study was to determine the different risk factors for development of proximal junctional kyphosis (PJK) in patients with adult scoliosis.

Summary of Background Data:
This study was conducted as the reasons for development of PJK in adult scoliosis are still not clear.

Materials and Methods:
In total, 314 patients met the inclusion criteria. The main outcome measure was the PJK, as described by Glattes and colleagues. Extent of the instrumentation, operative time, bleeding, and the use of an osteotomy as well as the type of proximal anchorage were collected. Radiologic variables included preoperative Cobb angles of the lumbar and the thoracic curvatures, pelvic parameters, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. All measures were performed using the KEOPS software.

Results:
The mean follow-up of this series was 2.5 years with a female to male ratio of 6.6/1 and a mean age of 56.66 years. The incidence of PJK was 25%. Proximal fixation extended to the proximal thoracic spine (TS) in 39%, to the middle TS in 39.5% of cases, and to the thoracolumbar junction in 20.4%, with a higher incidence of PJK noted in the first group. The proximal anchors had no effect on PJK incidence. Age as well as body mass index had a positive correlation to the incidence of PJK. The association, fusion to sacrum and fusion to the upper TS, is associated with the highest incidence of PJK. Preoperative pelvic tilt had a positive correlation with PJK occurrence. Finally, revision for PJK occurred in 2.3% of all patients and accounted for 15% of revisions.

Conclusions:
Increased age, as well as increased body mass index, is a risk factor for the development of PJK. The proximal extent of the construct is also shown to be a risk factor for PJK, but fusion to the sacrum is a risk factor only if fusion extends to the proximal TS. Moderate PJK was observed with undercorrection of the sagittal balance and severe PJKs with overcorrection of the sagittal balance.

Level of Evidence:
Level IV.