bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Diagnosis and Operative Management in Non Tuberculous Spondylodiscitis: Outcome in a Case Series of 34 Patients
Authors: Sudarshan Pramod , Panda Aditya , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan 
Published: April 2016

Introduction With the high prevalence of tuberculous spondylodiscitis in India and the tendency to label all spondylodiscitis astuberculous, it is prudent to have a high index of suspicion for non tuberculous infections and treat them accordingly. With the concern on the usage of metal implants in the infected spine, we study the safety and efficacy of debridement and stabilization with metal implants in infective spondylodiscitis. Material and Methods Patient records and radiographs of 34 patients of non tuberculous spondylodiscitis who were operated between 2003 and 2013, were reviewed. All the patients were managed with debridement of the infected segment, reconstruction and stabilization of the spine using titanium pedicle screws with interbody spacers. Clinico-radiological follow up was done at 1, 3, 6 and then yearly thereafter. Results 34 patients (M:23, F:11) with an average age of 48 years (20–68yrs)operated between 2003 and 2013. Low back pain with left radiculopathy for an average duration of 4 months (1–12months) was the most common presentation. Neurological involvement was seen in 12 patients (Foot drop- 8, Paraparesis-2 and Sensory deficits - 2). The pathology was monosegmental in 27 patients (L5-S1:10, L4–5:13, L3–4:2, L2–3:2). The infection was hematogenous in 18, post surgery (discectomy/laminectomy) in 15 and post UTI in 1 patient. The surgical isolates were mainly Staphylococcus aureus-17, E.coli and Gram negative bacilli-7, MRSA-5, Pseudomonas-1 and Fungal-4. 28 patients underwent posterior procedure, 1 anterior alone and 5 underwent combined anterior and posterior procedures. All the patients had appropriate antimicrobial therapy and mobilized as early as tolerated. All patients had excellent to good functional results and no evidence of infection at average follow-up of 72 months (27–130 months). ODI and Kirkaldy-Willis criteria showed significant improvement of function postoperatively. All the blood parameters were normalized in 3 months. 1 patient had dural tear which was repaired peroperatively without sequelae, 2 cases required wound exploration and lavage. No other major complications were encountered. All cases showed radiological fusion and no evidence of metal related complications at the latest followup. Conclusion Thorough debridement of necrotic material creates a good vascularised environment and restoring stability compromised by either infection or prior surgery helps in healing process and reduces morbidity of patients, with early return to normal activity. The use of metal implants is safe and efficacious even in the presence of infection.
Posterior Transpedicular Decompression and Pedicle Screw Fixation for Early Stage Thoracic, Thoracolumbar and Lumbar Tuberculosis
Authors: Dsouza Areena , Das Kalidutta 
Published: April 2016

Introduction Anterior decompression and fixation has been long considered as the gold standard for treatment of tuberculosis of spine. Recently the posterior approach surgery has gained popularity, based on the principle of adequate debridement and stable xation with much lower complication rates. This retrospective study aims at evaluating the role of a posterior transpedicular decompression and pedicle screw fixation for early stage thoracic, thoracolumbar and lumbar tuberculosis. Material and Methods Retrospective study of 55 patients treated with posterior transpedicular decompression and pedicle screw fixation for tuberculosis of spine between Jan 2009 to May 2014 and had a minimum of 18 months follow up were included in the study. Their functional outcome (VAS score), neurological outcome (ASIA grading) and radiological outcome (xray and MRI) were assessed. Patients with kyphotic angle > 30 degrees, more than 3 contiguous discal involvement and multifocal lesions were excluded from the study. Results Thoracic spine was involved in 29, thoracolumbar in 16 and lumbar in 10 patients. Mean follow up was of 30.6 months. Mean age of patients was 47.2 years. Most common indication for surgery was instability pain. VAS score improved from an average of 9.2 to 2.4 in post operative period and 3.2 at follow up. Neurological improvement was seen in all patients with neurological deficits preoperatively. Mean kyphosis angle was 20.6 ± 4.8 degrees and was corrected postoperatively to 7.4 ± 3.2 degrees (>50%). At the latest follow-up there was mean loss of correction of 3.4 degrees resulting in 6.5 degrees of final correction. Bony fusion was achieved in 78% patients with no patient having any clinical signs of psuedoarthrosis. Conclusion Posterior transpedicular decompression and pedicle screw fixation accompanied by chemotherapy, has shown an improvement in the functional outcome and the neurological status in most of the patients with good maintenance of spinal alignment without the need of an anterior decompression and fusion. Hence this can be considered as a relatively simple surgical option for early stage tuberculosis of spine.
Minimally Invasive Percutaneous Fixation of Thoraco-Lumbar Fractures in a Major Trauma Centre and Single Institute Experience
Authors: El-Maghraby Hussien , Bletechi Radu , Nagaraja Sanjoy 
Published: April 2016

Introduction Unstable spine fractures commonly occur in the setting of a poly-traumatized patients. The aim of management is to balance the need for early stabilization with quick patient's mobilization and reduction of additional trauma due to the major open surgery. Material and Methods To assess the operative data, clinical and radiological outcomes of patients undergoing minimally invasive management of Thoraco-lumbar fracture. Design Retrospective review of prospectively collected data. Methods 101 patients underwent minimally invasive percutaneous fixation of Thoraco-lumbar fractures percutaneous fixation with or without vertebroplasty. All patients were post-operatively either neurologically intact or improved. There were 60 males and 41 females with an average age of 44 years. Results The mean follow-up was 18 months (3–44 months). The mean operative time was 100 minutes (range 35–240 minutes) and the mean blood loss was < 100mL. VAS was significantly improved from 8.7 to 1 at last follow-up. No patient worsened his or her neurological condition postoperatively. Conclusion Minimally invasive percutaneous fixation of Thoraco-lumbar fractures in poly-traumatized patients appears to be a safe and effective technique to manage Thoraco-lumbar fractures without neurological impairment and allowing early rehabilitation.
Application of the Ultrasonic Bone Shaver in Spine Surgery: Experience in 307 Patients
Authors: Hazer Derya Burcu , Yasar Baris , Akbas Aytac , Rosberg Hans-Eric 
Published: April 2016

Introduction Spinal surgery requires microscopic bone removal, in which high speed drills are used. However, the spinning and increased heat production when drilling with diamond burrs under the microscope may cause damage to the soft tissues such as the dura, nerve roots, the cord and vessels. Ultrasonic bone removers have been introduced to spine surgery recently. We review the clinical application of different types of ultrasonic bone removers in spine surgery and discuss technical points, the safety and efficacy of ultrasonic bone shaver in various spinal surgeries. Material and Methods Between June 2010 and January 2014, 307 patients with various spinal diseases were operated with the use of Misonix ultrasonic bone curette with microhook shaver (MUBS). Patients' demographics, disease type, surgery performed and complications and follow up were recorded. Results Among the 307 patients, 33 (10,7%) cases had cervical disorder, 17 (%5,5) thoracic disorder, 3(0,9%) foramen magnum disorder and 254 (82,7%) cases had lumbar disorders. Hemilaminectomy, limited-extended foraminotomy, revision lumbar disc surgery, corpectomy, osteophytectomy and laminoplasty were performed either assisted-or alone by MUBS. The duration of the operations was comparable with conventional spine surgeries, and the need for blood replacement was relatively low. The one year follow up with Neck Disability Index (NDI) and Oswestry Disability Index Scores (ODI) were comparable with conventional studies. We had 5 cases of dural tears (1.6%) in patients with lumbar spinal disease. Conclusion MUBS does not produce excessive heat and is a useful instrument for procedures performed in narrow epidural spaces near the dura mater. According to our experience; it is also a safe tool with very low complications rates after the learning curve is reached. We recommend this device as an assistant tool in various spine surgeries, and as a primary tool in foraminatomies.
Report of One Year Follow up of Patients after TLIF using a 3-Dimensional Expandable Cage for Lumbar Fusion with Lordotic Correction
Authors: Morrison Robert , Rigal Julien , Le Huec Jean Charles , Schnake Klaus J. 
Published: April 2016

Introduction The use of a new 3 dimensional (3D) expandable cage for TLIF was extensively studied in biomechanical tests, cadaver specimens and preliminary clinical series. A wide footprint is achieved through a one side portal due to the articulated implant positioned in the anterior third of the disc space. The lordotic correction is accomplished due to the expansion of the device in place assisting on the overall sagittal alignment. Previous reports presented showed initial promising clinical results. One year follow up of the first 10 patients is now reported. Material and Methods Ten patients were included in a 12 months prospective review after a TLIF using a 3D Titanium alloy FLXFit expandable cage. The procedure was done for a single or two level fusion with positioning of the cage under fluoroscopy and expansion for disc space height and lordotic correction. All patients were supplemented with posterior instrumentation. Primary clinical outcomes were evaluated by preoperative, 6 months, 12 months and last follow-up visual analog scale (VAS) and the Oswestry Disability Index (ODI) scores. Complications and neurological impairment were recorded. Radiographic assessment of pre and post-operative results was performed with measurement of correction achieved in the frontal and sagittal planes with EOS imaging technology avoiding any distortion on X-Rays. All patients underwent CT scan control at 12 months. Results All ten patients underwent a successful one or two levels instrumented TLIF without any permanent neurological, vascular or visceral complication. The 3D cage implantation provided lordosis augmentation of 8° (± 2.1°) allowing restoration of the sagittal alignment according to pre-op planning. On early post-op CT scans, good footprint and no endplate violation were shown with no cage subsidence. Clinical outcomes showed significant improvement for both VAS and Oswestry scores ( P < 0.05), 3.7 (± 2.9) and 31% (±11) respectively. Similar outcomes were found at 12 months: no cage subsidence, VAS and Oswestry scores ( P < 0.05), 3.5 (± 2.7) and 28,4% (±12) respectively. Conclusion Lumbar interbody fusion using this new 3D expandable cage provided correction of the lordosis in a shorter and effective surgical procedure. A wide footprint well positioned cage, with customized height and angular correction achievement assured an optimal load transmission and biomechanical environment for fusion. Initial clinical results were followed with successful clinical outcomes in all patients.
A Case Report of Rod Migration into Cerebellum through Foramen Magnum after Lateral Mass Fixation
Authors: Sharma Ayush 
Published: April 2016

Introduction There are many methods of posterior cervical fixation for various indications and each with its own early & late known complications. Among the late complications, Screw or rod pullout, screw or plate breakage, and screw loosening are common. We are reporting here, connecting rod migration into posterior cranial fossa, a rare complication after lateral mass fixation. Case Report: A 55 year old male patient was operated with lateral mass fixation after posterior cervical decompression for ossification of posterior longitudinal ligament (OPLL). Patient had symptomatic recovery without any complication postoperatively. One and half years later the patient started complaining of sudden onset giddiness followed by loss of consciousness a few hours later. Ct scan showed lateral mass screws construct with migration of left sided connecting rod into the right cerebellum through foramen magnum. Patient was operated for rod removal but he never regained consciousness and was lost on eighth postoperative day. Autopsy confirmed damage to right cerebellum due to rod migration. Conclusion Clinician should be aware that superior rod migration is a rare but potentially disastrous complication. Regular follow up with radiological evaluation should be done to look for implant loosening, migration and non-union even in asymptomatic patients. The implant should be subsequently removed after it has served its purpose.
CT Analysis of Anatomical Variation and Injury Affecting Posterior Pedicle Screw Fixation for Unstable Hangman's Fractures
Authors: Lee Guangzhou , Wang Qing 
Published: April 2016

Introduction The aim of this study was to evaluate the anatomical variations and injuries in patients with unstable Hangman's fractures that affected the posterior pedicle screw (PS) placement of C2-C3 and retrospectively review our experience with management of these fractures. Material and Methods Clinical data were reviewed in 72 patients with unstable hangman's fractures, especially using three-dimensional computed tomography (3D-CT) scan to identify the presence of anatomical variations or injuries and analyzing the treatment strategies we used. Results Twenty-two patients(22/72,30.6%) with 39(C2 or C3) risk factors were not fit for safe C2–3 PS placement, due to factors such as small pedicle size of C2 or C3, high-riding vertebral arteries, fractured fragments encased into vertebral canal or transverse process foramen of C2, sclerotic pedicles and pedicle fractures of C3. One or more than one of these risk factors could pose more risks of arterial or neural structures damages in PS fixation for unstable Hangman's fractures. Individualized treatment plans were made to minimize the risks of surgery for the 22 patients. Conclusion There is a high incidence of anatomical variations and injuries in the C2- C3 region in patients with unstable Hangman's fractures that affect the PS placement. Preoperative evaluation of these conditions using 3D-CT scans is of paramount importance to avoid and decrease operative complications and to choose appropriate surgical techniques.
Assessment of Whole Spine MRI for Multilevel Noncontaguous Spinal Fractures: Incidence, Patterns, and Missed Injuries
Authors: Kanna Rishi , Gaike Chandrashekhar , Maheswaran Anupama , Shetty Ajoy Prasad , Rajasekaran S. 
Published: April 2016

Introduction Multi-level non-contiguous spinal injuries are not uncommon and their incidence varies from 1.6 to 77% depending on the type of imaging modality used. Delayed diagnosis and missed spinal injuries in non-contiguous spine fractures have been frequently described which can result in significant pain, deformity and neurological deficit. Mulitlevel injuries patterns have been studied in the past using X-rays and occasionally CT scans. With the growing use of MRI in assessment of spinal trauma scenario the impact of whole spine MRI in evaluation of multilevel injuries have not been assessed in the past. We performed this study to evaluate the impact of using whole spine sagittal MRI in the multilevel spine injuries. Methods Consecutive spinal injury patients treated between 2011 and 2013 were retrospectively evaluated based on clinical and radiographic records. Patient demographics, mode of injury, presence of associated injuries, clinical symptoms and the presence of neurological deficit were studied. Radiographs of the fractured region and whole spine MRI were evaluated for the presence of multi-level injuries We evaluated 484 consecutive patients undergoing whole spine sagittal MRI for multilevel injuries, missed injuries and analyzed the images for specific injury patterns. Results Among 484 patients, ninety five (19.62%) patients had multilevel injuries including 86 (17.76%) with noncontiguous injuries. Five common patterns of non-contiguous spinal injuries between different regions were observed. Pattern I: Cervical and thoracic- 29.1%, Pattern II: Thoracolumbar and lumbosacral - 22.1%, Pattern III: Thoracic and thoracolumbar- 12.8%, Pattern IV: Cervical and thoracolumbar - 9.1% and Pattern V: Lumbosacral and associated injuries- 9.0%. Whole spine MRI scan detected 24 (28.6%) missed secondary injuries of which 5 were unstable. Fall from height was the most common mechanism of injury I in 200 (51.6%), and road traffic accidents contributed to 145 case (37.1%). Neurological deficit was present in 251 patients (64.5%). Complete neurological deficit (ASIA A) was observed in 131 cases(53.3%) while incomplete deficit was present in 120 cases(47.8%). One twenty six patients (32.4%) had associated non-spinal injury including head injury ( n = 19), chest injury ( n = 22), abdomen injury ( n = 4), pelvic injury ( n = 6) and extremity injuries ( n = 75). Conclusion The incidence of multilevel non-contiguous spine injury using whole spine MRI imaging is 17.76%. Five different patterns of multi-level non-contiguous injuries were found with the most common pattern being the cervical and thoracic level injuries. The incidence of missed injuries identified using whole spine MRI was as high as 28.6% and among them the incidence of unstable injuries can be as high as 21%.
The Influence of Histological Subtype in Predicting Survival of Lung Cancer Patients with Spinal Metastases
Authors: Kumar Naresh , Tan Kimberly-Anne , Tan Jonathan , Zaw Aye Sandar 
Published: April 2016

Introduction Lung cancer is one of the most common primaries responsible for spinal metastases. Recent advancements in systemic therapies for lung cancer have significantly improved the survival of patients with certain histological subtypes. Existing prognostic scoring systems have little to no prognostic value in lung cancer spinal metastases, and this may be due to the lack of consideration of lung cancer histology in their algorithms. Since prognostication plays a key role in the decision for operative management of spinal metastases, this study aims to analyze survival of lung cancer patients with spinal metastases according to different histological subtypes, to provide some guidance in making more informed surgical management decisions, better complementing recent medical oncologic advancements. Materials and Methods All patients with histologically confirmed lung cancer treated for spinal metastases at our institution between May 2001 and April 2012 were retrospectively reviewed. The primary outcome measure was survival from the time of diagnosis. Survival data was obtained from the National Registry of Diseases Office. Patient demographic variables, lung cancer histology and various modalities of oncologic treatment were evaluated. Univariate and multivariate cox regression analyses of were performed using Stata v.12. Statistical significance was defined as p < 0.05. Results Out of a total of 180 patients, 51 were treated surgically. The overall median survival time was 4.8 months, (range: 0.1–111.1 months). When subdivided according to histology, patients with non-small cell lung cancer (NSCLC) had a median survival of 5.2 (range: 0.1–111.1) months while patients with small cell lung cancer had a median survival of 2.4 (range: 0.1–11.9) months. Female gender ( p = 0.049), chinese ethnicity ( p = 0.040), NSCLC ( p < 0.001), treatment with epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) therapy ( p < 0.001), treatment with platinum doublet chemotherapy ( p < 0.001), and local radiotherapy ( p = 0.070) for spinal metastases were all significant good prognostic factors upon both univariate and multivariate analysis. Surgery for spinal metastases itself did not significantly improve survival ( p = 0.147). Conclusions Female gender, chinese ethnicity, NSCLC, treatment with EGFR TKI therapy, treatment with platinum doublet chemotherapy, and local radiotherapy for spinal metastases are all independent favorable prognostic factors for patients with lung cancers spinal metastases. Profiling patients according to these factors should help guide decisions for surgical management of spinal metastases given that prognostic scoring systems are currently not predictive in this patient group.
Is Salvaged Blood Ideal for Transfusion in Metastatic Oncological Surgeries?
Authors: Zaw Aye Sandar , Kumar Naresh 
Published: April 2016

Introduction Metastatic oncological surgery is associated with substantial blood loss. Allogeneic blood is the current method for blood replenishment but it has been associated with significant side effects such as: transmission of infections, immunosuppression and other transfusion reactions. Autologous salvaged blood can be a good alternative; yet, it has been contraindicated in oncological surgeries for theoretical concern of reinfusing tumor cells and thereby causing tumor dissemination. We aimed to investigate whether there is any supporting evidence that can logically address the concerns of autologous salvaged blood transfusion in metastatic oncological surgery. Materials and Methods We searched and reviewed the literature through the electronic database – Medline, Scopus, Web of Science and Google Scholar for relevant publications from the past 20 years (January 1 1993 to December 31 2014). We also supplemented the results by searching related key articles from before this period. Relevant articles were selected using search terms: “cancer surgery,” “intraoperative cell salvage,” “autologous salvaged blood” “leucocyte depletion filter,” “circulating tumour cells,” “leucocytes” and “white blood cells.” Results The benefits of transfusion of salvaged blood over allogeneic blood were clearly appreciated in various oncological surgeries. Salvaged blood was comparable or non-inferior to allogeneic blood in terms of safety. In view of the existing circulating tumor cells in the patients with metastatic cancer diseases, the theoretical concern of re-infusing malignant cells from the salvaged blood does not seem to be logical. The reinfusion of salvaged blood was not found to worsen outcomes - tumor dissemination or distant metastases in patients receiving it. It was also found that preserving of white blood cells in the salvaged blood seemed to add benefits in promoting rapid immune recovery in the cancer patients. Conclusions There is evidence supporting the use of salvaged blood in various oncological surgeries. It was advocated that transfusion of salvaged blood is economically efficient, clinically effective and attractive alternative to other transfusion methods. Better understandings and evidence on the preserving white blood cells in the filtered salvaged blood would provide further advantages of salvaged blood in having rapid immune recovery in cancer patients.