bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting High Surgical Treatment Costs at Primary Spinal Tumor Patients
Authors: Szövérfi Zsolt , Lazary Aron , Koszó Izabella , Papik Kornél , Varga Péter Pál 
Published: April 2016

Introduction Surgical treatment cost of primary spinal tumors -due to the complexity and magnitude of the surgery- can be high. From a healthcare provider perspective being aware of those factors that influence treatment cost is essential for the best hospital resource management. However the impact of the individual patient characteristics on direct medical costs is unknown. Our objective was to identify those preoperative factors that predict a high direct cost at patients with surgically treated primary spinal tumors. Material and Methods A retrospective micro-costing study was conducted from a healthcare provider perspective. Total cost per patient resulted from the aggregation of inpatient-days costs, ICU days costs, OR time costs (surgery and anesthesiology), medication costs, blood transfusion costs and other material costs, including appropriate allocation of overheads. Patients with primary spinal tumors operated in the National Center for Spinal Disorders between 2011 and 2014 were selected. The prognostic value of ten preoperative factors (dignity, previous surgery, pathological fracture, neurological dysfunction, age, spinal level, ASA score, Charlson Comorbidity Index, BMI, tumor volume) was investigated in linear regression modelling. Results 72 surgically treated primary spinal tumor patients were included in the study. Median length of hospital stay was 12 days (3–115), the median ICU treatment was 1.4 days (0–21.7), the median OR time was 2.8 hour (0.4–20.4). Median cost per patient was 3,088.5 € (537.7 € to 21,860.6 €). In the univariate analysis only ASA score, Charlson Comorbidity Index and pathological fracture were not significantly associated with higher cost. The seven significant variables were further assessed in a multivariate model. Dignity, previous surgery, spinal level and tumor volume were associated with high cost and preoperative neurologic dysfunction showed only a trend toward significance (whole model: R=0,69, R2=0,44, df=5, F=12,34 p < 0,001). Conclusion The present study identifies four predictive variables for high hospital cost related to primary spinal tumor surgery. Malignant tumors, previous surgery, sacral involvement and large tumor volume significantly increase the cost of treatment. This method of cost analysis provides useful insights for resource management in the surgical treatment of spinal tumors.
Morphometric Analysis of Pedicle and Lateral Mass of C1 Vertebra in Indian population using 3D Reconstructed Computerized Tomographic Images, with Comparative Analysis of the Feasibility and Safety of two Proposed C1 Pedicle Screw Trajectories in Relation to Vertebral Artery and Internal Carotid Artery
Authors: Kanagaraju Vijayanth 
Published: April 2016

Introduction Lateral mass screw fixation has been considered the gold standard in the instrumentation of C1 vertebra since its introduction by Goel and Laheri. The morphometry of pedicle and pedicle screw fixation in C1 vertebra is poorly illustrated in literature. Further biomechanical studies have proved better pullout strength in C1 pedicle screws compared with C1 lateral mass screws. Here we analyze the morphometry of C1 pedicle and lateral mass in Indian population, with comparison of two proposed pedicle screw trajectories. Materials and Methods 3D CT reconstructed images of C1 vertebra of 100 adult Indian population(50 male and 50 female) were analyzed for 22 parameters(200 pedicles, 4400 measurements). The anatomic parameters include pedicle height(PH), pedicle sagittal angle(PSA), lateral mass height, length, width(LH,LL,LW). Two pedicle screw trajectories, straight(S) and medially angulated(M) were defined and comparative analysis were done using following parameters, entry point midline distance(SEMD,MEMD), axial length(SAL,MAL), pedicle length(SPL,MPL), distance from vertebral foramen(SVD,MVD), angle of freedom from vertebral foramen for screw trajectory(SVAF,MVAF), pedicle screw trajectory width(SPW,MPW), medially angulated pedicle screw transverse angle(PTA), shortest distance from internal carotid artery(ICA) to screw exit point in anterior cortex(SID,MID), angle of freedom from ICA for screw trajectory(SIAF,MIAF). Results All 22 parameters were analyzed using SPSS software with mean PH 3.4, PSA 19°, LH 11.3, LL 15.2, LW 13.1, SEMD 18.7, MEMD 21.7, SAL 24.9, MAL 25.4, SPL 9.6, MPL 6.6, SVD 3.3, MVD 4.1,SVAF 12.1°, MVAF 24.5°, SPW 6.6, MPW 8.3, PTA 22.3°, SID 5.8, MID 9.9, SIAF 5.2° and MIAF 20.3°(all linear measurements in mm). PW, PSA, LH, LL, LW, SEMD, MEMD, SAL, MAL, MVD, MVAF, MPW and SID were significantly dependant on sex. There was a statistically significant difference in values of measured parameters between both trajectory S and M. All parameters except MPL are quantitatively greater in trajectory M than S. Conclusion Out of 200 pedicles studied the PH of only 89 are ≥ 3.5mm, and 154 are ≥ 3mm. So ¾ of Indian C1 pedicles can accommodate only a 3mm screw. A preoperative CT analysis is necessary in all patients to evaluate the feasibility of C1 pedicle screw and for neurovascular safety. A medially angulated C1 pedicle screw with more lateral entry point is more accommodative and safer in respect to ICA and vertebral artery than the straight screw. Also a bicortical screw purchase is safer in a medially angulated screw than a straight screw, which is comparatively at a higher risk of injuring ICA. Still biomechanical studies have to be done comparing both screw trajectories.
The Relationship between Increased Signal Intensity on t2-weighted Magnetic Resonance Imaging and the Entropy of Gait Analysis in Cervical Spondylotic Myelopathy
Authors: Tsai Wan-Ling , Wu Chao-Cheng , Lin Jiann-Her , Chiang Yung-Hsiao , Chang Cheng-Kuei , Yang Chin-Wei , Chang Cheng-Kuei 
Published: April 2016

Objective To determine relationships between increased signal intensity (ISI) on T2-weighted cervical spine magnetic resonance imaging (MRI) and parameters of gait analysis in patients with cervical spondylotic myelopathy (CSM). Methods and Materials: Patients were evaluated by using the Nurick scale, cervical spine MRI, and gait analysis. The signals of 3-axis accelerometer was collected during the gait analysis, and then the entropy of frequency (EF)and amplitude (EA) of vertical axis was measured The increased signal intensity on the spinal cord was determined by two neurosurgeons. Results 7 CSM patients with ISI on the spinal cord and 2 CSM patients without ISI were included. In addition, 7 health subjects were recruited as the control group. Relative to patients without ISI and the control group, those with ISI showed significantly higher EAs of vertical axis signal ( p < .05), but not EFs. Moreover, postoperative EAs significantly decreased compared with preoperative EAs. The Nurick scales significantly correlated with EA. Conclusions The gait analysis showed that EAs of vertical axis were significantly higher in CSM patients with ISI and in preoperative gait analysis of those patients. EA of vertical axis also correlated well with the Nurick grades. EA of vertical axis in gait analysis may be a useful tool for evaluating gait functions in cervical myelopathy.
Berry's Ligament and the Inferior Thyroid Artery as Reliable Anatomical Landmarks for the Recurrent Laryngeal Nerve (RLN) - A Fresh Cadaveric Study Relevant to the Cervical Spine
Authors: Rajabian Ali , Quraishi Nasir A. 
Published: April 2016

Introduction While most cadaveric studies of the Recurrent Laryngeal Nerve (RLN) have focused on course variations as a suitable guide for Right versus Left RLN, they have mostly been done on preserved (fixed) cadavers which renders the RLN immobile. Our aim was to perform anterior cervical exposures from C2 to T2/3 with particular attention to the course of the RLN on right and left sided exposures in fresh cadaveric specimens. In addition, we aimed to expose the entire course of the RLN. Finally, we wanted to show the position of the RLN in relation to the trachea-oesophageal groove, inferior thyroid artery and Berry's ligament. Methods Eight fresh cadavers had extensive layer by layer dissections performed by 2 surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). The RLNs were exposed in their entire length and relationship to different landmarks recorded. Photographs were taken at each stage of the exposure. Results In all specimens, we were able to demonstrate the entire course of both RLNs from origin to insertion. The RLNs were consistently associated with the inferior thyroid artery and Berry's ligament bilaterally with the RLNs passing at almost perpendicular to these structures. Conclusion The near horizontal direction of the Berry's Ligament in the cervical tissue planes exposed during anterior cervical exposures enables the surgeon to reliably identify the expected position of RLN at its medial end and hence avoid it prior to visual observation of the nerve on either side. We found that the most reliable anatomical landmark bilaterally for the RLN was the inferior thyroid artery and Berry's ligament both of which would be encountered in anterior surgical exposure prior to the nerve itself. We believe that this will help spinal surgeons refine their surgical technique to identify this nerve where necessary and thus reduce the incidence of iatrogenic injury. [Figure: see text][Figure: see text][Figure: see text]
Cervical-thoracic Spine Inclination (CTSI): Anatomy Peculiarities and Surgical Options
Authors: Mushkin Alexander , Ryabykh Sergey , Gubin Alexander , Kolesov Sergey , Vissarionov Sergey , Snischuk Victor , Eduard Ulrikh 
Published: April 2016

Introduction The bayonet congenital abnormality of cervical-thoracic spine was previously described as a rarest clinical case under the title “congenital upper spine spondylolisthesis ” (Tokgozoglu AM et all., 1994) or “congenital dislocation of the cervical spine” (Shintaki M et all., 2013) without detailed description of anatomy and principles of surgical treatment. Our series include analysis of 10 CTSI cases from 4 clinics. Material and Methods Clinical, X-ray, CT and MRI peculiarities of 10 patients aged from 1 year 8 mns till 15 years were analyzed. The repeated cervical-thoracic abnormality included antero-posterior and cranial-caudad shift of the spine into the cervical spinal canal. All patients had arcs dysplasia, but any case has a complete posterior segmental defects, MMC or split spinal cord syndrome. Results According to Frankel scale the neurological status was estimated as a type E in one patient, type D – in 4, type C - in 4 and type B in one, incl. two paraparesis and 7 tetraparesis cases. Cranial spine was formed by 4 till 8 vertebrae (max – 6 vertebrae in 5 cases). Abnormality was accompanied by Sprengel disease in 2, by neurofibromatosis type I in one, by failure of segmentation (Klippel-Feil syndrome) in 5 and neural arc dysplasia in 10 cases. 9/10 patients were operated. The operations included circular decompression of spinal cord and posterior instrumentation; 8 operations were done from posterior approach only, 1 - from anterior and posterior approaches. Four procedures were done with Halo-cast fixation to produce pre-surgical local spinal stability. The post-op follow up floated from 7 month till 5 years. 6/9 patients demonstrated significant improvement in neurological sighs (one or more steps in Frankel scale) ; the neurological deterioration was occur in 2/9 cases, followed by a partial recovery in one and complete in another. Conclusion Our 10 cases series demonstrates a extremely rare type of the cervical-thoracic spinal abnormality. We the term “the cervical-thoracic spine inclination (CTSI)” because it reminiscent the cranial-vertebral pathology known as “the inclination of dens of C2 into foramen magnum.” From our point of view the inclination is a combined type of pathology which included an anterior-posterior and cranial displacement of caudal spinal segment(s); this pathology typical for transitional spinal zones and looks like spinal segmental dysgenesis but differ due to the absence of circular spinal column defect despite the combination of different types of vertebral abnormalities. CTSI is a repeated spinal syndrome which has a high risk of neurological complications. The spinal cord decompression and instrumentation are mandatory for this abnormality; the surgery could be done from the posterior approach only.
Anatomic Guideline for Approach to Lateral Thoraco-Lumbar Interbody Fusion
Authors: Cho Woojin 
Published: April 2016

Summary The decision making process for incision location during the course of lateral thoraco-lumbar interbody fusion (LLIF) at 857 levels was evaluated retrospectively, in an attempt to develop a clinically robust anatomic guideline. Introduction The minimally invasive technique of LLIF has shown powerful segmental deformity correction, with excellent fusion rates and minimal morbidity. However, in certain settings, adequate lateral access to permit a proper working angle into the disc space may be difficult to achieve. The purpose of this investigation was to establish a clinically robust anatomic guideline for incision location, with respect to laterality and level. Methods The operative reports and plain films of the thoraco-lumbar spine of 512 consecutive patients undergoing LLIF at our institute between 2009 and 2011 by the mini-open transpsoas method were reviewed. Results Distribution of operative levels is depicted in Table 1 . [Table: see text] The primary determinant of laterality (side) of operative approach involving the L4–5 disk space was coronal angulation of the L4–5 disk space, as depicted on 15° up-tilt view. A secondary determinant of feasibility of accessing the L4–5 disk space is a line drawn through the center of the L4 vertebra, parallel to the inferior end plate of L4. Extension of this line cephalad to the ipsilateral iliac crest indicates that this level will be surgically accessible. In the absence of segmental coronal angulation, the symptomatic side was chosen. In the setting of regional scoliosis, the concavity was the preferred side of approach, as up to three levels can be reached through a single small incision. There were no instances of approach failure using the method outlined above. Conclusion A clinically robust and worthwhile anatomic guideline to LLIF, with respect to level and laterality of incision placement, is presented.
Chronic Painful Osteoporotic Vertebral Compression Fractures (OVCFs) of Thoracolumbar Spine: Percutaneous Vertebroplasty versus Conservative Management among Egyptian Patients
Authors: Hasan Khaled , El-Sharkawi Mohammad 
Published: April 2016

Introduction Vertebral augmentation procedures are widely used today in treating Osteoporotic vertebral compression fractures (OVCFs) especially in acute and subacute fractures. However, percutaneous vertebroplasty for patients with chronic painful OVCFs has been less well studied. The purpose of this study is to compare the efficacy and safety of percutaneous vertebroplasty with conservative management for the treatment of chronic painful OVCFs in the thoracolumbar spine among Egyptian patients. Patients and Methods This prospective cohort study included 60 patients with chronic OVCFs (38 females, 22 males, mean age: 65.42 ± 8.63) who presented with severe back pain to the outpatient clinic during the period from October 2005 to December 2011. Twenty-eight patients were treated with percutaneous vertebroplasty (vertebroplasty group). Thirty two patients refused surgical treatment and constituted the control group (Conservative group). The inclusion criteria included: Chronic painful OVCFs (at least 3 months), at least 50 years old, T5 to L5, osteoporosis (T-score -2.5 or lower), Visual Analogue Scale (VAS) at least 5, and absence of neurological deficits. At presentation, all patients of both groups received back brace, analgesics, anti-osteoporosis therapy. All patients were evaluated with X-rays and CT scan, where Cobb angle and the anteroposterior height comparison (APHC) were measured. Overall pain and quality of life were assessed with the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Results All patients were followed for at least 12 months (range, 12 to 28). Statistical analysis of the demographic data of the two groups could not reveal any significant differences. At latest follow up, there was significant improvement in Cobb angle and APHC in vertebroplasty group compared with conservative group ( p < 0.05). Twenty nine patients (90.63%) showed complete union in the conservative group while all patients (100%) showed complete union in the vertebroplasty group at latest follow up. VAS and ODI were significantly better in vertebroplasty group than conservative group ( p < 0.05) at latest follow up. Cement extravasation into the disc occurred in 2 patients (5.41%), and into the paravertebral tissue in 3 (8.11%); none was associated with neurological symptoms, cement embolism, or infection. Recent fracture occurred adjacent to the formerly cemented ones in 2 patients (7.14%) and in non-adjacent level in one (3.57%). In conservative group, 3 patients (9.37%) presented with new osteoporotic vertebral fractures in adjacent levels and 2 (6.25%) in non adjacent levels. Three patients (9.37%) showed non union. Conclusion Percutaneous vertebroplasty is safe and effective in treatment of symptomatic chronic osteoporotic vertebral compression fractures with significantly better clinical and radiological outcomes when compared with conservative management.
Does Level of Response to SI Joint Block Predict Response to SI Joint Fusion?
Authors: Polly David W. , Cher Daniel , Whang Peter , Frank Clay , Lockstadt Harry , Harvey Charles , Sembrano Jonathan 
Published: April 2016

Introduction The threshold percent pain relief required to diagnose sacroiliac joint (SIJ) dysfunction during a diagnostic SIJ block (SIJB) is not known. Although there is no gold standard, one reference standard is response to definitive treatment. Methods Subgroup analysis of 320 subjects in two prospective trials of SIJ fusion: INSITE (NCT01681004) a randomized trial versus nonsurgical management (NSM) and SIFI (NCT01640353), a singlearm study. All participants were diagnosed with SIJ dysfunction via history (buttocks/leg pain and a positive Fortin finger test), at least 3 positive provocative physical examination signs, and a standardized diagnostic SIJB using fluoroscopically guided injection of local anesthetics in the target joint with a reduction of at least 50% in pain at 30 or 60 minutes after SIJB. The degree of improvement in VAS SIJ pain and Oswestry Disability Index (ODI) scores, expressed as absolute or percentage improvement from baseline, was correlated with the average acute improvement in SIJ pain during the SIJB, calculated as per Cohen et al. Results The average pain reduction during the first hour after SIJB was 79.3%. Pain reduction during block was unrelated to standard demographic predictors. Six months after SIJ fusion, the mean VAS SIJ pain reduction was 50.9 (28.6) points and the mean ODI reduction was 24.6 (20.5) points. SIJ pain and ODI reductions at 12 months in the SIJ fusion group were 50.8 (29.2) and 25.8 (20.5) points, respectively. There was little correlation in 6 or 12month improvements in SIJ pain or ODI with average reduction in pain during SIJB. In the SIJF group, the proportion of subjects achieving meaningful reductions in SIJ pain and ODI scores did not vary by average response during SIJB ( p = 0.8407 and 0.3069, respectively for 6 month changes, and p = 0.6368 and 0.5913). Similarly, response during SIJB did not predict the proportion of patients with followup pain scores < 30 or ODI < 20. Conclusions. In this study of > 300 patients with carefully diagnosed with SIJ dysfunction, the degree of improvement in acute pain during an SIJB did not predict 6month improvements in VAS SIJ pain or ODI score. Based on our study, a 50% acute pain reduction threshold during SIJB was resulted in excellent postsurgical results. The use of overly stringent selection criteria for determining which patients should undergo SIJF may serve to withhold a beneficial procedure from a substantial number of patients with SIJ dysfunction.
Double Blind Placebo-controlled Trial of Percutaneous Vertebroplasty (VOPE)
Authors: Hansen Emil Jesper , Simony Ane , Rousing Rikke , Carreon Leah Y. , Tropp Hans , Andersen Mikkel Ø. 
Published: April 2016

Introduction Osteoporotic vertebral compression fractures (VCF) affect ~20% of postmenopausal women and can lead to long-term disability. Since two double-blind RCTs in 2009, there has been a debate, whether Percutaneous Vertebroplasty (PVP) has any beneficial effects in treating acute osteoporotic VCFs. The two studies have been criticized in order of design and possible bias in results. PVP is a minimally invasive procedure, primarily used in patients with severe pain after VCF. Our objective was to investigate the clinical effects of PVP compared with a SHAM procedure when treating acute osteoporotic VCFs, with intense focus on VAS-activity and the first 3 months postoperative. Material and Methods Study Design - Double-blind randomized controlled trial. 52 patients were included in the study, and they were randomized to either PVP or SHAM, at the Center for Spine Surgery and Research, Middelfart Hospital. During the trial period 4 patients were excluded due to need for further spine surgery, and 2 patients excluded due to malignancy in peroperative biopsy. During the trial patients, investigators collecting data, and the statisticians were blinded. Results 46 patients were eligible for statistical analysis, 22 patients in the PVP group and 24 patients in the SHAM group. In both groups the VAS-scores, and health related Quality of life scores (SF-36; PCS-score and Eq. 5D-scores) improved significantly from baseline values ( p < 0.05). There was a statistical significant higher VAS-score in the SHAM-group throughout the trial period ( p = 0.001), with the main contribution from the VAS-activity. Conclusion Our study shows a statistical significant higher VAS-score in the SHAM group during the trial period, both groups improved significantly in all clinical parameters. Focus in the future of PVP and acute OVCFs must be on the 3 months convalescence period and the cost benefit analysis of early mobilization.