bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uncommon Intradural-Extramedullary Lesions Removed by Direct Uniportal Minimally Invasive Technique: Clinical and Radiological Results. A Study with 24 Months of Follow-up
Authors: Pesantez Carlos Fernando Arias , Peña Pablo 
Published: April 2016

Introduction Intradural extramedullary cervical lesions usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes standard fashion cut incision, open laminectomy and some cases fusión with a delayed recovery and return to daily activities. Material and Methods We present seven patients (four woman and tree man) with symptoms include radicular pain and/ or neurological deficit, due intradural-extramedullary cervical lesion. All the patients underwent total resection with minimally invasive uniportal technique using a tree blade MAXCESS retractor system (Nuvasive, Inc) and surgical microscope. We measured a VAS, Nurick scales preop and with follow up of 6 weeks, 3,6, 12 and 24 months of follow up. Surgical time, blood loss and time to discharge. All the patients was underwent control MRI postoperatively. Results Histologically report: Two patients neurenteric cyst, four patients: neurocisticercosis and the last: epidermoid cyst. The VAS and Nurick scales was decreased over the time line. The surgical time was 140 minutes mean, blood loss 30cc mean, All the patients was discharged 47hours mean and return to daily activities 10 days mean. Conclusion Intradural-extramedullary lesions can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization, disruption to local tissues and return to daily activities suggest that, this technique may present an alternative to traditional open resection with excellent follow up.
A Study of the Modified Quebec Task Force Classification of Chronic Low Back Pain with Regards to Activity Limitation, Global Percieved Effect, Sick Leave, and its Prognostic Implications
Authors: Varma Kalyan 
Published: April 2016

Introduction The Quebec Task Force(QTF) on activity related spinal disorders was a group of experts in various fields brought together by the Quebec Worker's Health and Safety Commission. It formally recognized that clinicians couldnot reliably differentiate between different patho anatomic causes of low back pain(LBP). Classifying patients as described by the QTF has shown associated differences on several characteristics which showed increasing severity from category 1(local LBP) across the categories of LBP+radiation above knee (category 2), LBP+radiation below knee (category 3) to LBP+neurological signs (category 4). The objective of the study is to determine the prognostic significance of the QTF classification in patients with chronic LBP and to compare the efficacy of the chronic LBP rehabilitation protocol among various categories of QTF. Material and Methods Routine data was collected at the time of presentation to an outpatient department of a tertiary care center in India. After taking a detailed history and clinical examination, the pain severity is assessed by Low Back Pain Rating scale (LBPRS) and the activity limitation is assessed by Roland Morris Disability Questionnaire (RMDQ). The patients were advised treatment according to the common standard rehabilitation protocol. The patients were followed up every 6 weeks to check for the progression of symptoms clinically and for the compliance with the rehabilitation protocol. The patients were evaluated at 3 months and again at 6 months for Global Perceived Effect (GPE), activity limitation (RMDQ questionnaire) and sick leave status along with LBPRS. Results A total of 188 patients were included with 75% 3 month and 70% 6 month follow up.category 1 had the least and category 4 had the most severe activity limitation at all time points.Patients in category 4 improved the most at the end of 6 months with the common rahabilitation protocol.Patients in category 4 landed up more frequently in surgery compared with others. There were no significant differences in comparisions between category 2 and category 3 Conclusion Categorizing patients based on QTF classification has shown significant association with activity limitation. Prognosis of the patient's condition based on the symptoms at presentation can be roughly estimated using the QTF classification. However, differentiating patients based on radiating pain above or below the knee has no significant prognostic implications. It was found difficult to establish a diagnosis based on symptoms alone. Hence, targeted treatment based on the QTF classification may have a potential role in better management of patients with chronic LBP.
The Choice of Upper Instrumented Vertebra in AIS and Shoulder Balance
Authors: Kharrat Khalil , Khouri Georges , Kreichati Gaby 
Published: April 2016

Background The choice of the upper instrumented vertebra has long been debated. With little proof regarding the best fusion level, scarce information about the final outcome and lack of consensus, four criteria were used to study each AP and lateral films to choose the most optimal level. The author's used criteria were (1) the positive shoulder sign defined as the contralateral shoulder to the main curve being the highest, (2) a proximal curve that is stiff on reduction maneuvers only to be corrected less than 30% a junctional kyphosis on lateral view between the main, (3) the proximal curve and finally a long proximal curve accounting for 5 and more vertebrae and (4) the final outcome being shoulder balance. The objective of this study is to study the concordance between these criteria used by our surgeons and those defined by Lenke in 2001 to select the most conservative posterior fusion possible to achieve coronal and shoulder balance in AIS. Methods Thirty Lenke type I AIS deformity patients, with a minimum postoperative follow up of 2 years, were divided according to the proximal fusion level with group 1+ being all patients who have a fused proximal thoracic curve and group 1- being all patient whose proximal thoracic curve wasn't included in spinal arthrodesis. Then a comparative study between the two groups was made, accounting for shoulder balance as the main outcome by measuring coracoid height, T1 tilt and clavicle angle between the two groups and comparing the results whether the proximal thoracic curve was included or not. Results The two groups were initially similar (p > 0.05) and remained equivalent having an appropriate shoulder balance in the immediate post-operative period and at last follow up without a significant difference in shoulder balance (p > 0.05) (coracoids difference, T1 tilt and clavicle angle). The study showed an average correction of 60% in the proximal thoracic curve and 70% in the main thoracic curve whether PT was included or not. A similarity study between Lenke criteria and the authors' criteria showed no difference between the two with the exception of a PT bigger than 5 vertebrae. Having a PT bigger than 5 vertebrae did not influence shoulder balance in AIS type I. The study showed a concordance of 74% between Lenke criteria and the authors'. Conclusion There is a high level of concordance between the authors' criteria and those defined by Lenke showing that whether to include the proximal curve or not depends on establishing whether the proximal curve is stiff i.e structural or not.
Preliminary Results of Treatment of Early Onset Scoliosis using Magnetic Growing Rods
Authors: Siam Ahmed Ezzat , Shaheen Elsayed , Mohamad-Ali Niazi , Pfandlsteiner Thomas , Wimmer Cornelius 
Published: April 2016

Introduction One of the major disadvantages of traditional growing rod systems is the requirement for multiple surgical procedures to lengthen the rods as the patient grows. This has been avoided by introduction of magnetically controlled growing rod (MCGR). Materials and Methods A prospective uncontrolled, single-center, single-surgeon, clinical and radiological study. Between November 2012 and August 2015, 16 children with EOS were treated using MCGR. Preoperative, postoperative and final follow-up (FFU) whole spine radiographs were reviewed to determine the degree of spinal deformity and correction, measured using Cobb angle. T1–S1 length was calculated. Clinical notes to determine number of rod lengthening procedures using remote control device and to record any complications during surgery or FU period. Mean age was 11.6 years, 3 boys and 13 girls; 11 children had primary correction by MCGR; 7 of them had neuromuscular, three infantile and one congenital scoliosis. All had a dual MCGR implanted. The remaining five patients had previously undergone other growing rod operation before converting to MCGR implant. Results Mean pre-operative Cobb angle of the primary group was 63.2°, postoperative 35.6° (40.5% correction), FFU 39°. Mean initial percentage of the lengthening was 14.8%. Thoracic kyphosis changed from preoperative mean of 49.1° to 34.1° postoperatively. One patient had wound infection, three had pull-out of proximal screws/hooks, one sustained a breakage of a single-rod construct 6 months after surgery and was replaced by a double magnetic-rod construct. A total of 40 distractions have been performed. Mean FU was 15.5 months. Conclusions In our consecutive series of patients treated with MCGR we found that scoliosis was well controlled. Cobb angle was significantly reduced following surgery in patients who had MCGR performed as a primary procedure. Generally, the correction was maintained at FFU. Despite the relatively high complication rate, comparing our results for MCGR and other growing rod techniques, they are comparable, without need to repeated surgery.
Conversion of Implant Failure in Early Onset Scoliosis to Magnetic Growing Rod. A Series of Five Cases
Authors: Siam Ahmed Ezzat , Shaheen Elsayed , Pfandlsteiner Thomas , Wimmer Cornelius 
Published: April 2016

Introduction Conventional growing systems allow spinal growth to continue and prevent curve progression but need multiple interventions that increase the risk of infection, complications of anesthesia. A more advanced, less invasive method is the remotely distractible, magnetically controlled growing rod (MCGR) system which has been developed to allow frequent non-invasive distractions. This is the first series focusing on the conversion of failed growing implant to MCGR. Materials and Methods A prospective single center study from 11/2012 to 8/2015 with consecutive patients with progressive deformity and implant failure. Five children have been converted to MCGR; one boy and 4 girls; mean age 11.9 years. The scoliosis was infantile in two and neuromuscular in 3 cases. Four patients had VEPTR and one had a conventional growing rod. Results Mean preoperative Cobb angle was 56.6°, thoracic kyphosis 59.6° and spinal length (T1-S1) 339mm. The upper fixation level was T3-T5 with a lower fixation to T11 and L2 in the infantile scoliosis and L3 in two neuromuscular cases. One neuromuscular scoliosis was fixed with hooks to the iliac crest. Mean operative time was 135 minutes and blood loss 217 ml. Mean postoperative Cobb angle was 48.1°, thoracic kyphosis of 49.8% and spinal length 379mm. During this study a total of 15 distractions have been performed to all children. At final FU (mean of 21.8m), mean Cobb angle was 48° (total additional correction of 2.5°), thoracic kyphosis of 51.5° (total additional correction of 3.2°) and spinal length of 387 mm (total spinal growth of 33 mm). One case reached to final fusion after 2 distractions. Double rods have been the rule with exception of one neuromuscular case. This single rod was broken after 6 months and replaced by a double rod system. The other complication was a proximal junctional kyphosis (PJK) that occurred primarily after VEPTR and again after magnetic rod. Conclusion Although conversion of implant failure from VEPTR and growing rod systems to MCGR is a good option to allow growth of the instrumented segment, this gives limited results when performed at a relatively older age. The postoperative correction in these cases is relatively limited due to prior correction by the older systems. One complication related to the implant occurred with single rod construct. Correction by MCGR will face the same challenge to prevent PJK, like other growing rod systems. The new technique provided a non-surgical repeated (sometimes outpatient) distractions.
Intraoperative Electromyography and Instrumentation in Patients with Idiopathic Scoliosis
Authors: Dias Anderson Alves , Lanna Rachel Alvarenga Boy , Junior Marcos Antonio Ferreira , Falcon Roberto Sakamoto , Rech Paulo Renato , Vargas Rogerio de Almeida , Menezes Cristiano Magalhães 
Published: April 2016

Introduction The objective of this study is to relate the use of intraoperative electromyography surgical time, proper placement of screws, type of curve and time for screw in idiopathic scoliosis correction surgery in a group of surgeons of Belo Horizonte. Methods This was a retrospective study of 80 patients undergoing surgical treatment for idiopathic scoliosis correction between December 2008 and January 2015. All patients was performed electromyographic monitoring (EMG) intraoperative by a single column group of surgeons Belo Horizonte. EMG was performed with stimulation of pedicle screws in patients undergoing instrumentation using pedicle screws and fasteners. Results It was observed that 85% were female, with a mean age of 17 years (minimum of 6 years and maximum of 34 years), 37.5% of the cases represented the curve was idiopathic Lenke 1AN. 60.0% of all surgical cases had EMG change, and of these 1.3% had already had deficits Pre-procedure and 3.75% of cases post deficits. Of the total cases analyzed 66.3% were positive for real results. Conclusion Intraoperative monitoring with EMG is a very important tool for the surgical treatment of patients with scoliosis patients with instrumentation with pedicle screws. Through this feature you can check if the screw is on the correct path contributing to decrease the error rate, post surgical arthrodesis allowing the change in surgical strategy. Besides contributing to the positioning time reduction of the screw and the end of the surgical time.
Intraoperative Electrophysiological Monitoring Navigation Results during Sagittal Anterior Reduction Maneuver of High Grade Spondylolisthesis L5-S1 using an ALIF Surgical Technique
Authors: Diaz Roberto , Berbeo Miguel , Guarnizo Aura , Sardi Juan 
Published: April 2016

Introduction Unstable isthmic spondylolisthesis is a common disease. Treatment of high-grade dysplastic spondylolisthesis remains challenging. According to the literature, decompressive laminectomy and posterolateral screws fusion is preferred by most surgeons. Surgical treatment of spondylolisthesis has been recommended in patients with pain refractory to conservative treatment, slippage progression, or severe slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. Moreover, some authors reported the incidence of L5 root palsy during the reduction procedure. We believe that satisfactory nerve root decompression may be achieved by complete anterior discectomy and restoration of disc height (Indirect Decompression), followed by ALIF graft and posterior pedicle screws Material and Methods We performed a prospective study of 23 cases of surgical treatment using intraoperative electrophysiological monitoring for patients with high-grade spondylolisthesis. Each patient received treatment consisting of anterior retroperitoneal approach and indirect nerve decompression with anterior sagittal progressive realignment maneuver, and circumferential fusion with ALIF cage and L5-S1 minimally invasive pedicle fixation with intraoperative neurological monitoring with transcranial electric motor evoked potentials and continuous spontaneous electromyography recording. Results Intraoperative monitoring did show different transitory patterns with no any final abnormal changes. The patients got well after surgery, and they showed no postoperative sensory changes and motor paralysis of the extremities. A postoperative X-rays films showed suitable reduction of the slippage. Conclusion This report describes 23 cases of surgical treatment using intraoperative electrophysiological monitoring with transcranial electric motor evoked potentials and continuous spontaneous electromyography for patients with high-grade dysplastic spondylolisthesis. We successfully perform anterior sagittal reduction maneuvers without any neurological deficit using intraoperative electrophysiological monitoring.
The SpineCor Brace in 2015: A Form of Chiropractic Child Abuse? A Report of Three Cases
Authors: Smith John , Heflin John 
Published: April 2016

Background When the SpineCor brace was introduced ~15 years ago, it touted promise that a flexible, patient friendly brace could arrest curve progression during growth similar to that documented for a rigid Boston-type brace. Subsequent experience with this brace demonstrated that failure rates were similar to the group randomized to no brace in the study by Weinstein et al. Most orthopedic surgeons have abandoned its use. However, Chiropractors have recently advocated that this “new and amazing flexible” brace cannot only control scoliosis but with spinal manipulation, but also correct the curve. This is a report of three cases treated with the SpineCor brace. Case Studies: Patient one is a 15 years/o pre-menarche female who presents with a right thoracic curve of 56 degrees. Surgery was recommended. The family chose to use the SpineCor brace and multiple chiropractic manipulations with a guarantee that surgery could be avoided. Two years later, the family returns to clinic with a curve measuring 110 degrees. Patient two is a 12 years/o female who presents with AIS measuring 54 degrees. Surgery is recommended. The father chose to go with a SpineCor brace, traction Table 4X per week, muscle therapy, a vibration bed, and nuchal therapy for four years. After “tens of thousands of dollars,” the child returns at age 16 with a thoracic curve measuring 115 degrees. Patient three is a 10-year-old female who presents with an AIS curve measuring 32 degrees. Rigid bracing is recommended but the family chose Chiropractic and a SpineCor brace and a promise that the curve could be corrected. She returns at age 13 years with a curve of 75 degrees and surgery is recommended. Conclusion There is no credible data that would support the use of a SpineCor brace as an effective alternative to rigid bracing, or that this brace can actually correct a curve. In addition, there seems to be no consequences or accountability for prescribing chiropractors when the brace fails, leaving children with severe, high-risk curves. As Orthopedic surgeons, we have a responsibility to educate the public and no longer ignore the misleading information that our patients are receiving about “complimentary” therapies. This is a small series of cases and probably missed all of the successes of the SpineCor brace.
Reconsideration of the Definition of Chiari Malformation Type 1 Radiologically and Clinically
Authors: Murakami Tomohiro 
Published: April 2016

Introduction Chiari malformation type 1 (CM-1) is diagnosed by more than 3 or 5 mm caudal displacement of the cerebellar tonsils through the foramen magnum. This definition is a simple and easy method neuroradiologically, but it is obscure which is 3 or 5 mm. The purpose of this study is to analyze their clinical symptoms and radiological features. Materials and Methods We had 7788 new outpatients in our neurosurgical hospital in 2013 and 2014. In whom, patients undergone head CT or MRI were examined retrospectively. We diagnosed chiari marformation type 1 using more than 3 mm tonsillar herniation. Their clinical symptoms and the following measurements were analyzed: the distances from the pontomedullary junction (PMJ) to the basion (PMJ-Ba), PMJ to the basion-opisthion (PMJ-BO), the distances from the basion-opisthion to tip of the cerebellar tonsil, from BO to the obex (BO-obex), and from basion to opisthion, the clivo-axial angle, and the length of the clivus using T1-weighted sagittal images. Results There were 32 patients with CM-1 aged from 10 to 78 years (mean: 37.6 years) consisted of 8 men and 24 women. In whom 20 patients with tonsillar herniation of less than 5 mm were determined as T-3 group (T-3) and remained 12 patients as T-5 group (T-5). No patients had syringomyelia. Headache was the most common symptom. Four patients in T-3 group were diagnosed incidentally, 3 in head injury and one in memory disturbance. The distances of PMJ-Ba, PMJ-BO, BO-obex, BO, the clivo-axial angle, and the length of the clivus were similar between both groups. Conclusions The patients in both groups had similar sympotms and posterior cranial fossa structures, however, patients in T-3 group without symptoms associated with CM-1 were diagnosed incidentally. Chiari malformation type 1 should be diagnosed based on not only tonsillar herniation but also clinical symptoms and other MRI findings such as brainstem ptosis.
Long-Term Outcome following Surgical Treatment for Spondylodiscitis in 211 Cases
Authors: Shiban Ehab , Janssen Insa , Meyer Bernhard , Reiner Jessica , Ringel Florian 
Published: April 2016

Aim To determine the safety and efficacy of surgical debridement with instrumentation in treating pyogenic infection of the spine. Material/Methods Between June 2006 and December 2013, 229 consecutive patients suffering from spondylodiscitis were admitted to our department. 211 (92%) underwent surgical debridement and instrumentation while 18 were treated conservatively. Surgically treated patients were analyzed. Clinical outcome was assessed with neurological and laboratory examinations at 3 months following surgery. Long-term clinical outcome was assessed at a minimum of 12 months following surgery with a telephone interview. Results The mean age at presentation was 67 years, 139 patients were male (66%). Distribution of the inflammation was lumbar in 134 (63%), thoracic in 37 (18%) and cervical in 30 (14%) cases. Ten patients (5%) had two concomitant non-contiguous spondylodiscitis in different segments of the spine. Epidural abscess was found in 74 patients (35%). 191 patients (90%) had pain. Neurological deficit was found in 96 patients (45%). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 34 cases, additional interbody fusion from dorsal was performed in 86 cases. 360-degree instrumentation was performed in 53 cases. In the cervical cases, ventral spondylodesis was performed in 13 cases and ventral plating, dorsal instrumentation alone in 8 cases and 360-degree instrumentation 13 cases. Postoperative intravenous antibiotics were administered for 13,6 ± 8,2 days followed by 3.0 ± 0.9 months of oral antibiotics. Complete healing of the inflammation was achieved in 204 (97%) of cases. Only 4 patients had a relapse of the inflammation, in 3 cases following dorsal instrumentation alone and in one case after additional interbody fusion with a PEEK cage from dorsal in the lumbar spine. This was followed by debridement and anterior interbody fusion upon relapse. Five patients died due to septic shock (two because of fulminant endocarditis and three by multiple organ dysfunction syndrome). 1 patient died postoperatively due to pulmonary embolism. From the 96 patients with neurological deficit, 44 (46%) had full recovery and 33 (34%) had improved incompletely after surgery. Conclusion Surgical debridement and instrumentation is relatively safe and very effective approach to achieve complete healing of spinal inflammation. Thereby, a short period of intravenous antibiotics of 1–2 weeks is followed by 3 months of oral antibiotics is appropriate in most cases.