bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is there Sacral Defromity Predisposing to L4 Degenerative Spondylolysthesis?
Authors: Díez-Ulloa Máximo-Alberto , Barahona-Lorenzo Daniel , Gallego-Goyanes Adrian 
Published: April 2016

Introduction Degenerative spondylolysthesis results from anteroposterior instability, giving rise to a facet remodeling, generally at the L4L5 level. For istmic lythihc spondylolydsthesis an intrinsic sacral deformity has been described (Antoniades Spine 2000, Díez-Ulloa Proc Geer 2007). This sacral kyphosis, if present could contribute to a disbalance scenario that would render L4 more prone to olysthesis. Hypothesis A sacral kyphosis S1S2 could be a contributing factor to degenerative spondylolysthesis at L4L5. Matherial and Methods A control group (group C), matchable for age and gender, was compared with a series of 83 patients with L5 istmic lythis spondylolysthesis (group D). Proximal sacral kyphosis measured by the angle formed by the S1 posterior wall and the S2 posterior wall, if S1 was kyphotic on S2 then it was considered a positive angle, other wise being negative. Statistics SPSS 21.0, working with means or medians and appropriate tests after studying whether the variable showed a normal distribution. Results Group C lordosis -2° (minimum -8°; maximum +7°). Group D kyphosis +2° (minimum -14°; maximum +22°). There were statistically relevant differences between group C and group D. Conclusion An intrinsic sacral deformity might be a contributing factor to L4 degenerative spondylolysthesis in a degenerative environment.
Cost per Quality Adjusted Life Years Gained following Anterior Cervical Discectomy and Fusion in Elective Degenerative Pathology in Obese and Non-Obese Paients
Authors: Chotai Silky , Parker Scott , McGirt Matthew , Cheng Joseph , Devin Clinton 
Published: April 2016

Introduction Obese patients are at increased risk of co-morbidities and complications after spine surgery, which might result in increase cost and lower quality of life compared with their non-obese counterparts. The aim of present study was to determine the cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients. Methods A total of 299 consecutive patients undergoing elective ACDF for degenerative cervical pathology over a period of four-years were included in the study. One and two-year medical resource utilization, missed work, and health state values (QALYs), calculated from the EQ-5D with US valuation using time weighted area under the curve approach) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost (direct + indirect) was used to compute cost per QALY gained. Patients were defined as obese for body mass index (BMI) ≥35 based on the WHO definition of class-II obesity. A subgroup analysis was conducted in morbidly obese patients (BMI≥ 40). Results A significant improvement in pain (NP/AP), disability (NDI) and quality of life (EQ-5D and SF-12) was noted 2-year after surgery ( p < 0.0001). Mean total 2-year cost was $24524 for obese patients and $22492 for non-obese patients ( p = 0.06). Obese patients had lower mean cumulative 2-year gain in QALYs versus non-obese patients (0.39 versus 0.47 QALYs, p = 0.19, Fig. 1). Two-year cost-utility in patients obese versus non-obese patients was $65,805/QALY versus $47,634/QALY. Morbidly obese patients had significantly lower (0.15) QALYs gained and significantly higher cost $168,915/QALY gained at 2-years ( p < 0.0001) (Table 1). Conclusion ACDF provided a significant gain in health-state utility in obese patients, with a mean 2-year cost-utility of $65,805/QALY gained, which can be considered moderately cost-effective. Morbidly obese patients had lower cost-effectiveness; however, surgery does provide a significant improvement in outcomes. Obesity needs to be taken into consideration as physician and hospital reimbursements move toward a bundled mode
Value of Combination of Two Minimal Invasive Techniques in Elderly Patients with Multisegmental Lumbar Canal Stenosis and Spondylosis. Midterm Results
Authors: Abdelrahman Hamdan , Alhashash Mohamed , Boehm Heinrich 
Published: April 2016

Introduction Lumbar canal stenosis (LCS) and spondylosis are the major causes of morbidity among the elderly. LCS remains the most common indication for spinal surgery in elderly patients. These patients are complaining from neurogenic claudication as well as back complaint. LCS remains the most common indication for spinal surgery in elderly patients. These patients are complaining from neurogenic claudication as well as back complaint. Although the decompression Procedures improve the claudication, the back complaint persist or even increase. We assess the efficacy of combination of microscopic assisted percutaneous decompression (MAPD) and percutaneous transpedicular screw fixation (TPSF) with PEEK rod. Material and Methods Prospective study. Between 2009 and June 2012, 20 Patients with LCS and lumbar spondylosis were included in this study. We reviewed demographic information, preoperative (preop.) and postoperative (postop.) Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Results 20 patients (14 males and 6 females; mean age 69.2 years), mean follow-up 14.2 months, co-morbidities are found in patients (cardiac 8, DM in 4, renal insufficiency in 4), ASA Score (Class I in 8, III in 10, III in 2). BMI; normal weight (7), overweight (6) and Obesity (7). Mean preop. VAS (back and leg) was 5.5 and 5.6 respectively; ODI was 57.2%, 3 months postop. VAS (2.65 and 1.3), ODI 26.4% and 18.2% at the last follow-up. The operated levels were (one level in 2 patients, two levels in 7, three levels in 7 and four levels in 4), eight patients with degenerative scoliosis (more than 10°) with mean cobb- angle of 15.4° preop. and postop. 5.75°. Mean Lumbar lordosis was 35.6° preop. and 39.5° postop. Sacral Slope was 27.8°preop. and postop. 30.3°. Mean operative time was 196 minutes and blood loss was 233.5 ml. Intraop. complications included 2 patients with dural injuries, no wound healing, Follow-up complications included one case with screw loosening. Conclusion Elderly patients are considered good candidates for lumbar surgical decompression using minimally invasive techniques. MAPD is a minimally invasive treatment option that affords a high level of safety, improved functions and decreased pain score. The spinal stabilization using PEEK rod possesses a good solution for spondyolotic back pain not
The Validity of Rasterstereography: A Systematic Review
Authors: Skwara Adrian , Mohokum Melvin , Schülein Samuel 
Published: April 2016

Introduction To investigate and monitor the progression of scoliosis and other spinal deformities in patients following idiopathic scoliosis (IS), non-invasive and radiation-free techniques are recommended because of the need for repeated radiographs. In a clinical setting, spine parameters can be quickly, cheaply and easily assessed using rasterstereography (RS). The objective of this paper was to assess the validity of the radiation-free technique RS based on surface topography compared with radiographs. Material and Methods MEDLINE, the Cochrane Library and EMBASE were systematically searched for studies which investigate the validity of rasterstereography compared with X-ray measurements. Studies published between January 1, 1990 and July 31, 2013 in English, German and French were included. Studies dealing with magnetic resonance imaging were excluded. Results Twelve studies with 570 patients were included; these articles were published between 1990 and 2013. The majority of studies investigated patients with IS, but other spinal pathologies included were thoracic hyperkyphosis and Scheuermann's disease. With regard to the quality assessment criteria for the included studies, three out of twelve studies were evaluated using a twelve point scale and two used a scale with eleven points. Conclusions RS facilitates clinical practice by analyzing the spinal column. It is completely radiation-free and could help to monitor scoliosis progression.
Oswestry Disability Index: Is Telephonic Administration Valid?
Authors: Yaszemski Alexandra , Ledonio Charles , Garber Tara , Polly David W. 
Published: April 2016

Introduction The Oswestry Disability Index (ODI) is a patient reported outcome questionnaire that assesses the functional status of a patient with back pain. It is widely used to assess the effectiveness of interventions for low back pain. The ODI is currently administered in outpatient clinics on a face-to-face basis, which can be expensive and time consuming. Telephonic administration of ODI, if valid, can be more convenient, may improve follow-up rates, and reduce costs. The objective of this study is to validate telephonic administration of ODI compared with face-to-face administration. Study Methods A convenience sample of employees and patients in an academic medical building were recruited. Face-to-face administration of ODI was done then retested 24 hours later over the phone. Reliability of each response from each section and overall scores were compared with determine test retest reliability by calculating the intraclass correlation coefficient. Results 22 individuals completed the ODI questionnaire face to face, then via telephone 24 hours later. There was a mean 2%(±3) intrarater ODI score difference, range 0% to 12%. The Intraclass correlation coefficient overall was 0.98 (95%CI: 0.96, 0.99, p < 0.001) with a range of 0.95 to 1.0 revealing near perfect testretest reliability. Conclusions Administration of ODI questionnaire over the phone has excellent testretest reliability compared with face-to-face administration.
Bacterial Contamination in Osteosynthesis Material Removed after 6/8 Months Postoperative
Authors: Nirino Carlos Mariano , Nemirovsky Carlos Eduardo 
Published: April 2016

Introduction The aim of this paper is to describe the results obtained in 26 patients, which their osteosynthesis material was removed after 6–8 months of their first surgery following the surgery standards of temporary fixation of our service. They were operated between November 2014 and July 2015 in our department of Orthopedics and Traumatology in Corporación Medica of General San Martin in Buenos Aires, Argentina. All the patients were operated by the same surgeon, the same assistants and the same surgical scrub nurse. In all cases we used the same technique, which consists in a lozenge on the previous surgical wound and the removal of the polyaxial pedicle screws and the corresponding bars. After the removal of the material we proceeded to send one screw of each patient for cultivation and subsequent antibiogram. The results were surprising because in three cases our bacteriology service found a germ growth. None of the 26 patients studied presented during the 6–8 months that the osteosynthesis material was placed any signs or symptoms of infection. Material and Methods 26 patients, 18 men and 8 women were evaluated in which the osteosynthesis material was removed according to the established protocols. All patients were studied by MRI and Rx and treated by the same surgeon, assistants and scrub nurse. In all cases the cultivation and antibiogram was performed by the same laboratory and the preliminary results were always between 72–96 hour. Surgical technique: Posterior approach, lozenge on the previous surgical wound and the subsequent removal of the polyaxial pedicle screws and the corresponding bars. Results In 3 of the 26 cases sent for cultivation and antibiogram we found positive samples. In one case the cultivation was for Pseudomonas aeruginosa and the remaining two cases were positive for Staphylococcus aureus. The rest of the samples sent were negative. None of the patients had postoperative complications. The entire surgical wounds healed normally, without any secretions or phlogosis. No patients required antibiotic therapy in the immediate postoperative nor in the following months. The following of them was held up to 6 months post surgery. Conclusion After an exhaustive study of each of our patients we conclude that in most cases where a postoperative infection occurs it is more due to patient factors such as nutritional status thereof; which keeps a close relationship with the immunological response of the patient; malnutrition or immunosuppression due to diabetes mellitus, alcoholism, chemotherapy agents or tumors than to factors which depend directly to the surgeon like the skin preparation or the operating room environment factors. Due to the type of sample sent; even though we took the necessary precautions; we cannot dismiss skin contamination.
Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine
Authors: Hassan Khaled , Elmorshidy Essam 
Published: April 2016

Introduction The aim of this study is to compare the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis. Material and Methods A total number of 42 patients with tuberculous spondylodiscitis of the thoracic and lumbar spine treated surgically were included in this study. Twenty patients (group A) underwent anterior debridement, decompression and instrumentation by anterior approach. Twenty two patients (group B) were operated by posterolateral (extracavitary) decompression and posterior instrumentation. Operative parameters, clinical, radiographic and functional results for the two groups were analyzed and compared. Results The average follow up period was 15 months (range, 12 to 24) in both groups. The average operative time, blood loss and blood transfusion of anterior group were significantly less than the posterior one. There was significant better back pain relief, kyphotic angle correction and less angle loss in the posterior group than anterior. There was no significant difference between the 2 groups regarding neurological recovery, functional outcome and fusion rate. Conclusions Both anterolateral and posterolateral approaches are sufficient for achieving the goals of surgical treatment of thoracic and lumbar pott's disease but posterolateral approach allows significant better kyphotic angle correction, less angle loss, better improvement in back pain but unfortunately more operative time and blood loss.
Debridement, Internal Fixation and Interbody Fusion to Treat Single Level Thoracic Tuberculosis via Anterior Approach Only
Authors: Refae Hesham , Refae Hesham 
Published: April 2016

Introduction Tuberculosis of the dorsal spine is a very serious situation which may cause paraplegia and disability Purpose: We evaluated the clinical efficacy and feasibility of one –stage anterior debridement, internal fixation and interbody thoracic fusion in the treatment of single level thoracic tuberculosis. Materials and Methods: Forty three adult patients (mean age: 49.5-years) fixed with Z-plate by anteriortransthoracic-transpleural approach. Assessment was done using Frankel classification, blood-loss, operative-time, Cobb-angle, correction loss, union and Oswestry disability index (ODI). Results All cases were followed up for 48.5 weeks on average. Average mean operative time was 167 min, evaluated blood loss during surgery 1015 ml, rate of kyphosis correction79.2%, loss of corrected angle 0.8 ± 1.2° and Cobb-angle improved from 36.6 ± 8.4° to 7.5 ± 2.3°. Postoperative Cobb-angles were significantly better than preoperative ones. ODI was 3.4 ± 4.1. All patients achieved union with 100% cure rate. All but one patient achieved full neurological recovery. No severe complications or spinal cord injury occurred. Superficial infection. Occurred in one case. Lung parenchymal injury in two case and DVT in one case. Conclusions This approach can directly and successfully remove the focus of tuberculosis and give very good union and kyphosis correction rate that were maintained overtime.
Simultaneous Anterior Debridement and Posterior Instrumentation for Multiple Level Tuberculous Spondylodiscitis
Authors: Koptan Wael , El-Sharkawi Mohammad , ElMiligui Yasser 
Published: April 2016

Introduction The incidence of tuberculosis has rapidly increased in the last decade. The aim of this work is to compare the results of iliac crest and rib grafts and to assess the role of short segment posterior instrumentation in patients with multiple level affections. Materials and Methods The results of 48 patients with multiple level resistant tuberculous spondylodiscitis surgically treated were retrospectively reviewed. Patients were followed-up for an average of 6.5y. The average age was 47y and 27 patients had an associated neurologic deficit. The disease affected two levels (36 patients) and three levels (12 patients). All had anterior debridement and bone grafting by iliac crest autograft in 26 patients (Group 1) and rib autograft in 22 patients (Group 2); followed simultaneously by posterior short segment instrumentation. Results Postoperatively, the kyphotic deformity was corrected from an average of 41 degrees to an average of 5 degrees (Group 1) and from an average of 47 degrees to an average of 6 degrees (Group 2). At the last follow up, both groups had a similar fusion rate (95% and 96% respectively) and loss of correction (averaged 2.4 degrees and 2.1 degrees respectively). Group 1 patients had 7 donor site complications. All patients except one had an improvement in their neurologic status. Conclusions Radical anterior debridement of multiple level spondylodiscitis eradicated the infection; short segment posterior instrumentation applied immediate stability, allowed adequate graft uptake and long term correction of the kyphotic deformities.
Medium-Term Outcome of Posterior Surgery in the Treatment of Non-Tuberculous Bacterial Spinal Infection
Authors: Aljawadi A. , Dawoodi Aryan , Imo Eze , Sethi Gagan , Arnall Frances , Chaudhry M. , George Joshi , Mohammed Saeed , Verma Rajat , Tambe Anant , Yasin Naveed , Siddique Irfan 
Published: April 2016

Introduction The aim of this study is to evaluate the outcome after posterior spinal stabilization surgery for the management of de novo non-tuberculous bacterial spinal infection. Materials and Methods Patients presenting to a single tertiary referral spinal center between August 2011 and June 2014 were included in the study. 21 patients with non-tuberculous bacterial infection were identified and included in the study. All patients were managed surgically with posterior stabilization, with or without neural decompression, without debridement of the infected tissue. Neurological state was assessed using the Frankel Grading System before and after surgery. medium-term follow-up data was collected using Spine Tango COMI questionnaires and Euro Qol EQ-5D system with a mean follow-up duration of 20 months postoperatively. Results The mean improvement in neurological deficits was 0.91 Frankel grade (range 0–4). At a 20 month mean final follow-up, mean COMI score was 4.59, average VAS for back pain was 4.28. These symptoms had no or minor effect on the work or usual activities in 52%. 38% of patients reported a good quality of life. The average EQ-5D value was 0.569. There were no problems with mobility in 44% of patients. In 72% there were no problems with self-care. Conclusions Our study has shown that posterior surgery for the management of bacterial, nontuberculous spinal infection can improve neurological outcome in approximately half of the patients. At medium-term follow-up, around 50% of patients were able to return their pre-morbid work or usual activities. Outcomes were comparable to other techniques including anterior or combined surgery.
Post Operative Comparison of the Results of the Use of Antibiotic Prophilaxis One and Five Days in Patients Undergoing Lumbar Arthrodesis
Authors: Junior Charbel Jacob , Junior José Lucas Batista , Cardoso Igor Machado , Maia Thiago Cardoso , Brazolino Marcus Alexandre Novo , Debom Tadeu Gervazoni , Roncaglio Bruno 
Published: April 2016

Introduction antibiotic prophylaxis for patients undergoing lumbar spine arthrodesis is controversial in the literature. The objective of this article is comparing the results of post-operative patients undergoing lumbar spine arthrodesis using first generation cephalosporin antibioticoprofilaxiacom by one and five days. Methods we evaluated 43 patients aged between 16 and 76 years (mean 49.9 years), prospectively randomized, undergoing lumbar arthrodesis of 01 to 03 levels between November 2012 and April 2014, divided into two groups. At first it was used a period of antibiotic prophylaxis of a day and, in the second group, prevention was kept by 05 days. Following clinical and laboratory criteria were evaluated. Results the prevention of surgical infections requires far beyond the administration of antibiotics, according to the CDC's latest update, however, the dose, spectrum and time of use thereof remain controversial in the literature. The current recommendation for antibiotic prophylaxis in clean surgery of column is of single dose and, if a new dose is added, this should not exceed 24 hours the post-op. Conclusion A single dose of antibiotic prophylaxis with 1st generation cephalosporin is as effective as multiple doses scheme pre and post operative in lumbar arthrodesis surgery up to three levels, not justifying the costs and risks of submitting the patient hospitalization under medicated wide.
Complications and Re-operation Rate after Extra-foraminal Microscopic-Assisted Percutaneous Nucleotomy
Authors: Shawky Ahmed , Babic Dusko , Siam Ahmed Ezzat , Ezzati Ali 
Published: April 2016

Introduction Foraminal and extra-foraminal lumbar disc herniations are uncommon. Main presentation is radicular pain related to the exiting nerve root in the affected level. Different approaches for surgical intervention include median or para-median open microscopic-assisted techniques, endoscopic approach or trans-tubular microscopic-assisted percutaneous technique. Patients and Methods Between October 2012 and March 2014, 40 patients (18 females and 22 males) with foraminal or extra-foraminal lumbar disc prolapse were operated on in our center. Extra-foraminal percutaneous trans-tubular microscopic-assisted approach was used. Preoperative investigations included plain radiographs and MRI. Preoperative clinical evaluation included Visual Analogue Scale (VAS) for radicular pain and neurological state. The mean follow up period was 18 months (range 12 - 30). Results The mean age was 56 years. The most commonly affected level was L4/5 (22 patients = 55%). The mean preoperative VAS for leg pain was 82 mm, improved to 15 postoperatively. The average operative time was 69 minutes. There were no intraoperative complications. One patient had temporary postoperative quadriceps weakness (L4 radiculopathy) that was completely improved at 3 months follow up. Another patient had deep venous thrombosis after discharge and he was readmitted. Two patients had recurrence within the first 6 months postoperatively. They were re-operated using the same technique without complications. Both were followed up for one year without a second recurrence. Two patients with primarily severe degenerative changes and neuroforaminal stenosis had recurrence of symptoms with back pain and leg pain, re-operation as Transforaminal Lumbar Interbody Fusion (TLIF) was done Conclusion Trans-tubular percutaneous extra-foraminal microscopic-assisted nucleotomy is advantageous for foraminal and extra-foraminal disc herniations. It is a muscle splitting minimal-invasive approach with minimal morbidity. Re-operation rate is not different compared with microsurgical open or endoscopic techniques. Results seems to be better in cases with sequestrated disc lesion rather than degenerative neuroforaminal stenosis.