bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of PMMA Screw Augmentation on the Primary Stability of an Anterolateral Plating System in Osteoporotic Vertebrae
Authors: Rüger Matthias , von Rüden Christian 
Published: April 2016

Introduction Expandable anterolateral plates facilitate the reduction of posttraumatic deformities of thoracolumbar spine injuries and are commonly used in cases of unstable injuries or compromised bone quality. In this human cadaver study, the craniocaudal yield load of the bony fixation of an anterior angle stable plating system and the influence of Polymethyl Methacrylate (PMMA) augmentation on the primary stability of the screw–bone interface during kyphosis reduction was evaluated in twelve osteoporotic thoracolumbar vertebrae. Material and Methods The anterolateral stabilization device used for this study is comprised of two swiveling flanges and an expandable midsection. It facilitates the controlled reduction of kyphotic deformities in situ with a geared distractor. Single flanges were attached to twelve thoracolumbar vertebrae. Six specimens were augmented with PMMA by means of cannulated bone screws. The constructs were subjected to static, displacement controlled craniocaudal loading to failure in a servohydraulic testing machine. Results The uncemented screws cut out at a mean of 393 +/− 66 N, whereas the cemented screws demonstrated significantly higher yield load of 966 +/− 166 N ( p < 0.02). No significant correlation between bone mineral density and yield load was detected in this setting. Conclusion The results of this study indicate that PMMA augmentation is an effective method to increase two- to 3-fold the primary stability of the screw–bone interface of an anterolateral spine stabilization system in osteoporotic bone. We recommend the system in cases of severely compromised bone quality to reduce the risk of screw loosening during initial kyphosis correction and to increase long-term construct stability.
Posterior Only Vertebral Column Resection (PVCR) for Fixed Angular Kyphosis (FAK)
Authors: El-Sharkawi Mohammad , Koptan Wael , Elmorshidy Essam , Tammam Hamdy , Hasan Khaled , El Miligui Yaser 
Published: April 2016

Introduction VCR is the most suitable osteotomy for rigid angular kyphosis especially if the correction needed is high. The prospective cohort study assessed the efficacy of Posterior Vertebral Column Resection (PVCR) in management of Fixed Angular Kyphosis (FAK). Patients and Methods Thirteen cases of FAK managed by PVCR in Assiut University Hospital and followed up for a mean of 20.31 (12–48) months. Seven cases (53.8%) were females and six cases were males, the mean age was 13.77 years. Eleven cases were congenital (84.6%) and two cases were post tuberculous. Five cases (38.5%) affected the thoracic region, six cases (46.2%) affected thoracolumbar region and two cases (15.4%) affected lumbar region. VAS, ODI, SRS-22, and neurology together with local kyphotic angle were compared pre, post and at last follow up visit. One case suffered progressive paraplegia. Results Five osteotomies were at L1; four at D11, and one osteotomy at D10, D12, L2 and L3. The VAS improved from 6.57 ± 2.14 to 1.29 ± 0.75 ( p = 0.001). The mean ODI improved from 56.22 ± 20.59 to 22.81 ± 11.33 ( p = 0.001). Total SRS-22 score improved from 2.11 ± 0.60 to 3.35 ± 0.65 ( p = 0.002). The mean local kyphotic angle improved from 65.38°±29.95 to 14.69°±19.78 ( p = 0.001), the mean operative time was 465.38 ± 76.44 (320–600) minutes and the mean blood loss was 3323 ± 934.6 (1600–4500) cc. The preoperatively neurologically impaired case recovered completely. Four cases suffered complications (30%), one case suffered postoperative weakness of quadriceps which improved with physiotherapy, two cases suffered asymptomatic proximal junctional kyphosis and one case experienced pull out screws which was revised. Conclusion PVCR seems to be highly effective tool for correction of fixed angular kyphosis avoiding the morbidity of anterior or combined approaches.
Posterior Selective Fusion with Pedicle Instrumented Correction in Thoracic and Thoracolumbar Idiopathic Scoliosis
Authors: McConnell Jeffrey R. , Debnath Ujjwal K. 
Published: April 2016

Introduction To evaluate clinical and radiological outcome of selective fusion for adolescent idiopathic scoliosis (AIS) in thoracic and thoraco-lumbar curves i.e., Lenke 1C and 5C curves. Material and Methods 32 consecutive patients (22 females, 10 males) with 20 Lenke 1 C and 12 Lenke 5C were operated through posterior approach for AIS. Risser stage at the time of operation was 0–3 in 24patients and more than 3 in 4patients. Mean age was 13.5 years. Not every vertebra was instrumented with pedicle screws. Apical vertebral derotation and translation on the concave side were performed for correction. All patients underwent a selective fusion (1C only thoracic curve fused; 5C only thoracolumbar/lumbar curve fused). The data were prospectively collected preoperatively and at 6 weeks, 1year and 2 years post-operatively. Cobb angle, sagittal and coronal balance, and lowest fused vertebral tilt were documented at all time-points. Uninstrumented compensatory curves were measured at all time points. Results Lowest instrumented vertebra (LIV) was distal end vertebra in 15 patients and was one below distal end vertebra in 3 patients in Lenke1C curves. The main thoracic curve correction in Lenke1C was 66%, from 60° ± 12° preoperative to 20° ± 7° at 6 weeks. The Cobb angle was 20° ± 10° at 1 years and 24° ± 10° at 2 years. The apical vertebral rotation improved by 38%, the non-instrumented lumbar curves improved 50%. The last instrumented vertebral tilt decreased from 22° ± 8° preoperatively to 5° ± 5° postoperatively. The average thoracolumbar/lumbar (TL/L) preoperative Cobb angle in Lenke5C curves was 46° ± 8° which was corrected to 14° ± 7° (70% correction) at a 2-year follow-up. 25% of the uninstrumented thoracic curve had spontaneous correction. The coronal balance improved significantly ( p < 0.05) and remained stable from the first postoperative visit to the 2-year follow-up visit. The SRS-22 total scores improved significantly from before surgery to 2years after surgery ( p < 0.0001). No pseudarthrosis or reoperation was observed. One 12 girl with Lenke1C (65°) had intra-operative loss of neural monitoring signals who was paralysed postoperatively for a period of 2 weeks. She recovered completely by 2 months. Conclusion Posterior correction of thoracic and thoracolumbar AIS with pedicle screw instrumentation is safe and produces a long-term stable correction and high patient satisfaction. In Lenke 1C and 5C AIS deformity patterns fused selectively, the uninstrumented compensatory curves do not seem to progress. Selective fusions, when successfully performed, will optimize mobile segments of the spine in AIS patients.
CT-Myelogram Predictors of Outcome in Patients with Cervical Spondylotic Myelopathy: Results of a Systematic Review
Authors: Waly Feras , Abduljabbar Fahad H. , Fortin Maryse , Weber Michael 
Published: April 2016

Introduction Magnetic resonance imaging (MRI) is used routinely to diagnose cervical spondylotic myelopathy (CSM). However, in cases where MRI is contraindicated, CT myelogram remains the preferable imaging modality for the diagnosis of CSM. There remains no confirmed consensus on the use of specific CT myelogram parameters and their relationship with regards to CSM disease severity, clinical presentation and prognosis after surgical treatment. The purpose of this study is to determine the CT myelogram imaging parameters in patients diagnosed with CSM that correlate with severity of CSM and predict postoperative patient outcome Materials and Methods An electronic database search was performed using Ovid Medline and Embase. CT mylogram studies investigating the correlation between imaging characteristics and CSM severity or postoperative outcomes were included. Two independent reviewers performed citation screening, selection, qualitative assessment and data extraction using an objective and blinded protocol. All authors involved in the study have no disclosures related to present study. No funding was needed for this study. Results We found no studies investigating the correlation between CT myelogram parameters and CSM severity. A total of 5 studies (402 patients) were included in this review and investigated the role of CT myelogram parameters in predicting outcome after surgical treatment. All studies were retrospective cohort studies. CT mylogram characteristics included the transverse area of the spinal cord at maximum level of compression, spinal canal narrowing, number of blocks, spinal canal diameter and flattening ratio. There is low evidence suggesting that patients with a transverse area of the spinal cord >30 mm2 at the level of maximum compression have better postoperative recovery and outcome. Conclusion Patients with greater transverse area of spinal cord at the level of maximum compression on CT myelogram are more likely to have better neurological outcome after surgery. There is insufficient evidence to suggest that any of the other CT mylogram parameters investigated are predictors of postoperative outcomes in patients with CSM.
Clinical Outcome of Anterior vs Posterior Approach for Cervical Spondylotic Myelopathy
Authors: Cahueque Mario , Cobar Andres , Ortiz Alfredo , Caldera Gustavo 
Published: April 2016

Introduction Cervical spondylotic myelopathy is a common cause of neurological morbidity. The decompression of the neural elements is the gold standard procedure for this pathology, but there is still a lot of controversy for the selection of the approach, anterior, posterior or combined. Methods 42 patients were enrolled with the diagnosis of cervical spondylotic myelopathy, the 42 underwent surgery with either anterior or posterior approach at the hospital Centro Médico Nacional de Occidente, Guadalajara, México, a follow up for up to one year was made, comparing the results with the modified score for the Japanese Association of Orthopaedics (mJAO) and the Nurick score. Results Patients were divided into two groups. homogeneity analysis were made, finding similar results between both groups ( p < 0.05) Group A. 19(45%)patients received surgery by an anterior approach (Corpectomy with expandable cage and anterior plate fixation) and group B. 23 (55%)underwent posterior approach, from this 23 patients, 18(43%) had a laminectomy with posterior instrumentation and fusion, and 5 (12%) had a laminoplasty. 38% female patients and 62% male patients, median age was 75 years old. Functional outcomes were measure with the modified score for the Japanesse Association of Orthopaedics (mJAO) for up to one year follow up. Group A had a lower score (x:15.52) compare with group B (x:17.13) (15.52 versus 17.13, p < 0.05. While in the Nurick score Group B got a higher score (x:0.73) compare with group A (x:0.30) (0.73 vs 0.30, p < 0.05). Conclusions The election of the surgical approach in the cervical spondylotic myelopathy should be individualize according to the characteristics of the injured elements, it should be focused in the decompression of the neural elements and the recovery to the sagittal balance. In this study a statistical difference was found according to the mJAO and the Nurick scale in favor of the posterior approach, but the anterior decompression may also have good results according to the one year follow up ( p < 0.05). More studies should be made with a bigger population and a longer follow up
The Minimum Clinically Important Difference of the modified Japanese Orthopaedic Association Scale in Patients with Degenerative Cervical Myelopathy
Authors: Tetreault Lindsay , Kopjar Branko , Cote Pierre , Nouri Aria , Fehlings Michael 
Published: April 2016

Introduction The modified Japanese Orthopaedic Association (mJOA) score is the most frequently used clinician-administered tool to assess functional status in patients with degenerative cervical myelopathy (DCM). By defining the minimum clinically important difference (MCID) for this scale, clinicians can evaluate treatment outcomes for this condition and better interpret evidence from clinical studies. This study aims to establish the MCID of the mJOA in patients with CSM. Material and Methods Three different methods were used to determine the MCID of the mJOA: 1) distribution-based, 2) anchor-based and receiver operating characteristic (ROC) analysis and 3) professional opinion. The first two methods were accomplished using data from 517 patients enrolled in the AOSpine CSM-North America or CSM-International studies. Distribution-based methods were used to estimate the MCID by computing the half standard deviation and standard error of measurement. Using anchor-based methods, mJOA at 12-months after surgery was compared between patients who “slightly improved” on the Neck Disability Index (NDI) and those who were “unchanged.” ROC analysis was then performed to compute a discrete integer value for the MCID that yielded the smallest difference between sensitivity and specificity. Finally, MCID estimates were obtained by surveying members of AOSpine International. We repeated the anchor-based methods for patients with mild (mJOA: 15–17), moderate (mJOA: 12–14) and severe disease (mJOA < 12). Results Our cohort consisted of 315 men and 202 women, with ages ranging from 21 to 86 years (mean age: 56.37 ± 11.60). The mean baseline mJOA score was 12.48 ± 2.71. One hundred and twenty-nine patients were classified as mild (mJOA = 15–17) preoperatively, 208 as moderate (mJOA = 12–14) and 180 as severe (mJOA < 12). Based on the NDI at 12-months following surgery, 76 (14.70%) patients worsened (NDI < −7.5), 130 (25.15%) were unchanged (−7.5≤NDI < 7.5), 87 (16.83%) slightly improved (7.5≤NDI < 15) and 224 (43.33) showed marked improvements (15≤NDI). The half standard deviation of the baseline mJOA was 1.36 and the standard error of measurement was 1.21. The difference in mJOA between patients who “slightly improved” on the NDI and those who were “unchanged” was 1.11. ROC analysis yielded a value of 2 for the MCID (Fig. 1). The survey of 416 spine professionals confirmed these estimates: The mean response was 1.65 ± 0.66, although the most commonly selected answer was 2 (39.42%). The MCID significantly varied depending on myelopathy severity: ROC analysis yielded a threshold of 1 for mild patients, 2 for moderate patients and 3 for severe patient. Conclusion The MCID of the mJOA is estimated to be between 1 and 2 points and varies significantly with myelopathy severity. This knowledge will enable clinicians to identify meaningful functional improvements in surgically treated CSM patients.
Degenerative Changes in the Cervical Spine are More Common in Middle-aged Patients with Thalidomide Embryopathy than in Healthy Individuals
Authors: Jahani Shadi Afarin Ghassemi , Daielsson Aina , Ab-Fawaz Rana , Hebelka Hanna , Danielson Barbro , Brisby Helena 
Published: April 2016

Introduction The aim of the study was to compare the degree of degenerative changes in the cervical spine of thalidomide embryopathy (TE) patients−in whom upper limb malformations often necessitate help with grip function through the mouth or by head motion, and may thereby add extra load to the spine−with that in a control group (CTR). Material and Methods Twenty-seven middle-aged TE patients and 27 age- and gender-matched healthy CTR were examined by cervical MRI. The presence of malformations, disc herniations, osteophytes, nerves and medullary compression, were evaluated. Disc degenerations (DD), were graded according to the Pfirrmann classification. Results Similar frequencies of disc herniation and disc space narrowing were observed in both groups, but there was more foraminal narrowing in the TE group (ρ < 0.002). Significantly more DD were seen in the TE group than in the controls (ρ < 0.001). Evaluation of all discs ( n = 135 per group) showed Pfirrmann grade I in 0% of the TE group and 2% of the controls. Grade II was found in 3% and 36%, respectively, grade III in 46% and 50%, grade IV in 38% and 11%, and grade V in 13% and 0% (ρ < 0.001). DD were observed frequently at all levels for the TE group, however mainly in the two lower levels for the CTR. Conclusion The more frequently observed degenerative changes of foraminal narrowing and disc signal changes in the TE group support the theory that a higher load on the cervical spine leads to earlier development of DD.
Surgery for Spinal Tuberculosis: A Multi-Center Experience of 582 Case
Authors: Alam Shah , Phan Kevin , Karim Rezaul , Jonayed Sharif Ahmed , Munir Hasan Khalid Md. , Chakraborty Shubhendu , Alam Tashfique 
Published: April 2016

Introduction Tuberculosis of the spine is a common form of TB infection for 50% to 60% of osseous tuberculosis. Although uncommon, spinal TB still occurs in both developed and developing countries. The diagnosis of spinal tuberculosis is difficult and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity. Material and Methods A total of 582 patients with tuberculosis of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January, 2003 to July, 2014. Thoracotomy along with anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were done in 113 cases. Posterior decompression, posterior interbody and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods were done in the remaining 469 cases. Appropriate anti TB drugs were given to all patients for 18–24 months. The follow-up period was 3 months to 10 years. Results The average age was 32.5 years. All patients survived surgery. There were 7 cases of superficial infections (1.2%) while there were 4 cases (0.7%) of deep infections. Revision surgery was performed in 6 patients (1.0%). Implant failure occurred in 4 cases (0.7%) while malposition of screws occurred in 12 cases (2.1%). Perioperative bleeding complications were reported for 4 patients (0.7%). Neurological improvement occurred in all patients except for 2 cases (0.3%). Preoperatively, the majority of patients ( n = 221, 38%) were classified with Class A on the American Spinal Injury Association (ASIS) neurological impairment scale. This was significantly reduced postoperatively to 0.4%. Conclusion For patients with spinal tuberculosis anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion.
Spondylodiscitis 10 Years Experience of 40 Cases in a Third Level Hospital in Bogotá, Colombia
Authors: Bedoya Constanza , Alvarado Fernando , Morales Luis Carlos , Rodriguez Andres , Farfan Miguel Andres , Rodriguez Andres Felipe , Tafur Daniela 
Published: April 2016

Introduction Spondylodiscitis is an infrequent pathology and may be overlooked in clinical practice. Diagnosis requires a high level of suspicion by physicians; a multidisciplinary approach is essential. The objective was to describe the incidence, risk factors, clinical characteristics, management and outcomes of patients with spontaneous spondylodiscitis. Material and Methods Medical records of patients treated for infectious discitis at a third level hospital in Bogotá, Colombia, between January 2003 and August 2014 were reviewed. Postoperative infections and vertebral osteomyelitis were excluded. Results Spontaneous spondylodiscitis was diagnosed and treated in 40 patients (mean age 60,8 years, 60% male, 40% female). Most patients presented with subacute pain, 25% with fever, one patient with hypoesthesia in both legs, normal physical exam was observed in 24% of patients and no patient had paresis/paralysis. Among comorbid diseases, type 2 diabetes mellitus was the most relevant (20%). Concomitant infection at diagnosis was present in 7.5% of patients. WBC count and PCR were the most frequent laboratory test and MRI the most performed radiological test being positive in all cases. Procalcitonine was assessed in 10% of patients. Lumbar segments were involved in 62,5% of patients. S. Aureus and S. Epidermidis were the most common isolated microorganism (10% of patients) 55% of patients received I.V. inhospital antibiotic for less than 1 month, followed by 2–6 weeks of oral antibiotics in 75% of patients. Linezolid, Rifampicin and Vancomycine were the most frequently used antibiotics (alone or in combination). 20% of patients underwent surgical treatment. Abscess was observed in 7 patients (17,5%) all of whom went to surgical treatment. 2 patients developed infectious endocarditis and 1 patient died. 8 patients presented recurrence of the disease. Mean inhospital length was 30 days. Conclusion Spondylodiscitis diagnose must be suspected in patients presented with persistent back pain and specific risk factors (i.e., Diabetes Mellitus, Immunosuppression). Appropriate images and laboratory tests (MRI, WBC count, PCR and procalcitonine) must be assessed to reach an early diagnosis and antibiotic treatment guided by causative organism. Surgical treatment must be considered in specific cases. Recurrence is not common and must be prevented.
Demographics of Tuberculosis of Spine and Factors Affecting Neurological Improvement in Patients Suffering from Tuberculosis of Spine - A Retrospective Analysis of 312 Cases
Authors: Sharma Ayush , Chhabra Harvinder , Chabra Tarun 
Published: April 2016

Objective The purpose of the study was to study demographics of tuberculosis of Spine and analyze factors that might affect neurological improvement in patients suffering from tuberculosis of spine. Materials: Of the 638 suspected cases of spinal tuberculosis, 312 cases with confirmed diagnosis with at least one year follow up were selected for retrospective analysis. 200 cases that presented with neurological deficit were further divided into three groups- completely improved, partially improved, and no improvement according to AIS (American Spinal Injury Association impairment scale) grading. All continuous variables and categorical variables were compared across groups. Results 66.99% patients had typical clinical presentation. 84.62% had typical MRI presentation. Thoracic levels (T1–10) were most commonly affected in 45.78% followed by thoracolumbar levels 27.52%(T11-L2). In 80.32% disease was restricted to one or two adjoining vertebrae. At presentation 35.89% patients were neurologically intact whereas 31% were AIS-D, 20.83% were AIS-C, 2.5% were AIS-B and 9.61% were AIS-A. The three groups of patients with complete improvement, partial improvement, and no improvement were significantly different in their levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration on statistical analysis. Conclusion Age, sex, radiological presentation, co–morbidities and presence of pulmonary tuberculosis has no significant effect on neurological improvement. Levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly effects the final neurological improvement in cases of tuberculosis of spine.