bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spinal Osteotomy for Sagittal Deformities using “Posterior Only Approach”: A Novel Classification System
Authors: Rajasekaran S. , Reddy Sreekanth , Shetty Ajoy Prasad , Kanna Rishi 
Published: April 2016

Introduction Numerous types of posterior approach based osteotomies have been described but often there is a loss of clarity on the best osteotomy for each patient. We have proposed a morphological classification of sagittal deformities based on the status of the anterior and posterior column, the extent of column deficiency and the flexibility of the deformity. This classification will be useful as guideline for osteotomy selection and for comparing the practice preferences and outcomes between different institutions. Methods We analyzed retrospectively collected data for 187 posterior based osteotomies for sagittal deformity. A morphological classification of sagittal deformity was created on basis of collected data. The deformities with intact anterior and posterior column was Type I, where 1A had mobile disc spaces and 1B ankylosed segments. Type II had deficiency of any one column with IIA having a deficiency of posterior column only and Type IIB of anterior column only. Type III had an insufficiency of both columns with Type IIIA being less than 60°, IIIB > 60° and IIIC having buckling collapse. We then prospectively analyzed this morphological classifcation in seventy-five patients with sagittal deformity who underwent various osteotomy procedures for different pathologies. We matched all the cases for six types of anatomical spinal osteotomies and one salvage procedure (anterior strut fusion). The osteotomy procedures considered were partial facetectomy, Ponte's osteotomy, pedicle substraction osteotomy, disc bone osteotomy, single vertebrectomy, multilevel vertebrectomy and salvage procedure in the form of anterior strut grafting. Results The mean age was 20.1years and mean sagittal deformity was 67.70°(28–129°). An average correction of 41% (11 to 78%) was achieved and an association of more complex osteotomies for higher class of deformities was noted. The inter-observer agreement for four spine surgeons classifying the 75 deformities was noted to be high (agreement rate K-0.83) using the above morphological classification. A chi-square analysis performed to test the association between the classification and the type of osteotomy, which showed an observable trend with a highly significant association ( p < 0.001) showing that the type of osteotomy to be performed could be predicted by the classification. Conclusion The proposed classification of the sagittal deformity had a high inter-observer agreement and was useful in predicting the type of osteotomy. The classification would be valuable in training and teaching purposes. This classification could also be used for comparing the osteotomy selection and outcomes between different institutions.
Tranexamic Acid Administration in Adolescent Idiopathic Scoliosis Surgery Reduces % Total Blood Volume Loss
Authors: Butler Elissa , Garber Tara , Ledonio Charles , Polly David W. , Cohn Claudia 
Published: April 2016

Introduction Multilevel spinal fusion surgery for adolescent idiopathic scoliosis (AIS) is typically associated with significant blood loss. Antifibrinolytics such as tranexamic acid (TXA) have been proposed to reduce both blood loss and the need for transfusions. This study compares the blood loss and % total blood volume loss of AIS surgery patients with or without tranexamic acid. Materials and Methods A retrospective comparative case-control study design was used to evaluate multilevel spinal fusion operations for AIS by a single surgeon from October 2011 to August 2014. Efficacy of TXA was evaluated by comparing mean estimated blood loss (EBL) and %TBV loss (calculated by Nadler's formula: males = 0.3669 * Ht m3 + 0.03219 * Wt kg + 0.6041; females = 0.3561 * Ht m3 + 0.03308 * Wt kg + 0.1833). Clinical factors including number of levels fused and length of operation were tested for correlation with % TBV loss. Results From 2011 to 2014, 36 adolescents underwent AIS surgery (18 with and 18 without TXA). Mean age was 16 (±3) years and 86% (31/36) were female (controls 15/18 and TXA 16/18). There were no statistically significant mean differences between the ()TXA and (+)TXA groups in terms of the following: BMI (20.2 vs 22.2); estimated blood volume (3380 mL vs 3797 mL); levels fused (9.6 levels vs 10.5 levels); EBL (583 mL vs 474 mL) ( p = 0.18); and EBL per level fused (61 mL/level vs 43 mL/level). Percent total blood volume loss and % TBV per level fused was significantly less in the TXA group (12% and 1%) compared with control group (17% and 2%) ( p < 0.05). There was a moderate but significant direct correlation between number of levels fused ( p = 0.024) and length of operation ( p = 0.007) with % total blood volume loss. Conclusions Administration of TXA during pediatric scoliosis surgery reduced % total blood volume loss by 30% compared with no TXA.
Do Racial Differences Affect Surgical Outcomes in Patients with Degenerative Cervical Myelopathy?: Results from the Prospective Multicenter AOSpine International Study on 479 Patients
Authors: Nagoshi Narihito , Tetreault Lindsay , Nakashima Hiroaki , Nouri Aria , Fehlings Michael 
Published: April 2016

Introduction Degenerative cervical myelopathy (DCM) is the most common disease of the cervical spine in the elderly worldwide, and surgical decompression is a widely accepted procedure to prevent neurological deterioration. Although racial background affects clinical outcomes in various medical conditions and diseases, few studies have evaluated the impact of racial differences on surgical outcome after DCM. The purpose of this study is to comprehensively evaluate whether racial background is an independent predictor of surgical outcomes for DCM. Material and Methods A total of 479 patients with symptomatic DCM were prospectively enrolled in the AOSpine CSM-International study at 16 global sites. Patients' functional status were evaluated using the modified Japanese Orthopedic Assessment scale, the Nurick score, the Neck Disability Index, and the Short- Form 36 (SF-36) Health Survey. Improvements in functional status and QOL were assessed between baseline and 24-months follow-up. A mixed model analytic approach was used to evaluate differences in surgical outcome between races, while controlling for relevant baseline characteristics and surgical factors. Results Of the 479 DCM patients, 324 (67.64%) and 106 (22.13%) were Caucasians and East Asians, respectively. Other races were excluded as there were too few patients to conduct separate analyses. There was no difference in the incidence of ossification of the posterior longitudinal ligament (OPLL) between the two races; however a greater percentage of Caucasians in India (46.15%) and Turkey (41.38%) exhibited OPLL than Caucasians at sites in other regions. The frequency of spondylosis was significantly higher in Caucasians ( p < 0.0001). Caucasians had a significantly longer duration of symptoms ( p = 0.0002), a greater number of co-morbidities ( p = 0.0288), and a lower preoperative score on the SF-36 Physical Component Score ( p = 0.0002) than East Asians. At 24-months postoperative, there were no significant differences in functional status or QOL between East Asian and Caucasian patients, after adjusting for variations in baseline characteristics, surgical preferences and disease causation. In addition, rates of perioperative complications were not significantly difference between the races ( p = 0.261). Conclusion Although the frequency of subcategories of DCM differs between racial backgrounds, this does not affect surgical outcomes for DCM. Decompressive surgery for DCM is equally safe, and provides comparable functional gains both in Caucasians and East Asians. Although the prevalence of OPLL in East Asians has generally been thought to be higher than amongst Caucasians, our findings indicate that individuals from India and Turkey may also be at a high risk of OPLL development.
Post-traumatic Spondylodiscitis. Update, Series of 17 Patients and Review of the Literature
Authors: Abdelrahman Hamdan , Shousha Mootaz , Boehm Heinrich 
Published: April 2016

Introduction With increased risk and predisposing factors, the incidence of pyogenic spondylitis is rising. The term locus minoris resistentiae is defined as a place of less resistance, any part or organ which is more susceptible than others to the attack of a morbific agent. Hence the posttraumatic spondylodiscitis becomes not uncommon with acute or chronic presentation. In the literature only 17 publications (1939–2012) are reporting on a total of 20 cases. Material and Methods A retrospective uncontrolled clinical case-series in a single institution. Between January 2000 and May 2015, 17 patients were operated due to vertebral osteomyelitis after spinal fracture. We have analyzed the preoperative condition, risk factors, diagnostic findings, time between fracture and presentation, causative organism, treatment and outcome Results Total of 17 patients; 9 males and 8 females with mean age 68 years (44–81). High energy Trauma was reported by 5 patients. The mean interval between the fracture and spinal infection was 111.6 days (5 - 601). Twelve patients presented within less than 3 months of the fracture, whereas 5 presented later. Affected region was lumbar in 12, thoracic in 4 and cervical in one patient. Comorbidities were found in 94% of the patients: DM in 9 cases, renal insufficiency in 6 and cardiac diseases in 8 cases. Associated infections had been detected in 12 (71%). Mean CRP at time of presentation was 115 mg/l, WBCs 11x103/mm3 and ESR 81 mm/hr. The most common isolated organism was Staph. aureus in 9 cases (53%). Mean VAS after injury was 6.8/10 and at the time of presentation with spinal infection was 7.8/10. The most common presenting symptoms were increased local pain in all patients, fever in 11 and neurological manifestations in 6 patients. All patients except 2 patients, who died preoperatively, had been treated surgically (anterior Debridement and posterior stabilization). Conclusion Spinal osteomyelitis is commonly caused by hematogenous seeding. Predisposing factors that compromise the immune system render the host more susceptible to spinal infection. The fracture hematoma represents a suitable site for inoculation and development of infection and this can explain the acute presentation. The altered local vascularity at the fracture site can lead to blood stagnation and facilitate the bacterial seeding. Inflammatory parameters can be mildly elevated after trauma and should be differentiated from increase due to infection.
Anterior Column Reconstruction with Bundled Autologous Rib Graft after Thoracic Spinal Tuberculosis Debridement
Authors: Wang Qing , Xu Shuang , Wang Gaoju 
Published: April 2016

Introduction Vertebral defects are created after radical debridement for spinal tuberculosis, which often require anterior spinal column reconstruction with a strut graft. Autologous rib can be harvested through the same skin incision and can be exploited to reconstruct anterior column defect for thoracic spinal tuberculosis. The purpose of this study was to assess the clinical efficacy of bundled autogenous rib graft for anterior column reconstruction after thoracic spinal tuberculosis debridement. Material and Methods Fifty-eight patients with a confirmed diagnosis of thoracic vertebral tuberculosis (T4-T11) between January 2008 and December 2013 were analyzed retrospectively. All patients underwent anterior radical debridement and immediate reconstruction using bundled autologous rib with anterior instrumentation. We retrospectively analyze the clinical and radiographic data. Results All patients were followed 24–42 months and achieved solid bony fusions. There was no slide, subsidence, migration and breakage of bundled autogenous rib and screw-rod system. No significant loss of deformity correction was noted. Spinal cord function was effectively improved in all patients who had incomplete paralysis before surgery. There was no recurrence of tuberculosis. Pleural damage occurred in 10 ases while the rib was harvested. They were treated successfully with repair and closed drainage after operation. Two patients suffered from intercostal neuralgia postoperative and were relieved using non-steroidal anti-inflammatory (NSAID). The length of the rib harvested intraoperative was 15–22 cm with an average of 17.1 cm. Length of bundled autologous rib was 1.5–4.6 cm with an average of 3.7 cm. Cross-sectional area of bundled autologous rib accounted for an average of 35% of the endplate area adjacently. Conclusions This case series demonstrates anterior radical debridement, graft and instrumentation are safe and effective methods for thoracic tuberculosis. The bundled autogenous rib graft and anterior instrumentation could work effectively to provide immediate stabilization for reconstruction of anterior column defect created by radical debridement for thoracic spine.
Comparison of Surgical Outcomes by the Age at the Time of Surgery in the Treatment of Congenital Scoliosis: More than 10-year Follow-up
Authors: Chang Dong-Gune , Kim Jin-Hyok , Na Ki-Ho , Lee Jung-Hee , Suk Se-Il 
Published: April 2016

Introducion There is little information reported about the long term follow-up of surgical outcomes that pertain to the timing of surgery for congenital scoliosis in children under age 20 years. This study is to compare the surgical outcomes of posterior vertebral column resection (PVCR) for congenital scoliosis in children less than 20 years of age. Materials and Methods Forty-five congenital scoliosis patients ( N = 45) under age 20 at the time of surgery were treated by PVCR and fusion with PSF. These cases were retrospectively studied and had a minimum 10-year follow-up. We assigned patients into two groups: Group 1 ( N = 19) patients who had surgery before 10 years of age, Group 2 ( N = 26) those who had surgery after 10 years of age. Results In Group 1, the mean Cobb angle of the main curve was 44° before surgery, 10.2° after surgery, and 14.2° at last follow-up. In Group 2, the mean Cobb angle of the main curve was 48.7° before surgery, 17.2° after surgery, and 20.4° at last follow-up. The mean operative time was 189 minute (range: 70 to 405 minute) in Group 1 and 245 minute (range: 80 to 395 minute) in Group 2. The mean estimated blood loss (EBL) was 1285 mL (range: 270 to 3000 mL) in Group 1 and 2376 mL (range: 600 to 6000 mL) in Group 2. The mean fused segments were 3.3 in Group 1 and 4.6 in Group 2. Conclusions In congenital scoliosis patients, PVCR is an effective procedure for the management of congenital scoliosis under age 20. PVCR and fusion with PSF for congenital scoliosis before the age of 10 years had significantly better deformity correction compared with the group after the age of 10 years and did not cause crankshaft phenomenon. The mean operative time and EBL in children under age 10 were both significantly less compared with children between 10 and 20 years of age.
Effect of Posterior Dynamic Instrumentation on High-Intensity Zone in Lumbar Degenerative Disc Disease
Authors: Canbay Suat , Ataker Yaprak , Canbolat Nazan , Kabaoglu Zeynep Unal , Oktenoglu Tunc , Sasani Mehdi , Ozer Ali Fahir 
Published: April 2016

Introduction To investigate high-intensity zone (HIZ) changes after lumbar posterior dynamic instrumentation. Material and Methods Our study included 53 patients: 27 patients in group 1, 26 patients in group 2. All patients had one or two levels of degenerative disc disease with an HIZ confirmed by magnetic resonance imaging (MRI). Group 1 underwent one- or two-level dynamic lumbar posterior instrumentation. Group 2 was treated conservatively with an exercise program. Patients were evaluated using MRI, a numerical visual analog pain scale (VAS), and the Oswestry Disability Index (ODI) at baseline, at 1 year after surgery, and at final follow-up evaluation. Results The mean duration of follow-up was 49.3 months in group 1 and 47.19 months in group 2. The baseline VAS and ODI scores were similar for both groups. The mean VAS score of group 1 was significantly improved at 1 year after surgery and at final follow-up. The mean ODI value was lower in group 1 than in group 2 at 1 year and at final follow-up. Pfirrmann grades in group 1 significantly differed at 1 year and at final follow-up but did not change in group 2. The number of HIZs significantly decreased in from baseline to 1 year and from baseline to final follow-up in group 1 but did not differ in group 2. Conclusion Dynamic lumbar stabilization systems are promising. Observations such as Pfirrmann grade improvements and disappearance of HIZs are concordant with improvements in VAS and ODI scores demonstrate that dynamic stabilization systems may provide an environment for regeneration.
Adipose-derived Stem Cells as a Potential Additive Therapy in Chronic Compression Neuropathy in Rodents: a Diffusion Tensor Imaging Study
Authors: Sottaz Lima , Schären Stefan , Madduri Srinivas , Schäfer Dirk , Kalbermatten Daniel 
Published: April 2016

Introduction Compression neuropathy and nerve root compression are a leading cause of morbidity as well as a major cause of work impairment. Surgical and conservative treatments are widely used but there is still a lack of long-lasting effects. We seek to provide an additive therapy consisting of injected adipose-derived stem cells (ASCs) in the epineurium of a chronic nerve compression rodent model. In animal studies, evaluation of peripheral nerve injury and therapy monitoring is commonly performed using clinical scoring and histopathological workup. Recent developments in magnetic resonance imaging allow for the direct evaluation of nerve fiber integrity. Here we present the evaluation of this imaging method, diffusion tensor imaging (DTI) in the context of chronic sciatic nerve compression. Material and Methods We created a compressive lesion with a polymer clip on the left sciatic nerve of Sprague-Dawley rats. 0.5 million ASCs were injected in the epineurium under ultrasound guidance two weeks after the crush injury in a first group. The second group was injected with culture medium as control. The clips were removed in a third group who benefited from an intraoperative injection of ASCs and a fourth group underwent the same procedure but received the sham injection. Gait analyses with calculation of the Sciatic-Function-Index using a computed track were performed before the cells or sham injections as well as after two and four weeks. Two weeks post injection, respectively four weeks, post-mortem imaging was acquired on a 3-Tesla scanner. The Fractional Anisotropy (FA), a measure of fiber integrity, was measured for the proximal and distal part of the lesion and for the contralateral nerve. Afterwards, histomorphometry of cross sections of the nerve, histochemistry for muscle fiber typing and calculation of the gastrocnemius muscle weight ratio were undertaken. Results The FA showed no differences between the injured and uninjured side at the proximal site. Distally, the FA was clearly reduced on the injured side. The FA in the group treated with ASCs who underwent clip removal was significantly higher as well as the FA ratio (distal value/ proximal value). These findings could be correlated with clinical and histological analyses that showed faster regeneration and faster clinical recuperation in this group associated with reduced muscle atrophy. Conclusion ASCs alone seem to be insufficient to provide a clinically relevant treatment in this context of severe crush injury. Nonetheless, regenerative cells could be an interesting additive therapy after surgical decompression. Furthermore, our results indicate that DTI may be used to quantitatively assess sciatic nerve injury after treatment using ASCs in a rat model.
Safety and Efficacy of Local Bone with PEEK Cage versus Iliac Bone Graft in Anterior Cervical Discectomy and Fusion: A Prospective Study
Authors: Liu Zhili , Liu Jiaming , Xiong Xu , Xu Risheng 
Published: April 2016

Introduction A prospective study was performed to compare the clinical and radiological results between the use of local bone graft with a PEEK cage versus an iliac bone graft in anterior cervical discectomy and fusion (ACDF). Materials and Methods A total of 60 consecutive patients who underwent ACDF were evaluated from January 2010 to January 2013. 29 patients received an ACDF with a PEEK cage combined with local bone graft (local bone cohort) and 31patients received an ACDF with tricortical iliac bone graft (iliac bone cohort). The intraoperative and perioperative complications of both cohorts were recorded. Preoperative and postoperative radiographs were taken to calculate the ratio of interbody height to the disc height and the interbody bony fusion rate. The Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) were used to estimate postoperative clinical outcomes. Results The mean follow-up time was 25.0 ± 3.8 months in the local bone cohort and 24.4 ± 3.4 months in the iliac bone cohort ( p = 0.56). Although there was no statistically significant difference between the two cohorts in terms of blood loss ( p = 0.17), the length of surgery was significantly less in the local bone cohort compared with that of the iliac bone cohort ( p = 0.01). Postoperatively, VAS scores were significantly decreased, and JOA scores were improved in both cohorts. However, no statistically significant difference was found between the two cohorts at final follow up ( p = 0.45, p = 0.93). The disc space height and segmental interbody angle at the surgical segment were greater in local bone cohort than those in the iliac bone cohort ( P < 0.001 and P < 0.001). The fusion rates were 93.1% (27/29) in local bone cohort and 90.3% (28/31) in the iliac bone cohort at last follow up ( p = 0.70). Perioperative complication rates in local bone cohort and iliac bone cohorts were 6.8% and 29%, respectively ( p = 0.04). Conclusions In a prospective study of 60 patients receiving ACDF with either local bone graft with a PEEK cage or an iliac bone graft alone, the former had a statistically shorter operation time, lower perioperative complications rate, and better radiological results. Although further long-term studies will delineate whether these improved radiographic findings will translate into better clinical outcomes, the local bone graft with a PEEK cage appears to be a safe alternative to the iliac bone graft during the perioperative period.