bluuebunny/crossref_metadata_2025_split huggingface dataset:
How to Minimize Complications of Classic Decompression and Fusion in Lumbar Spinal Stenosis: is a Complemental Interspinous Fusion an Alternative?
Authors: Slawomir Moszko 
Published: April 2016

Introduction Lumbar spinal stenosis (LSS) is the most common reason for back surgery in patients over 50 years. LSS decompression may cause an instability or deteriorate it. A classic fusion with pedicle screws enhances the hazard of the surgery in geriatric patients. The goal of the study was to find out, if the additional interspinous fusion (partly combined with interbody fusion) with a rigid intespinous device can minimize the risk of classic procedure. Material and Methods 94 patients (44 men and 46 women) in age of 49- 88 years (mean 69) underwent LSS decompression with interspinous fusion, some of them additionally with intervertebral cages. Interspinous rigid fusion device were used to provide fusion. Demographic data, indications, operated levels, results in terms of approval of ODI, VAS back and legs, walking distance and satisfaction were analyzed. Blood loss, OP-, fluoroscopy time and complications were registered. Fusion was determined by CT performed at least 6 months post OP and X- rays. Results 78 patients (83%) were operated with stand alone interspinous fusion device and 16 (17%) received additionally an intervertebralcCage. The follow- up was 6 to 36 months (mean 20). Indications: LSS with instability 41, LSS 28, LSS with disc herniation 19, deformity 3 and adjacent segment disease 3. The Op time ranged from 35 to 209 minutes (mean 82). The blood loss was between 10 to 450 ml (mean100ml). The fluoroscopy time reached from 2 to 18 seconds (mean 6). Mean values for ODI and VAS are presented in Table 1. [Table: see text] 2 years post OP the improvement of ODI was 54%. VAS back 50% and VES legs 72% respectively. The walking distance increased at least at 50% in 86 patients (91,5%). Concerning the satisfaction 90 patients (96%) would undergo the surgery once more, 4 of them (4%) not. Following complications were observed: cage subsidence (3), cage dislocation (1), epidural hematoma (2), wound infection (1), deep infection (1), dural tears (7), seroma (4). It means all in all 19 adverse events (20%). Only in 10 patients (11%) they had a consequence with revision surgery. Radiological criteria of the fusion had 59% of the patients with 6 months follow up, in 94% patients with 12, 98% with 24 and 100% with 36. Conclusion The results of the study show, that the LSS decompression can be supplemented using an interspineous rigid device to provide a fusion without significant extending the Op time. More extended surgeries with pedicle screw fixation can be avoided and thus the complication rate reduced. 11% of complications, which require a repeat surgery are acceptable in population of aged patients with comorbidities. The advantage is the less invasive technique with less blood loss and only 0,1 minutes fluoroscopy time. We found no real liminations in decision making for the surgery. There were 22 drop outs.
Neurological Outcomes following Iatrogenic Vascular Injury during Posterior Atlanto-axial Instrumented Fusion
Authors: Ahmad Faiz , Akinduro Oluwaseun , Baum Griffin , Howard Brian , Pradilla Gustavo , Grossberg Jonathan , Rodts Gerald 
Published: April 2016

Introduction Iatrogenic vascular injury is a feared complication of posterior atlanto-axial instrumented fusion. A better understanding of clinical course following this injury will allow surgeons to better care for these patients. The object of the study was to systematically review the neurologic outcomes after iatrogenic vascular injury during atlanto-axial posterior instrumented fusion. Methods A systematic review of the PubMed database was performed, following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The extracted data was recorded in an excel spreadsheet. To be included, the patients must have undergone fusion of the C1/C2 joint using posterior instrumentation with injury to an arterial vessel directly attributable to the surgical procedure. Results 86 incidences of vascular injury were found in 41 articles with 11200 patients. The average age of included patients was 46.4 +/− 24.1 for the screw rod construct (SRC) group and 36.2 +/− 28.2 for the transarticular screw (TAS) group. Vascular injury in SRC cases resulted in ipsilateral stroke in 15.9% ( n = 7/44) of patients and neurologic deficit in 22.7% ( n = 10/44) of patients with a permanent neurologic deficit occurring in 11.4% ( n = 5/44) of patients. Vascular injury following TAS fixation resulted in ipsilateral stroke in 11.9% of cases ( n = 5/42) and neurologic deficit in 23.8% of cases with the deficit being permanent in 9.5% ( n = 4/42) of cases. Death was the result of injury in 9.1% ( n = 4/44) of SRC cases and 7.1% ( n = 3/42) of TAS cases. Conclusions Neurological morbidity after iatrogenic vascular injury during posterior C1/2 fixation is higher than previously reported in literature. There has been no large-volume studies aimed at identifying a rate of neurologic complications after iatrogenic injury. Surgeons should be aware of the normal and anomalous vertebral artery anatomy to avoid this potentially catastrophic injury.
Frequency of Post-Operative Hematoma in Lumbar Disc Excision through Fenestration without Closed-Suction Drainage
Authors: Umair Muhammad , Bashir Muhammad Farrukh Bashir , Aziz Amer , Akram Rizwan , Ahmad Saeed 
Published: April 2016

Introduction Spinal epidural hematoma is a well-known complication of spinal surgery. To prevent hematoma formation its routine that suction drain is placed for 24 to 48 hours after laminectomy. But Clinically insignificant small epidural hematomas develop after Lumbar disc excision through interlaminar fenestration. The aim of this study is to find out Frequency of Post-Operative Hematoma in Lumbar Disc Excision through Fenestration without closed-suction drainage. Materials and Methods This was a descriptive case series done at Ghurki trust teaching hospital Lahore from from January 2009 to January 2014. Total 423 cases who underwent Lumbar Disc Excision through Fenestration were included in the study. All the patients were followed for 7 days for postoperative Spinal Hematoma Formation which was considered positive in patients who either develop a new postoperative neurological deficit or pain and on mri shows Spinal Epidural Hematoma at the site of surgery. Results Frequency of post-operative hematoma after lumbar disc excision through fenestration without using closed-suction drainage reveals 2.13%( n = 9) while 97.87%( n = 414) had no findings of hematoma. Conclusion We concluded that frequency of post-operative hematoma after lumbar disc excision through fenestration without using closed-suction drainage is determined as insignificant.
Should we Remove Bullets from the Spinal Cord?
Authors: Grandidge Lisa , Michael Antony , Athanassacopoulos Michael , Chiverton Neil , Breakwell Lee , Cole Ashley 
Published: April 2016

Introduction To discuss a case and review evidence for and against intra-dural bullet removal. Materials and Methods A 45 year-old gentleman presented with gunshot wound, with a loss of sensation below his chest and loss of power in his lower limbs. On examination there was a single 1cmx0.5cm bullet entry wound on the anterolateral aspect of the left shoulder, with a T3 motor and sensory level. PR revealed reduced tone and no squeeze. A full body CT showed a bullet within the spinal canal adjacent to the T3 vertebral body. The spinal injuries team diagnosed a T3 complete ASIA A paraplegia. He underwent a posterior decompression of T3 and intra-dural bullet removal with dura repair on the same day. Surgery revealed a dural tear and an intra-dural bullet with obvious cord damage. This was removed with rubberised forceps and handed to police for ballistics. He was given flucloxacillin and transferred to the spinal injuries unit for rehabilitation. He made no neurological recovery but did not develop any further complications. Results A thorough literature search revealed the role of surgery in gaining lost neurological function remains ambiguous. Indications for bullet removal include acute neurological deterioration and CSF fistulas. Epidural haematoma/abscesses, radiological compression or a destabilized spine are also considerations. Removals of bullets below T12 have had an effect on motor recovery. However similar neurological recoveries have been reported in both surgical and conservative management of incomplete deficits. Compete deficits are unlikely to improve neurologically regardless of surgical intervention, however cervical injuries with early detection of compressive pathology should be considered. Complication rates are reported to be higher if operated. Prophylactic antibiotics should be started immediately on admission. Surgery does not reduce the incidence of infection. Pain may be intensified when caused by a gunshot injury, but there is no evidence of improvement with bullet removal. One indication for surgery in this case was to prevent post traumatic syringomyelia (PTS). The incidence is 0.3–3.2%, however radiological/autopsy studies suggest up to 22%. There has been one prior reported case where a patient developed symptoms 14 months following initial gunshot injury. However due to lack of data it is uncertain if initial surgical management reduces development of future syrinxes. Conclusions This appears to be the first reported case of an intra-dural bullet in the UK. Treatment should be focused on ensuring spine stability, enhancing potential for neurological recovery and preventing complications. The role of surgery versus non-surgical treatment is still debate.
Factors Influencing Outcomes during and Post Hospitalization in Geriatric Cervical Spine Injuries- do the Young and Old Elderly Differ?
Authors: Dsouza Areena , Chhabra Harvinder , Mittal Vivek 
Published: April 2016

Introduction Geriatric patients with cervical spine injuries are known to have high morbidity and mortality. Our aim was to evaluate the acute outcomes of geriatric cervical spine injuries in terms of morbidity, mortality, and factors influencing it during hospitalization and after discharge, and the differences between young and old elderly patients. Material and Methods Hospital records of 62 geriatric patients with cervical spine injuries from 2003–2014 were retrospectively reviewed and telephonic interview after discharge were done. Patients were divided into young (65- 74yrs) and old (>74yrs) elderly groups. Demographics, mechanism and level of injury, duration of stay (ward/ICU), radiographic findings, neurological deficits, comorbidities, type of management, mortality, factors influencing mortality and complications rates were studied. Results 45 patients were young elderly and 17 old elderly. Mean age was 70.46 years. 39 sustained high velocity injury and 23 low velocity. C4–5 was the most common injured level. 34 patients had preexisting co-morbid conditions, cardiac was most common. 34 patients underwent surgery. Mean ICU stay was 16.93 days and ward stay 43.94 days. Pulmonary complications were most common in old elderly. Tracheostomy was required in 20 patients and ventilator support in 24 patients. 28 patients had complete deficit, 27 had incomplete neurology and 7 had normal neurology. Mean duration of follow up was 3.2 years. 14 patients died in our series. 10 patients had returned to preinjury functional level. Mortality was more common in old elderly patients with conservative treatment, patients with higher level of neurological deficit, multiple comorbidities, and ventilator dependancy. Conclusion Differences exist between young and old elderly with cervical spine injuries, and there are high morbidity, mortality rates. Efforts should be made to reduce pulmonary complications in this age group of patients. Surgical management can be performed reasonably safely when indicated.
Traumatic Atlantoaxial Rotatory Fixation (AARF) with Odontoid Fracture, Case report
Authors: Shaker Ahmed 
Published: April 2016

Introduction Atlantoaxial rotatory fixation (AARF) is also known as rotatory subluxation, rotatory displacement, rotary deformity, rotational subluxation, and is characterized by incomplete dislocation of the inferior atlantal and superior axial articular facets.1 AARF in combination with odontoid fracture is an extremely rare injury.2–6 Atlantoaxial injuries can be classified according to Fielding 1 or White and Panjabi7 classification. The management of this combination is a matter of debate. 1,8,9 Material and Methods We present a case of a 78 years old woman who sustained a fall on the ground from a couch directly on her forehead, resulting in atlantoaxial dislocation with type II odontoid fracture accompanied with left sided hemiparesis ASIA type C. Results After failure of closed reduction, the treatment plane was to achieve reduction under anesthesia and C1–2 fusion, but again reduction was not possible. Occipitocervical fusion to C3 was done to have better stability in osteoporotic bone. Successful reduction was achieved during rod reduction from the occiput to C2 pedicle screw and C3 lateral mass screw. Cervical collar was advised for 3 months, and good fusion and improvement of the neurological status to ASIA type D was achieved after 6 month. Conclusion AARF with Odontoid Fracture is a rare combination and reduction may be impossible. Occipitocervical fusion is a good option in such case as C1–2 reduction is a prerequisite for transarticular screw. C2 pedicle screw offers good purchase even in osteoporotic bone which enabled reduction after rod repositioning. References Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 1977;59(1):37–44 Born CT, Mure AJ, Iannacone WM, DeLong WG Jr. Three-dimensional computerized tomographic demonstration of bilateral atlantoaxial rotatory dislocation in an adult: report of a case and review of the literature. J Orthop Trauma 1994;8(1):67–72 Jones RN. Rotatory dislocation of both atlanto-axial joints. J Bone Joint Surg Br 1984;66(1):6–7 Moore KR, Frank EH. Traumatic atlantoaxial rotatory subluxation and dislocation. Spine 1995;20(17):1928–1930 Robertson PA, Swan HA. Traumatic bilateral rotatory facet dislocation of the atlas on the axis. Spine 1992;17(10):1252–1254 Wise JJ, Cheney R, Fischgrund J. Traumatic bilateral rotatory dislocation of the atlanto-axial joints: a case report and review of the literature. J Spinal Disord 1997;10(5):451–453 White AA III, Panjabi MM. The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am 1978;9(4):867–878 Schmidek HH, Smith DA, Sofferman RA, Gomes FB. Transoral unilateral facetectomy in the management of unilateral anterior rotatory atlantoaxial fracture/dislocation: a case report. Neurosurgery 1986;18(5):645–652 Crockard HA, Rogers MA. Open reduction of traumatic atlanto-axial rotatory dislocation with use of the extreme lateral approach. A report of two cases. J Bone Joint Surg Am 1996;78(3):431–436
Lumbo-iliac Reconstruction after Total Sacrectomy
Authors: Saavedra Javier M. , Buritica Jose L. , Madrinan-Navia Humberto , Riveros Mauricio , Garcia Marco 
Published: April 2016

Introduction Giant sacral tumors often require a radical and extensive surgical approach. En bloc–sacrectomy implies a surgical challenge for the anatomical stability of the spino-pelvic joint. Different fusion approaches have been used to address this situation. We describe the surgical technique and summarize the clinical outcome after a total resection of giant sacral tumors and a transpedicular lumbo-iliac fusion. Material and Methods Case report of three patients who underwent an En-bloc sacrectomy between february of 2013 and February 2015. A combined extraperitoneal and posterior approach was used headed by a multidisciplinary surgical group of neurosurgeons, colorectal and plastic surgeons.We used a transperitoneal approach for anterior and lateral tumor isolation and for sacral dissection from ligaments and muscle insertion sites. Subsequently a posterior approach was used through which an L5-S1 diskectomy was performed followed by lateral osteotomies for sacral wing separation and bilateral S1 pedicle and laminae osteotomies with intact preservation of S1 nerve roots. Then the dural sac was ligated and the sacrum was amputated. For reconstruction of tumor site, a lumbo-iliac arthodesis was performed using polyaxial bilateral pedicle screws in L3, L4, L5 and two bilateral Transiliac Monoaxial screws. Vertical rods placed alongside the spine bylaterally maintaining lorditic axis, Cross links to connect the two vertical rods and Heterologous bone grafts were used. Results The three patients underwent a successful en bloc sacrectomy and lumbo-Iliac reconstruction without perioperative mortality and significant morbidity. Total tumor resection was performed in the three patients. None of the patients had gait disturbances after surgery. Patients were followed 6 to 30 months after surgery and at the final checkup there were no local recurrence reported and no instrumentation failure were noted. Conclusion Lumbo-iliac reconstruction through screw assisted transpedicular L3, L4, L5 and transiliac stabilization system after total oncologic sacrectomy provided spino-pelvic stability maintaining functional gait.
Malignant Osteolytic Lesions in the Sacrum (S1-S3) Treated by Targeted Radiofrequency Ablation: A New Option for Metastases in the Sacrum
Authors: Müller-Broich Jacques Dominik , Kretschmar Tobias , Porten Marius , Demukaj Sadri , Saxler Guido 
Published: April 2016

Introduction Sacral metastases and myelomatous lesions often result in debilitating pain and significant morbidity in patients with prolonged life expectancy. Radiation therapy and cement augmentation are well described local therapies for controlling cytokine mediated osteolytic bone resportion and skeletal related events associated with metastatic and myelomatous sacral lesions. Ablative therapy has been reported in recent years as a minimally invasive therapy permitting both local treatment of bone lesions and immediate stabilization, when followed with cement augmentation. This case study reports multimodality minimally invasive treatment of patient with multiple painful osteolytic lesions using a novel articulating bipolar RF ablative therapy and an ultrahigh viscosity cement. Material and Methods A 75-year-old-patient with history of multiple myeloma and significant lumbar back pain presented with diffuse lytic spinal disease throughout the thoracolumbar and sacral spine. Following review by multidisciplinary tumorboard, percutaneous targeted radiofrequency ablation (t-RFA) was performed in T12-L4 and a unilateral sacral lesion (S1-S3) using an articulated bipolar electrode containing thermocouples to assess real time growth of the ablation zone followed by delivery of ultrahigh viscosity cement using RF energy warmed cement (RF-Targeted Vertebral Augmentation, RF-TVA). Pain was demonstrated preoperatively with 9 using the visual analog scale for both locations. On the first postoperative day pain was at 4(VAS), in the 6 weeks control pain was at 2(VAS). At the 3 months control pain was at 2(VAS). Results The combined approach of t-RFA and RF-TVA in the sacrum was technically and clinically feasible with an immediate pain reduction, improvement in quality of life and functionality at 6 weeks and 3 months after the procedure and no complications. CT performed 6 weeks post procedure confirmed the absence of cement leakage. Conclusion t-RFA combined with RF-TVA of the sacrum can be safely and effectively performed via a single access port resulting in significant palliative relief and functional improvement. In combination these procedures may provide an alternative palliative, minimally invasive treatment option for painful osteolytic lesions in the sacrum(S1-S3) requiring stabilization for patients in which radiation therapy may not be an option.
Surgical Treatment of Solitary Spinal Plasmacytoma
Authors: Abdel-Wanis Mohamed 
Published: April 2016

Introduction Solitary plasmacytoma of the vertebra is a rare condition. Treatment options include radiotherapy, surgery, radiotherapy combined with surgery, and vertebroplasty or kyphoplasty. Although radiotherapy is the treatment of choice for solitary plasmacytoma of the spine, recommendations for treatment have been based on limited data from retrospective studies. Material and Methods Thirteen patients of solitary spinal plasmacytoma were treated at Sohag University Hospital between 2003 and 2014. Patients were 12 males and 1 female. Age ranged between 35 and 74 (mean 57.7) years. Lumbar spine was affected in 7 patients and thoracic spine in 6 patients. Pain was assessed on Denis pain scale. On presentation 8 patients had pain grade P5, 4 patients had pain grade P4 and 1 patient had pain grade P2. The Frankel grading system was used to assess the neurologic outcome. On presentation, 6 patients had neurological deficits; 3 Frankel grade C, and 3 Frankel grade D. Indications for surgery included pathological fracture (9 patients) and neurological compromise (6 patients). All patients received operation through a single posterior exposure. The lesion was curetted and anterior reconstruction was achieved by spinal shortening (5 patients), or anterior bone grafting (6 patients), and anterior reconstruction was not needed in 2 patients. Then posterior fusion was performed. Radiotherapy began 3 weeks after the operation. Results All patients got neurological recovery to Frankel grade E and improvement of pre-operative pain (6 patients to P1, 5 patients to P2 and 2 patients to P3). No local recurrence occurred after follow up for 7–102 (mean 36.9). Conclusion Gross-total tumor resection on piecemeal basis with post-operative adjuvant radiotherapy for solitary plasmacytoma of the spine gives long-term local control of the tumor. It can help to improve patient's quality of life.