bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Unsuspected Malignancy in Patients with Vertebral Compression Fracture undergoing Percutaneous Vertebroplasty
Authors: Hansen Emil Jesper , Simony Ane , Rousing Rikke , Carreon Leah Y. , Tropp Hans , Andersen Mikkel Ø. 
Published: April 2016

Introduction Osteoporotic vertebral compression fractures (VCF) affect ~20% of postmenopausal women and can lead to long-term disability. Percutaneous Vertebroplasty (PVP) is a minimally invasive procedure, primarily used in patients with severe pain after VCF. Even with a thorough clinical examination, MRI scans and blood samples, some fractures maybe caused by an underlying malignant disease. Objectives were to determine the prevalence of malignancy and histology in bone biopsies obtained during PVP for osteoporotic VCF. Material and Methods Study design - Retrospective study of a prospective collected cohort. 144 consecutive patients underwent PVP for painful VCF, at the Center for Spine Surgery and Research, Middelfart Hospital. All patients had bone biopsies obtained during the PVP, and these biopsies were sent to the Department for Pathology at Vejle Sygehus for histologic diagnosis. Results 144 patients were included in this study. The majority of the biopsy specimens (137, 95,1%) were acceptable for histological diagnosis. 129 (89.6%) of the biopsies showed no signs of malignancy. Seven (4,9%) were positive for malignancy. 1 biopsy was positive for MGUS. Seven (4.9%) of the biopsies were unsuitable for histologic diagnosis. Conclusion Our study shows a prevalence of unsuspected malignancy in biopsies during PVP of 4.9%. Conservative treatment with analgesics and brace can potentially delay diagnosis and treatment of underlying malignant disease. We recommend biopsy during PVP as a standard-procedure, to insure not to overlook any underlying malignancy despite the MRI-scan, blood analysis and clinical examination being inconspicuous.
Upright, Prone, and Supine Spinal Morphology in Adolescent Idiopathic Scoliosis
Authors: Brink Rob , Schlösser Tom , Colo Dino , Vincken Koen , van Stralen Marijn , Hui Steve , Chu Winnie , Cheng Jack , Castelein René 
Published: April 2016

Introduction Adolescent idiopathic scoliosis patients are exposed to ten times more radiation as compared with healthy adolescents, this leads to increased risk of developing malignancies. To minimize the radiation exposure, non-ionizing imaging modalities, such as MRI, can be used, but this is acquired in supine positioning, unlike the standing X-rays that are the gold standard. As far as we know, this is the first study to compare the 2-D morphology of the spine on conventional radiographs with the 3-D morphology on supine MRI and prone CT images. The objective is to evaluate the correlation between the morphology of the spine on conventional radiographs in the upright position and 3-D supine and prone imaging modalities in patients with adolescent idiopathic scoliosis. Material and Methods 62 adolescent idiopathic scoliosis patients planned for scoliosis surgery and had undergone standard pre-operative work-up (upright radiographs, supine MRI for exclusion of neural axis abnormalities and prone CT for navigation surgery for posterior pedicle screw fixation) were included. In all three positions, Cobb angles, thoracic kyphosis, lumbar lordosis and apical vertebral rotation (2-D X-rays: method of Perdriolle, 3-D scans: semi-automatic software) were determined. In addition, on reconstructed 3-D MR and CT images, the true sagittal and coronal morphology were measured semi-automatically (previously validated technique). Chi-square tests were used for correlation analysis between the positions. Results In the thoracic and (thoraco)lumbar curves, Cobb angles correlated significantly between conventional radiographs (68 ± 15° and 44 ± 17°), supine MRI (57 ± 14° and 35 ± 16°) and prone CT (54 ± 15° and 33 ± 15°; r ≥ 0.89; p < 0.001). In the axial plane, the apical vertebral rotation showed a good correlation between the positions (upright, 22 ± 12°; prone, 20 ± 9° and supine, 16 ± 11°; r ≥ 0.56; p < 0.001). The thoracic kyphosis and lumbar lordosis on the conventional upright X-rays did not correlate with the true sagittal morphology on MRI or CT. The relation of the thoracic Cobb angle between the standing X-rays and the lying down images of moderate to severe patients is expressed by the formula: upright radiograph (°) = 10.81 + 1.01*supine MRI(°) and prone CT(°) = −3.02 + 1.00*supine MRI(°). Conclusion Although there is slight underestimation of the morphology of the 3-D spinal curvature in the supine position as compared with upright, there is a significant correlation of the deformation in all three dimensions between the different body positions and imaging modalities. Therefore, accurate estimation of the upright morphology of adolescent idiopathic scoliosis is possible, using non-ionizing supine MRI or prone CT scans.
Larger Curve Magnitudes (> 70 Degrees) in Adolescent Idiopathic Scoliosis are Associated with Significantly Higher Cost of Surgical Treatment and a Delayed Return to Function
Authors: Tarrant Roslyn , Kiely Patrick 
Published: April 2016

Introduction Surgical procedures to correct larger curve magnitudes >70°in patients with adolescent idiopathic scoliosis (AIS) are still common globally. Despite the increased complexity associated with surgical correction of these curves, there is limited evidence available assessing the effect of preoperative curve severity on clinical or economical outcomes. This study aimed to examine the impact of preoperative curves >70° versus those ≤ 70° on perioperative, functional and financial outcomes in patients with AIS undergoing posterior spinal fusion (PSF). Material and Methods Seventy seven eligible AIS patients who underwent PSF were prospectively followed-up, until return to postoperative function was reported. Preoperative curves > 70° versus ≤ 70°, were analyzed in relation to surgical duration, estimated blood loss, perioperative complications, length of hospitalisation, return to function and cost of surgical treatment per patient. Results Severe preoperative curves greater than 70°, identified in 21 patients (27.3%), were associated with significantly longer surgical duration (median 6.5 hour versus 5 hour, p = 0.001) and increased blood loss (median 1,250ml versus 1,000ml, p = 0.005) – these patients were 2.1 times more likely to receive a perioperative blood product transfusion (Relative Risk 2.1, Confidence Interval 1.4–2.7, p = 0.004). Curves greater than 70° were also associated with a significantly delayed return to school/college, and an increased cost of surgical treatment (€33,730 versus €28,620, P < 0.0001). Conclusion Surgeons can expect a longer surgical duration, greater intraoperative blood loss and double the blood product transfusion risk when performing PSF procedures on AIS patients with curves greater than 70°versus those ≤ 70°. Surgical correction for curves > 70°, often as a result of lengthy surgical waiting lists, also incurs added expense and results in a partial delay in early functional recovery.
Is There a Difference in Outcome between Top and Side Loading Instrumentation System Used for the Surgical Treatment of Adolescent Idiopathic Scoliosis (AIS)
Authors: Fallatah Salah 
Published: April 2016

Introduction Different Instrumentation systems has been developed for the surgical correction of Adolescent idiopathic Scoliosis (AIS) with different deformity correction techniques. Material and Method: The purpose of this retrospective study was to compare top loading to side-loading instrumentation systems used in the surgical treatment of AIS looking at the clinical, functional and radiological outcomes as well as the cost difference between different systems. Thirty matched surgically treated female patients were assigned to 2 groups, group one were treated using a top loading system and in group 2 a side-loading spinal instrumentation system was used. The groups were evaluated for curve magnitude, percent correction, functional outcome using the scoliosis research society questionnaire-30. Results both groups were similar in their demographic data, preoperative clinical and functional variables. The cost of instrumentation was significantly higher in group 2. At 2 years follow up: both groups have significant improvement in all domaines of Scoliosis Research Society score-30. Group 1 had a better (not significant) correction of the rib hump and both groups had similar percent correction of the main curve. Conclusion The surgical treatment of AIS with side loading systems was significantly more expensive but had statstically similar functional and radiographic results to the top loading system. The top loading system achieved better correction of the rib hump.
Surgical Technique for Cervical Pedicle Screw Insertion using O-Arm
Authors: Shimokawa Nobuyuki 
Published: April 2016

Introduction Posterior cervical fixation using lateral mass screw and cervical pedicle screw (CPS) is getting available for various disorders such as trauma and degenerative disease and so on. The purpose is to report our detail surgical technique for CPS insertion using O-Arm, about cannulated CPS particularly. Material and Methods Consecutive one hundred twenty patients underwent posterior cervical fixation using CPSs since January 2007. Preoperatively we made further evaluation of the each patient's radiological condition including collateral circulation using MRI and MR angiography and CT angiography. We evaluated local instability with dynamic cervical radiography at each. During making pilot hole of CPS, usually we have felt resistant strong force which cervical back muscles and subcutaneous tissues have produced. So if we made short midline skin incision in particular, CPS underwent through the bilateral another skin incision which we made at the paramedian area. Using O-arm, CPSs were inserted slowly and intermittently taking care not to produce axial rotation or sagittal bending of the cervical spine, which related to the screw malposition including VA injury. And recently we used to use the cannulated screw. Results We inserted 668 CPS and classified their position with Neo's classification using postoperative CT scan, grade 0 (635 screws, 95.0%), grade 1 (27 screws, 4.0%), grade 2 (6 screws, 0.9%), grade 3 (0 screws). No neurovascular complications associated with surgery were encountered. Conclusion We believe what is the most important for safe CPS insertion is preoperative detail further evaluation including the indication of CPS. We think our procedure and techniques for CPS insertion are useful and safe.
The Comparison between O-Arm Navigation System and C-Arm Fluoroscopy Navigation System for the Amount of Radiation Exposure in Balloon Kyphoplasty
Authors: Maruo Yohei , Maruo Yohei 
Published: April 2016

Introduction Recently, balloon kyphoplasty(BKP) is widely used for osteoporptic vertebral fracture. In this study, we compare the amount of the radiation exposure between O-arm navigation system and C-arm fluoroscopy navigation system in BKP. We consider further review for the radiation exposure in BKP from here on. Material and Methods 63 patients with vertebral fracture is recruited from Kansai Erectronic Power Hospital between March 2011 and June 2014. In all cases, we monitored the amount of radiation exposure by each device. In 63 cases,10 is O-arm navigation system and 53 is C-arm fluoroscopy navigation system. Results The average amount of the radiation exposure is 35.994mGry (range 0.52–97.27) in O-arm and 17.284mGry (range 2.69–86.6) in C-arm. The average radiation time is 35.227 second (range 1.9–57.71) in O-arm and 94.886 second (range 25–319) in C-arm. Conclusion O-arm navigation system use is shorter in radiation time and larger in radiation exposure than C-arm fluoroscopy navigation system. However, the amount of the radiation exposure per unit time in O-arm navigation system is larger than in C-arm fluoroscopy navigation system. We should consider the way to reduce the radiation exposure by stepping down the output power in O-arm.
O-arm Imaging and Naviation Systems for Transvertebral Anterior Cervical Foraminotomy
Authors: Umebayashi Daisuke , Yamamoto Yu , Nakajima Yasuhiro , Hara Masahito 
Published: April 2016

Introduction Anterior cervical discectomy and fusion (ACDF) results in excellent initial clinical results for herniated cervical disc and an osteophyte. On the other hand, the development of adjacent segment disease after ACDF is well recognized. However, most patients do not require total discectomy and vertebral fusion because most radiculopathies are caused by focal lesions of the intervertebral foramen. Especially, in patients who have unilateral radiculopathy with physiological alignment, we should avoid removal of healthy discs. Transvertebral anterior cervical foraminotomy (TVACF), nonfusion and nondiscectomy technique, can preserve intervertebral disc and reduce adjacent intervertebral degeneration compared with intervertebral fusion. Therefore, we have reported the advantages and usefulness of TVACF. However, TVACF requires skillfulness, especially for the appropriate drilling direction control for the keyhole. Recently, O-arm imaging and navigation systems were progressed. This navigation systems help to make the correct direction of the keyhole. Material and Methods We have performed TVACF under O-arm imaging and naviation systems. The patient was placed in the supine position. A lateral radiograph was used to identify the skin incision level. A 3.5cm transverse skin incision was made at half a level higher than the affected disc level. We approached the anterior surface of the vertebra from the affected side. After then, O-arm imaging and navigation systems were applied. We determined the appropriate keyhole position under the navigation. The lateral and caudal side trajectory of the tunnel was also decided under the navigation. The tunnel was ~6 mm in diameter. Results Under O-arm imaging and navigation systems, we were able to easily determine the appropriate keyhole position and the lateral and caudal side trajectory of the tunnel. Intraoperative findings and postoperative computed tomography imaging showed the accuracy of keyhole position. Conclusion Successful surgery is possible with using O-arm imaging and navigation systems. This navigation facilitate TVACF. As a result, TVACF is able to be more widely used among spinal surgeons in safe.
Neurological Recovery after Traumatic Cervical Spinal Cord Injury is Superior if Surgical Decompression and Instrumented Fusion are Performed within 8 h versus 8–24 h after Injury: A Single Centre Experience
Authors: Jug Marko , Kejžar Nataša , Vesel Miloš , Al Mawed Said , Dobravec Marko , Herman Simon , Bajrovic Fajko 
Published: April 2016

Introduction Traumatic spinal cord injury (tSCI) is a catastrophic event with enormous personal, social and economic impact. Despite recent progress in understanding the pathophysiology of acute tSCI and the positive effects of acute spinal cord decompression on neurological recovery reported in standardized preclinical studies, neurological benefits of early surgical decompression (SD) remain elusive in the clinical setting. Material and Methods A prospective study was performed to evaluate the impact of SD and instrumented fusion within 8 hour versus 8–24 hour after injury on neurological recovery after cervical tSCI in patients operated on in the UMC Ljubljana, Slovenia. Only patients with the ASIA Impairment Scale (AIS) grades of A through C and with MRI-confirmed spinal cord compression were enrolled. The primary outcome was the change in AIS grade at the six-month follow-up. Results Of the 48 enrolled patients, 22 patients who underwent surgery within 8h (Group-8h) and 20 patients who underwent surgery between 8 and 24h (Group-8–24h) after injury concluded the study. At admission, there was no statistically significant difference in AIS grade between the study groups. At the six-month follow-up, an improvement of at least two AIS grades was found in 45.5% of patients in Group-8h and in 10% of patients in Group-8–24h ( p = 0.017). In a multivariate analysis, adjusted for the preoperative AIS grade and the degree of spinal canal compromise, the odds of an at least two-grade AIS improvement were at least 106% higher for patients in Group-8h than for patients in Group-8–24h (OR = 11.08, p = 0.004). No statistically significant difference was found in the rate of pneumonia, the number of ventilator-dependent days or the mortality between the groups. Conclusion Our results suggest that the patients with tSCI who undergo SD within 8h after injury have superior neurological outcomes than patients who undergo SD 8 to 24h after injury, without any increase in the rate of adverse effects.
Early Decompression (<8h) versus Delayed Surgical Management Improves Functional Outcome after Traumatic Cervical Spinal Cord Injury
Authors: Grassner Lukas , Wutte Christof , Klein Barbara , Mach Orpheus , Riesner Silvie , Panzer Stefanie , Vogel Matthias , Högel Florian , Bühren Volker , Strowitzki Martin , Maier Doris , Vastmans Jan 
Published: April 2016

Introduction Traumatic cervical spinal cord injury affects the individual in a multi-faceted way. Early decompression of the spinal canal is recommended. The optimal time point for this intervention has been under debate for decades. This study compares a variety of neurologic, radiologic and functional outcome parameters between patients after early (<8 hour) versus delayed decompression. Materials and Methods We performed a retrospective analysis at the Center for Spinal Cord Injuries (Trauma Center Murnau, Germany), an over-regional level-I trauma center. Follow-up data was collected prospectively for one year after injury, according to institutional and international consensus criteria. We included data acquired over a 10-year period (2004 – 2014). We only analyzed patients over 18 years with traumatic cervical spinal cord injury without concomitant extremity injury, traumatic brain injury or central cord injuries. Results We identified 70 patients (59 males), who met in- and exclusion criteria. Out of this population, 35 patients were decompressed within the first 8 hour (average: 4.36 hour after the insult) (= early group). After one year, patients from the early group showed a significantly higher gain in total motor score (TMS) points and upper extremity motor score (UEMS) points. Additionally, this patient cohort showed significantly better grades on the American Spinal Injury Association Impairment Scale (AIS) and a significantly higher AIS conversion rate. Furthermore, they were more likely to experience a significant greater difference in the Spinal Cord Independence Measure (SCIM) within the follow-up period. Conclusion This study shows that an early surgical decompression not only leads to higher AIS conversion rates, but – most importantly – also to a better functional outcome (as indicated by the SCIM score).
New Surgical Attitude in Complete Acute Traumatic Spinal Cord Injury
Authors: Iencean Stefan Mircea , Iencean Andrei Stefan 
Published: April 2016

Introduction Studies have shown the values pattern of the phosphorylated form of the high-molecular-weight neurofilament subunit (pNF-H) in CSF is a predictive biomarker for acute traumatic spinal cord injury (SCI). Materials and Methods A previous study of pNF-H in CSF of patients with SCI showed it is a specific biomarker for SCI, it can distinguish the severity of SCI and it is a predictive biomarker because of its values pattern can show the reducing or stopping of the secondary lesion and a favorable result. At 22 subjects with acute traumatic SCI we correlated the pNF-H concentration in CSF with the MRI, with the diffusion tensor tractography on the SCI site and with the clinical evolution. All patients underwent surgery during the first 24 hours (decompression, stabilization). In two cases with unfavorable pattern of pNF-H after 4 and 7 days, MRI identified the SCI site with an extensive spinal cord edema and a necrotic cavity. A second microneurosurgery was done: opening the dura 5 levels, duraplasty and opening the spinal cord in the midline and debridement of the necrotic tissue. Results Complete SCI cases had a specific pattern of values of pNF-H correlated with the MRI and the clinical evolution. A second microneurosurgery solved the cord edema and the spinal cord laceration. One case has improved progressively after 6 months and the other case - no neurological improvement after one year of rehabilitation. Conclusions Patients must undergo surgery during the first 24 hours: a large decompression on 5 – 7 levels with duraplasty and stabilization. After these we can use the predictive unfavorable pattern of pNF-H correlated with MRI and a second microneurosurgery in SCI site must be done: opening the spinal cord in the midline and microsurgical debridement of the necrotic tissue. This surgical attitude can create favorable conditions for functional recovery of the remaining spinal cord.
Efficacy and Safety of Riluzole in Acute Spinal Cord Injury (SCI). Rationale and Design of AOSpine Phase III Multi-center Double Blinded Randomized Controlled Trial. (RISCIS)
Authors: Fehlings Michael , Kopjar Branko , Grossman Robert 
Published: April 2016

Introduction There is convincing evidence from the preclinical realm that the pharmacologic agent riluzole attenuates certain aspects of the secondary injury cascade leading to diminished neurological tissue destruction in animal SCI models. The safety and pharmacokinetic profile of riluzole have been studied in a multicenter pilot study in 36 patients. Efficacy of riluzole in acute human SCI has not been established Material and Methods This ongoing multi-center, international double-blinded phase III RCT will enroll 351 patients with acute C4—C8 SCI and ASIA Impairment Grade A, B or C randomized 1:1 to riluzole and placebo. Primary outcome is the change in ASIA Motor Score (AMS) between baseline and 180 days. Other outcomes include ASIA Upper and Lower Extremity MS; ASIA Sensory Score; ASIA grade; SCIM); SF-36v2; EQ-5D and GRASSP. Two-stage sequential adaptive trial statistical design has 90% power to detect 9 points difference in the ASIA Motor Score at one-sided α = 0.025. Results A matched cohort analysis performed in the Phase I study showed that riluzole treated cervical SCI patients experienced an additional 15.5 points in AMS recovery at 90 days post injury. Although the phase I study was underpowered to investigate efficacy the current phase III study is poised to definitive address this question. Subject enrollment for this trial began on October 1, 2013 in 11 international centers. To date, 31 subjects have been enrolled. Average age of the enrolled subjects is 49 years (SD 16.9); 83.9% males. ASIA at arrival and Pre-Injury status, ASIA Grade A (45%), B (29%), C (26%). GRASSP 54.1 (SD 12.8), SF35v2 PCS 52.6 (SD 9.0) SF36v2 MCS 55.6 (SD 12.8). Conclusion This is a Phase III study of riluzole in acute SCI.