bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior Selective Fusion with Pedicle Instrumented Correction in Thoracolumbar Adolescent Idiopathic Scoliosis (AIS)
Authors: Debnath Ujjwal K. , McConnell Jeffrey R. 
Published: April 2016

Introduction To evaluate clinical and radiological outcome of selective fusion for adolescent idiopathic scoliosis (AIS) in thoraco-lumbar curves i.e., Lenke 5C curves. Material and Methods Twelve(12) patients with Lenke 5C curves were operated through posterior approach for AIS. Risser stage at the time of operation was 0–3 in 6patients 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 (5C only thoracolumbar/lumbar curve fused). The data were prospectively collected preoperatively and at 6 weeks, 1year and 2years 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 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. Conclusion Posterior correction of thoracolumbar AIS with pedicle screw instrumentation is safe and produces a long-term stable correction and high patient satisfaction. In Lenke 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.
A Comparison of Stryker Xia3 and Depuy Expedium FAS Instrumentation for the Correction of Adolescent Idiopathic Scoliosis
Authors: Khan Almas , Fragakis Angelo , Loughenbury Peter , Ong Jeffrey , Husein Rodwan 
Published: April 2016

Introduction In 2012, our institution held a tender for the supply of its instrumentation which resulted in a majority supply being awarded to Stryker for Xia3 spinal instrumentation. Prior to this we had been using Depuy Expedium FAS for the preceding 5 years. As the surgeons would have to go through a learning curve for the use of the instrumentation system, we felt it important to demonstrate that the correction of curve obtained and the intraoperative risks were the same for each from the outset of the change. Material and Methods We examined the post-operative X-rays of our patients who had adolescent idiopathic scoliosis corrected in our institution using Expedium FAS and Xia3 instrumentation between 2011 and 2014. We excluded curves that had previously had growing rods, previous pseudarthrosis or other spinal complication, anterior spinal surgery, implant removal, and incomplete records. Patients were identified using our hospital's theater management software. We measured the pre- and postoperative and 1 year follow up Cobb angle on our PACS system. Blood loss and transfusion requirements were obtained from our cell-saver and blood bank database, and other information was obtained from the clinical notes. Results 173 patients were identified. 53 had incomplete datasets. 22 were excluded due to having previous growing rod, combined anterior/posterior procedure, or a Skagg's Procedure. 63 cases using Expedium FAS and 35 of Xia3 were found. Expedium had 59 (21–99)% curve correction, 5.40 (2–12.5) hours operative time, 0.87 (0.2–1.5)l intraoperative blood loss and 8.5 (5–42) days hospital stay. The Xia3 group had 63 (34–90) % curve correction, 4.87 (3–7.5) hours operative time, 1.6L (0.4–2.5)l blood loss, and 10 (5–42) days LOS. Only the difference in blood loss reached statistical significance, however transfusion rates were the same. Conclusion Despite being at different parts of the learning curves with each instrumentation systems, a group of 4 experienced scoliosis surgeons were able to achieve equal correction of scoliosis using either instrumentation systems in all variables except for blood loss. Moving instrumentation systems can be daunting, however can be done safely if managed in a proactive manner.
Pedicle Subtraction Osteotomy in Management of Rigid Thoracolumbar Kyphosis in Adults
Authors: Negm Mohammad 
Published: April 2016

Introduction Thoracolumbar kyphosis represent a big challenge for spine surgeons specially if the case is of significant deformity which may affect patients life, Pedicle subtraction osteotomy (PSO) is one of the best methods that cane correct the deformity and give satisfactory result to the patients as it corrects the deformity and allow the patients to gain near normal daily activity. Material and Methods Four patients were treated by this method by PSO of lumbar 2 vertebra, 3 of them complaining of ankylosing spondylitis and one post traumatic, all patients are neurologically stable. All are assisted by X-ray and MRI preop. PSO is carried through a posterior midline approach with fixation of D12 to L4 Results All patients are satisfied with near full correction average 90%. Conclusion PSO is an excellent method for management of rigid thoracolumbar kyphosis in adults
Prevalence and Complications of Post-Operative Transfusion for Cervical Fusion Procedures in Spine Surgery; an Analysis of 11,588 patients from the ACS-NSQIP Database
Authors: Aoude Ahmed , Aldebeyan Sultan , Fortin Maryse , Nooh Anas , Jarzem Peter , Ouellet Jean , Weber Michael H. 
Published: April 2016

Introduction Cervical spine fusion have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications and acceptable results. The purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect, if any on complication rates. Material and Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion surgery from 2010 to 2013. Univariate and multivariate regression analysis was used to determine post-operative complications associated with transfusion and cervical fusion. Results We identified 11,588 patients who had cervical spine fusion between 2010 and 2013. The overall rate of transfusion was found to be 1.47%. All transfused patients were found to have increased risk of: venous thromboembolism (TBE) (OR 3.19, CI: 1.16–8.77), myocardial infarction (MI) (OR 9.12, CI: 2.53–32.8), increased length of stay (LOS) (OR 28.03, CI: 14.28–55.01) and mortality (OR 4.14, CI: 1.44–11.93). Single level fusion had increased risk of: TBE (OR 3.37, CI: 1.01–11.33), MI (OR 10.5, CI: 1.88–59.89), and LOS (OR 14.79, CI: 8.2–26.67). Multilevel fusion had increased risk of: TBE (OR 5.64, CI: 1.15–27.6), surgical site infection (OR 16.29, CI: 3.34–79.49), MI (OR 10.84, CI: 2.01–58.55), LOS (OR 26.56, CI: 11.8–59.78) and mortality (OR 10.24, CI: 2.45–42.71). ACDF surgery had an increased risk of: TBE (OR 4.87, CI: 1.04–22.82), surgical site infection (OR 9.73, CI: 2.14–44.1), MI (OR 9.88, CI: 1.87–52.2), LOS (OR 28.34, CI: 13.79–58.21) and mortality (OR 6.3, CI: 1.76–22.48). Posterior fusion surgery had increased risk of: MI (OR 10.45, CI: 1.42–77.12) and LOS (OR 4.42, CI: 2.68–7.29). Conclusion Our results demonstrate that although cervical fusions can be done as outpatient procedures special precautions and investigations should be done for patients who receive transfusion after cervical fusion surgery. These patients are demonstrated to have higher rate of MI, DVT, wound infection and mortality when compared with those who do not receive transfusion.
Stand Alone Anterior Multiple Levels Cervical Cage
Authors: Khattab Mohamed , El Ghamry Sherief , El-Hawary Youssry 
Published: April 2016

Introduction Anterior cervical discectomy and fusion is common surgical procedure for treatement of cervical spondylotic radiculopathy and or myelopathy after failure of conservative management. Previous studies of multilevel cervical discectomies and fusions have shown decrease fusion rates with increase number of surgical levels. fusion rate and sagittal contour is better with anterior plating but complications like increase dysphagia rates, tracheoesophageal lesions, plate malposition and accelerated adjacent disc degeneration, even when low-profile plates are used. Further To avoid the adverse effect of autograft harvesting techniques Allograft can be used. Cages were used to add stability and prevent graft complications. Stand alone PEEK cages filled with Allograft were used in 3–4 levels anterior cervical discectomy and fusion. Material and Methods 33 patients 18 males 15 females 28 with cervical spondylotic radiculopathy and 5 With cervical spondylotic myelopathy was treated with multiple levels anterior cervical discectomies and fusion using stand alone PEEK cages filled with Allograft. Total numbers of levels114, 18 patient operated for 3 levels ACDF and 15 patients operated for 4 levels. Clinical evaluation using visual analogue scale (VAS), neck disability index (NDI), and patient satisfaction were analyzed. Cervical lordosis, cervical fusion and complications were assessed. Results Improvement of the clinical outcome and the radiological parameters were detected Conclusion 3–4 levels anterior standalone PEEK cages filled with allograft is very good option for treatment of degenerative cervical disc disease with low complication rate, good clinical and radiological outcomes.
Change in Impairment following Operative Treatment of Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis
Authors: Shamji Mohammed , Tetreault Lindsay , Kurpad Shekar , Brodke Darrel , Smith Justin , Arnold Paul , Brodt Erika , Dettori Joseph , Fehlings Michael 
Published: April 2016

Introduction The primary objective of this work was to define the neurological benefit conferred by surgical intervention to patients with degenerative cervical myelopathy (DCM). Secondary objectives included assessing how preoperative disease severity and duration impacted on that benefit and defining the surgical complications encountered by these patients. Material and Methods A search was undertaken for articles published until May 2015 evaluating the operative treatment of DCM using electronic databases. Prospective studies of adult surgical myelopathic patients were included. Extracted data included study design, patient demographics, diagnosis, surgical approach, preoperative and postoperative neurological status (mJOA, NDI, Nurick, VAS), and complications. Preoperative disease severity and duration of symptoms were recorded. Risk of bias (Newcastle-Ottawa Scale) and quality of evidence (Grades of Recommendation Assessment, Development and Evaluation) were assessed. Primary outcomes included assessment of change in neurological (graded by mJOA, NDI, and Nurick scores) and pain (graded by VAS score) following surgical intervention for myelopathic patients. Secondary outcomes were also assessed for dependency on preoperative duration of symptoms and preoperative disease severity. Safety of surgery was assessed by pooled estimates of perioperative complications encountered. Results Among 32 included studies, surgical intervention for DCM patients provided clinically-significant improvement in neurological dysfunction and pain. This improvement occurred at short-term assessment (fewer than 12 months) and was durable in longer-term (greater than 36 months), consistent over several different scoring systems. Shorter duration of symptoms may be associated with a higher likelihood of neurological recovery. Conclusion Surgical intervention for DCM is an appropriate evidence-based therapy with an acceptably low rate of perioperative complication. Further work is important to define optimal surgical approach and timing.
Influence of Lumbar Lordosis Restoration on Clinical Outcome in Degenerative Lumbar Patients from the “Pre-Balance” Period: Ex Post Analysis of Spinal Parameters Restoration and Clinical Outcome in a Medium Follow-Up
Authors: Martini Carlotta , Pieracci Edoardo Maria , Lepori Paolo 
Published: April 2016

Introduction Restoration of spinal balance is a widely accepted principle of spinal surgery planning. There is a huge amount of data supporting the correlation of clinical outcome and the restoration of theoretical physiological curves of the spine. Flat or hypolordotic fixations are rarely seen today, but there is someone who claims that spinal balance principles are too often pushed to extremes and, surprisingly, there is still some resistance to accept the routinary application of these concepts in the “simple” degenerative surgery, claiming that in short fixations for degenerative lumbar spinal disease it is not mandatory to be strict in the restoration of correct, theoretical spinal parameters to achieve satisfactory clinical results. In this study we present a homogeneous population of patients, operated by a single surgeon in a 3 years time, 7 to 10 years ago, with homogeneous degenerative pathology and similar constructs (2 to 4-level fixations). The peculiarity of this study is that all the patients have been operated regardless to spinal parameters restoration, because at the time of surgery the presurgical planning of spinal curves was not being sistematically adopted. The population is therefore a kind of spontaneous randomization, with patients with a good restoration of spinal theoretical curves and patient who didn't get any correction of sagittal curves. Material and Methods 36 patients with homogeneous diagnosis of degenerative spinal disease, operated by a single surgeon with a 2 to 4-level fixation until 2010 has been selected. ODI and Prolo scales has been used for direct clinical evaluation. The mean last follow-up was 4 years 4 months, with a minimum of 3 years. Radiological assessment has been performed by lumbar standing XRays AP and LL pre and postop, and PI-LL mismatch and the difference between theoretical lordosis and effective postoperative lordosis have been calculated. Statistical evaluation used Spearman correlation test between PI-LL mismatch and clinical scales values. Results Statistical correlation exists between clinical scale values and PI-LL mismatch. As a qualitative result, we observed that the higher is the difference between theoretical lordosis and effective postsurgical lordosis, the higher is the incidence of construct failure. Conclusion According to the results of this study, respect of the spinal balance principles seems to be helpful to achieve good clinical results in a medium follow-up for lumbar degenerative patients. These results come from a dataset that is not culturally influenced by spinal balance principles, coming from the past. Additionally, the single-surgeon, single-observer and single-center experience is somehow minimizing the confounding factors that usually affects this kind of studies.
Lumbosacral Parameters and Intervertebral Disc Changes in Adult Patients with Pars Defects
Authors: Baco Abdul Moeen , Mukhtar Khalid , Khan Nasser Mehrab , Ghouri Syed Imran , Shaikh Emad Salman 
Published: April 2016

Introduction Pars defect refers to fracture in the pars inter articularis and is believed to be one of the leading cause of back pain. Pars defects usually acquired and caused by microtrauma. Spondylolysis is seen in 4–6% of population. 82% occur at L5/S1 and 11% occurs L4/5 (11%). Materials and Methods Between March 2013 and April 2014, we collected particulars of all patients presenting with low back pain with pars defects on standing erect lumbosacral spine X-rays. Patients were excluded if they had (1) Deformity, (2) Non availability of MRI. 57 patients were included. Their X-rays and MRI were studied by two orthopedic surgeons measuring: Lumbar lordosis and Sacral slope on Plain Xrays; Lumbar slip according to meyereding grading; Intervertebral disc status on MRI: (1) Disc degeneration according to Pfirmann's grading, (2) Degree of disc prolapsed. Results 57 subjects had their data reviewed: 30 males, 27 females; ages ranged between 15 and 65 years (mean age = 40 years). Data was collected and cleaned using Microsoft Excel. Then analysis done using SPSS ver.17.characteristics of the sample population were displayed in frequency tables while testing for correlations as wellas student t-testwere taken as significant for P values < 0.05. There's a significant difference between males and female ages (p-value 0.01); males were younger with a mean age of 37 years versus 45 years. Sacral Slope: Ranged between 17 – 64 degrees (Mean = 38 degrees). Lumbar Lordosis: ranged between 15 – 77 degrees (Mean = 52 degrees). Slip degree according to myerdings grading: Grade 0 = 38%, Grade 1 = 58%, and Grade 3 = 4%. On MRI disc changes according to Pfirmann's grading was grade 1 26%, grade 2 5%, grade 3 24%, grade 4 32%, grade 5 11%. And finally the disc prolapse severity wasas under: (1) No bulge 32%, (2) Bulge 29%, (3) Extrusion 34%, (4) Sequestration 4%. Statistically significant correlation found between: (1) Age and degenerative disc changes; cor. coefficient 0.43 and p value 0.001; (2) Age and prolapsed disc; cor. coefficent 0.39 and p value 0.003; (3) Degenerative disc changes and prolapse; cor. coefficient 0.83 and p value < 0.001; (4) Between sacral slope and lumbar lordosis; cor. coefficient 0.72 and p value < 0.001. Conclusions There is increased prevalence of disc degeneration in patients with pars defect. There is direct correlation between age and disc degeneration plus degree of disc prolapse. Severity of degeneration is directly related to degree of disc prolapse. The lumbar lordosis and sacral slope were not found be statistically related to degree of spondylolisthesis. The disc is not protected in patients with defect.
Stand Alone ALIF for Degenerative Lumbar Spine Diseases
Authors: Elbanna Yasser 
Published: April 2016

Introduction With progress continuing in the development of anterior lumbar constructs, the need for complete anterior access to the lumbar spine continues to increase. Material and Methods The study included 18 patients with various types of degenerative lumbar spine diseases as degenerative disc lesions with or without hernias (15), degenerative spondylolisthesis (2) and degenerative stenosis (one case). The follow up period was 6 months. Results Back and leg pain have been markedly improved and assessed by ODI. Conclusion With various techniques evolving over the years, the mini-open retroperitoneal approach is becoming the standard, with decreased complication rate, better cosmesis and less abdominal wall disruption to provide exposure to the lumbar spine.
Unplanned Reoperation of Lumbar Spinal Surgery during the Primary Admission: A Multicenter Study Based on a Large Patient Population
Authors: Liu Jiaming , Liu Zhili , Huang Shanhu , Deng Huilin 
Published: April 2016

Introduction Unplanned reoperation is suggested to be a useful quality indicator for spinal surgery. However, the rates of unplanned reoperation in patients underwent lumbar spinal surgery during the primary admission are not well established. The purpose of this study was to identify the rates and reasons, also the risk factors for unplanned reoperation of lumbar spinal surgery during the primary admission in terms of a multicenter and a large patient population study. Materials and Methods A retrospective study was performed to review all the patients who underwent lumbar spinal surgery at three institutions from January 2010 to April 2015. Patients with unplanned reoperations after primary surgery during the same admission were included in this study. The demographics, diagnosis, surgical procedure and complications of patients were reviewed and statistical analysis was performed to investigate the incidences and risk factors of unplanned revision. Results A total of 3936 patients who underwent lumbar spinal surgery from three institutions were reviewed, and 82 (2.08%) required unplanned reoperation during the primary admission because of wound infection (0.94%), screw misplacement (0.53%), cerebrospinal fluid leakage (0.27%), wound hematoma (0.18%) and neurologic deficit (0.15%). For the diagnosis, patients with lumbar spinal spondylolisthesis had a much higher rate of reoperation (4.3%) than those of lumbar stenosis (2.3%), vertebral tumor (2.2%), vertebral fracture (1.2%) and disc herniation (1.1%) with a significant difference ( P < 0.001). The revision rate was significantly higher in patients underwent posterior lumbar interbody fusion (PLIF) than those received transforaminal lumbar interbody fusion (TLIF) ( p = 0.007). Conclusions Unplanned reoperation rate of lumbar spinal surgery was 2.08% and the most common reasons for it were wound infection and screw misplacement. Patients with a diagnosis of lumbar spinal spondylolisthesis or who underwent PLIF were more likely to required unplanned reoperation during the primary admission.
Clinico-Radiological Evaluation of Unilateral Single Cage filled with Local Morselized Bone Graft in Posterior Lumbar Interbody Fusion (PLIF) for Degenerative Lumbar Disc: Retrospective Study
Authors: Kumar Suresh 
Published: April 2016

Introduction Retrospective clinico-radiological evaluation of 200 patients who underwent posterior lumbar interbody fusion(PLIF) using unilateral single cage filled with local morselized Bone graft for degenerative lumbar disc. Material and Methods 200 patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft of which 182 patients were single level and 18 patients two levels, during the year, january 2010 to january 2015 were enrolled in this study. The average follow-up duration was 2years. The clinical outcomes were evaluated with, using the visual analogue scale (VAS) and Oswestry Disability Index at the pre-operative period, and Oswestry Disability Index at 1month, 3 months, 6 months, 12months and 24 months year post-operative period. The radiological outcomes were evaluated according to bone fusion and bony bridging, the radiolucency, the instablity and the disc height. Results Clinical outcome for pain was evaluated using the visual analogue scale (VAS) and Oswestry Disability Index along with functional evaluation showed excellent results and radiological outcomes were evaluated according to bone fusion, disc height, instability and bony bridge, showing no cage back out or implant loosening or screw back out or implant breakage. Conclusion PLIF using a unilateral single cage filled with a local morselized bone graft was found to be good and has the advantages of a shorter operation time, less blood loss and a shorter hospital stay, low cost, less complications like dural tear, as compared with the PLIF using bilateral cages, for treating degenerative lumbar spine disease. This technique also provides excellent outcomes according to the clinical and radiological evaluation.