bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Stand-alone Polyetheretherketone (PEEK) Cages
Authors: Shiban Ehab , Meyer Bernhard , Lehmberg Jens , Nies Moritz , Kogler Johann 
Published: April 2016

Aim To evaluate long-term results after one- and two-level anterior cervical discectomy and fusion (ACDF) with stand-alone polyetheretherketone (PEEK) cages. Methods We performed a retrospective review of a consecutive patient cohort with degenerative disc disease that underwent ACDF with stand-alone PEEK cages between 2007 and 2013 with a minimum follow-up of 12 months. Radiographic follow-up included static and flexion/extension radiographs. Changes in the operated segments were measured and compared with radiographs directly after surgery. Clinical outcome was evaluated by a physical examination, pain visual analog scale (VAS) and health-related quality of life (HRQL) using the EuroQOL questionnaire (EQ-5D). Results Of 667 consecutive cases, 554 met all inclusion criteria. Follow-up data were obtained from 439 (79.2%) cases. The mean age at presentation was 55 years and 237 patients were male (54%). 220 and 219 patients had one- and two- level surgeries, respectively; 220 (50%) presented with spondylotic cervical myelopathy and 219 (50%) with cervical radiculopathy. Fusion was achieved in 85.9% and 86.3% of segments in one- and two-level surgeries, respectively. Cervical alignment was better in 37% and 40%, same 32% and 43%, worse in 30% and 17% in one- and two- level surgeries, respectively. Subsidence was observed in 27.7% and 26.5% of segments in one- and two-level surgeries, respectively. Follow-up operations for symptomatic adjacent disc disease and implant failure at index level were needed in 34 (7.7%) and 22 (5%) cases, respectively. Mean VAS declined from 5.3 ± 3.5 to 2.6 ± 2.3 ( p < 0.001) and 4.5 ± 3.7 to 2 ± 2.5 ( p < 0.001) for neck and arm pain, respectively. Health-related quality of life (HRQL) as measured by the EuroQOL questionnaire (EQ-5D) improved most cases. Conclusions One and two level ACDF with stand-alone PEEK cages achieved very high fusion rates and a low rate of follow-up operations. The rate of good clinical outcome is highly satisfactory.
Dysphagia Due to Ossification of the Cervical Anterior Longitudinal Ligament. Report of Three Cases
Authors: Valacco Marcelo , Imposti Felix , Servidio Mariano 
Published: April 2016

Introduction Symptomatic ossification of the anterior longitudinal ligament is rarely pathology. Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition in the aging spine. DISH, also called with the eponym Forestier's disease, is a clinical syndrome characterized by the abnormal formation of osteopytes involving the spine. These are largely asymptomatic, however are recognized as an unusual cause of dysphagia, which may occur secondary to the mechanical compression with partial obstruction or perioesophageal inflammation caused by pharyngo- esophageal motion over the osteophytes. Dysphagia is reported in up to 28% of patients. Surgical treatment is advocated only after failure of conservative therapies. Conversely, in absence of relevant clinical signs due to the presence of DISH, surgery is not considered mandatory. However, surgical resection of the osteophyte has been reported to be an effective treatment for severe cases. Therefore, from 1995, we started to observe long-term postoperative courses of DISH patients with recalcitrant dysphagia who underwent surgical resection of osteophytes. The purpose of this study was to examine these surgical outcomes and literature review. Material and Methods Case 1. A 70-year-old man referred to our clinic because of progressive dysphagia for solids and liquids and cervical pain. A lateral cervical spinal X-ray and cervical MRI revealed giant cervical osteophytes at the ventral portion of the C 2/3/4 vertebral bodies and contiguous calcification of the anterolateral cervical vertebral bodies. Case 2. A 57-year-old man presented with a 1.5-year history of increased difficulty swallowing. A plain lateral radiograph revealed OALL ventral to the C3–5 vertebral bodies. Three- dimensional computerized tomography studies further demonstrated extensive C3–5 OALL. Case 3. A 75-year-old white man was seen at Hospital with the main complain of increased difficulty in swallowing solid food over the past two years. Routine cervical spine films revealed prodigious osteophytes of the cervical spine involving the bodies of C-2, C-3, C-4, C-5 and C-6 consistent with DISH. A magnetic resonance imaging (MRI) scan of the cervical spine revealed an elongated ossification of the frontal planes of the vertebral bodies, with spurs projecting into the soft tissues of the neck. Results The three patients underwent uneventful operative excision of the anterior cervical osteophytes. Surgery was performed with an anterolateral approach. They had marked improvement in swallowing function and were able to resume a normal diet after one to two months. Conclusion Diffuse idiopathic skeletal hyperostosis or Forestier's disease is an uncommon etiology of progressive dysphagia. This unrecognized condition may provide a new challenge for spine surgeons who are not as familiar with DISH as rheumatologists. Surgical decompression through osteophytectomy is effective for patients who fail conservative treatment
Role of Spinal Diffusion Tensor Imaging in Predicting Post-operative Outcome in Cervical Degenerative Pathologies
Authors: Ahmad Faiz , Rindler Rima , Eshraghi Sheila , Chokshi Falgun , Mossa-Basha Mahmud , Buster Bryan , Chu Jason , Pradilla Gustavo 
Published: April 2016

Introduction Predicting post-operative recovery after surgery for cervical spondylotic myelopathy (CSM) is challenging. The authors performed a systematic review of the literature evaluating the diagnostic ability of DTI in CSM, and its ability to predict post-operative outcome. Material and Methods A systematic PubMED search adherent to PRISMA guidelines included relevant clinical studies reporting use of DTI in adult humans undergoing operative management for CSM from 1980 onwards. Available data on pre-operative clinical status and imaging and post-operative clinical outcomes were abstracted. Results Six of 562 studies were eligible for detailed review. There were 112 patients with CSM and 45 healthy controls. Seventy-three (59.8%) underwent operative management with mean follow-up time 90–730 days. Fractional anisotropy (FA) was significantly lower in patients compared with controls across multiple studies, and correlated with pre-operative assessment (modified Japanese Outcome Assessment). FA and fiber tractography ratio (FTR) correlated with post-operative clinical assessments, with FA independently predicted surgical need and good outcome post-operatively. Conclusion DTI may be a valuable tool in identifying patients in need of surgical decompression and predicting post-operative outcome. Future prospective studies are required for choosing optimal DTI parameters, anatomic levels and acquisition techniques.
Successful Treatment of Severe Occipitocervical Pain from C1-C2 Osteoarthritis Using a Modified Harms Technique
Authors: Deukmedjian Ara , Cianciabella Augusto , Patel Bharat , Deukmedjian Arias 
Published: April 2016

Introduction C1-C2 fusion with instrumentation is an established treatment for C1-C2 instability due to trauma or inflammatory disease. C1-C2 fusion for debilitating occipitocervical pain secondary to C1-C2 osteoarthritis has been reported in a small number of patients. Here we report the successful treatment of three patients that underwent C1-C2 instrumented fusion using a modified Harm's technique for medically refractory occipitocervical pain. Materials and Methods Between August 2012 and July 2015, three consecutive patients with debilitating, unilateral occipitocervical pain and radiographic C1–2 osteoarthritis, underwent posterior instrumented C1-C2 arthrodesis using bilateral polyaxial C1 lateral mass and C2 pedicle screw and rod constructs (modified Harms technique). All three patients failed preoperative conservative treatment including therapy, medical management and interventional pain management including facet joint injections. In all three patients, the source of occipitocervical pain was confirmed preoperatively with direct C1-C2 joint injection using 0.5ml of a mixture of 2% lidocaine/0.5% Marcaine/10mg kenalog. All three patients had immediate but temporary relief of their occipitocervical pain from the diagnostic C1-C2 joint injection. Preoperative CT scan confirmed the presence of C1-C2 osteoarthritis on the symptomatic side. Outcome measures include pre and postoperative VAS, patient reported resolution of pain, hospital LOS, EBL and complications. Results Each of the three patients surgically treated had complete resolution (100%) of their preoperative occipitocervical pain beginning immediately after instrumented posterior fusion of C1–2. Average VAS improved from 8.3 preoperatively to 0.0 postoperative for the cohort. Average follow up is 33 months. Average age for the group at the time of surgery was 75 years old and the M:F ratio is 1:2. Hospital LOS was 1 day for each patient. EBL was 45ml on average with a range of 15ml - 75ml. There were no postoperative complications. Conclusions Instrumented posterior C1-C2 fusion, using a modified Harms technique, is a safe and effective treatment for refractory occipitocervical pain secondary to C1-C2 osteoarthritis. The source of pain should be confirmed preoperatively with both CT scan and diagnostic joint injection.
The Quantitative Observation of Interbody Fusion with Local Autogenous Bone Harvested from Single Interlaminar Fenestration in PLIF
Authors: Wang Qing , Yang Yong 
Published: April 2016

Introduction Local autogenous bone (LABORATORY) harvested from interlaminar fenestration or total facetectomy has been widely applied in interbody fusion of lumbar disc degenerative diseases (DDD) with satisfactory clinical results. However, there was lack of weight and volume observation of LABORATORY harvested from single interlaminar fenestration(SIF). The aim of this study was to quantitative observe the interbody fusion feasibility with LABORATORY harvested from SIF in PLIF. Materials and Methods 107 patients were undergone PLIF only by LABORATORY+one cage at L4/5 and/or L5S1 due to DDD. The weight and volume of LABORATORY from SIF were measured by analytical balance and 5ml disposal sterile syringe. The height of cages used intraoperative were recorded. The area of endplate (Se) and the contact area (Sc) between the cartilaginous endplate and LABORATORY +cage at every intervertebral space was measured and calculated by PACS of CT workstation. The clinical results and fusion status were estimated by JOA score and 3D-CT at 12, 18 and 24 months postoperative. Results 113 segments of 107 patients were successfully fused only by LABORATORY harvested from SIF. The weight and volume of LABORATORY from SIF showed no significant differences at different ages, genders, segments and type of DDD, and the same result exists about Se and the height of interbody space in L4/5 or L5S1 segments. The mean volume and weight of LABORATORY were 3.1ml and 3.7 g from SIF. The packing ratio (PR) of LABORATORY+one cage was 38.1%. The volume and weight to reach 30% PR needed ~2.5ml and 3.0 g LABORATORY. 94 cases (98 segments) were followed up for average 24 months postoperative. The improvement rate of JOA score was 82.5%, and the fusion rate was 92.9%. Conclusion SIF can provide enough LABORATORY for one interbody fusion in PLIF. The average volume and weight of LABORATORY from SIF were 3.1ml and 3.7 g respectively. 38% PR, including one cage, is achievable at fusion segment in present study. 2.5 ml (3.0 g) LABORATORY+one cage can perform ~30% PR.
Early Adjacent Segment Degeneration after Short Lumbar Fusion
Authors: Masevnin Sergei , Ptashnikov Dmitry , Mikhaylov Dmitry , Smekalenkov Oleg , Zaborovskii Nikita , Lapaeva Olga 
Published: April 2016

Introduction Today in a review of the world literature there is no consensus about the main risk factor for the symptomatic adjacent segment disease, as well as the terms and conditions of its occurrence. Furthermore there are more and more questions about the reasons for the early development of ASD in the event of a short fixation, which according to some authors, should be associated with the wrong tactics of treatment and regarded as a complication of surgery. Material and Methods This study evaluated 146 patients who underwent one level 360° fusion lumbar surgery from 2005 to 2012 for the treatment degenerative conditions of the lumbar spine. It should also be noted, that patients with L5-S1 fusion were excluded from the study due to the peculiarities of the biomechanics of the segment. So we compare 2 groups according to the presence and extent of initial degenerative changes in the adjacent upper segment. These groups were similar of major risk factors for ASD, such as obesity, age, smoking, menopause, global balance disturbance. Patients in both groups had no significant differences in sex and age composition, the level of quality of life and daily physical activity. First group include 86 patients with no pre-existing or 1 to 3 stage degenerative changes by Pfirrmann modified, second group include 60 patients with initial adjacent disk degenerative changes of stage 4 and above according Pfirrmann modified classification. The average follow-up period was 42.2 months (range, 28–112 months). Results In the I group symptomatic ASD was found in 14 (16,3%) cases and ASD average development time was 35 (8–56) months. In the II group during the follow-up period 24 (40%) patients had ASD with average development time 21,5 (3–46) months. Symptomatic adjacent segment pathology was significantly more frequent in the II group ( p < 0.05). The timing analysis of the symptomatic ASD showed statistically significant data on the earlier development of this disease in the second group ( p < 0.05). Conclusion Patients with pre-existing degenerative changes in adjacent levels above stage 3 by Pfirrmann must be assigned to a high risk group for early ASD development even in the short lumbar fusion.
Postoperative Complications in Patients Undergoing Minimally Invasive Sacroiliac Fusion
Authors: Schoell Kyle , Buser Zorica , Jakoi Andre , Pham Martin , Patel Neil , Liu John , Hsieh Patrick , Wang Jeffrey C. 
Published: April 2016

Introduction Minimally invasive sacroiliac (SI) fusion has become increasingly popular as a treatment for non-traumatic sacroiliac joint pain in recent years. This has created significant need for reliable data addressing risks associated with the procedure. Initial investigations have focused primarily on efficacy and patient satisfaction with small sample size. Furthermore, the majority of past studies have been primarily single center or case series investigations and as such their findings were limited to their sample populations. The aim of this study was to analyze complications associated with minimally invasive SI fusion using a large medical record database that more closely and accurately models the American population as a whole. Material and Methods Patients undergoing minimally invasive SI fusion from 2007–2014 were selected from records of the nationwide private insurance provider Humana. Using the Pearl Diver patient records database (Pearl Diver Technologies, West Conshohocken, PA, USA), patient data on age, procedure date, and medical diagnoses before and after the procedure was acquired. ICD-9 diagnosis codes (International Classification of Diseases 9th edition) were used to reveal incidence of post-operative complications including infection, pain, osteomyelitis, joint derangement, uterine tract infection (UTI), and nerve pathology. Cases of pre-existing conditions were excluded from the analysis. The data was also examined for incidence of patients with diagnoses of new lumbar pathology following the procedure. Patients undergoing SI fusion for surgical revision, neoplasia, or pelvic ring trauma were excluded from the study. Results Data from 469 patients (305 female; 164 male) showed a substantial increase in the number of minimally invasive sacroiliac fusion procedures performed from 2007–2014 [ p < .05]. Among these patients, an overall complication rate of 13.2% was seen at 90 days and 16.4% at 6 months post-op. Rates of individual complications were as follow. Infection: 30 days = 3.0%, 90 days = 3.6%, 6 months = 4.1%. Pain: 90 days = 2.6%, 6 months = 4.1%. UTI: 90 days = 3.8%, 6 months = 4.9%. Nerve pathology: 90 days = 4.3%, 6 months = 6.2%. Incidence of novel lumbar pathology was 3.6% at 90 days post-op and 5.3% at 6 months. Males experienced diagnoses of novel lumbar pathology at higher rates than females at both 90 days (M=6.7%; F≤3.3%) and 6 months (M=9.1%; F≤3.3%) [ p < .01]. Conclusion The results of this study show that minimally invasive SI joint fusion may carry higher risks of complications than previously stated, including a possible association with the development of lumbar pathology. These finding are critical for physicians and patients considering minimally invasive SI fusion as a treatment for chronic SI joint pain, and should be taken under careful consideration when deciding if surgical treatment is warranted.
Lumbar Spinal Stenosis Associated with Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-analysis of Secondary Fusion Rates following Open vs. Minimally Invasive Decompression
Authors: Schöller Karsten , Alimi Marjan , Cong Guang-Ting , Christos Paul , Navarro-Ramirez Rodrigo , Härtl Roger 
Published: April 2016

Introduction Decompression surgery plus instrumented fusion is the gold standard in patients with lumbar spinal stenosis (LSS) associated with degenerative spondylolisthesis (DS) when conservative treatment has failed. Open laminectomy (OL) alone is an option in patients with stable low-grade DS, but progressive instability contributes to significant secondary fusion rates and compromises patient outcome. A minimally invasive unilateral laminotomy (MIL) for “over the top” decompression is a potentially less destabilizing alternative. The aim of our systematic review and meta-analysis was to analyze secondary fusion rates after open laminectomy and minimally invasive laminotomy in patients with LSS associated with DS. Material and Methods We performed a systematic literature search in the National Center for Biotechnology Information Database (Pubmed/MEDLINE) using the keywords “lumbar spondylolisthesis” and “decompression surgery.” All studies that separately reported the outcome of patients with LSS associated with DS that were treated by decompression surgery only were included. The accepted decompression techniques were 1.) open laminectomy and 2.) microsurgical transmuscular or subperiosteal unilateral laminotomy with “over the top” decompression. The primary end point was secondary fusion rate. Secondary end points were total reoperation, complications, postoperative progression of listhetic slip, and patient satisfaction. Results We identified 37 studies with a total number of 1156 patients that were published between 1983 and 2015. 19 studies reported the outcome after OL, and 18 after MIL. There were two randomized controlled trials, 8 prospective, and 24 retrospective cohort studies or case series. In two trials the study design was unclear. None of the trials compared OL to MIL. The pooled secondary fusion rates were 12.8% in the OL cohort, and 3.3% in the MIL cohort; the pooled total reoperation rates were 16.3% after OL, and 5.8% after MIL. The complication rate ranged from 0–5.4% in the OL cohort, and from 0–8.1% in the MIL cohort. Surgery-related deaths, major permanent complications, or medical complications were not reported by the studies. In the OL cohort 72% of the studies displayed a slip progression compared with 0% in the MIL cohort, respectively. After OL the pooled analysis of satisfactory outcome was 62.7% compared with 76% after MIL. Conclusion In patients with LSS associated with DS a minimally invasive laminotomy is associated with lower reoperation and fusion rates, less slip progression and greater patient satisfaction than open surgery. Better quality studies are needed to corroborate these results. These results also indicate that routine fusion may not be necessary in all patients with LSS and DS.
Short Percutaneous Posterior Instrumentation: a Reliable Option in the Treatment of Thoraco-lumbar post-traumatic Spinal Fracture
Authors: Caruso Giuseppina , Turiano Francesco , Tramacere Martino , Campello Mauro 
Published: April 2016

Introduction There are several options to treat instable thoraco-lumbar spinal fractures without spinal cord involvement. A short percutaneous posterior instrumentation [SPPI] (i.e., involving only one level up and one level below the lesioned level) is a fast choice, safer than other more invasive options at the cost of an apparent less efficacy in restoring proper alignment or in the ability to maintain good results in the long term. Aim of our present contribution is to report the incidence of worsening during time of spinal alignment features in patients treated with SPPI. Material and Methods Between September 2010 and August 2015, among 230 consecutive operations for instable post-traumatic thoraco-lumbar spinal fractures, we performed 47 SPPI and 130 other percutaneous instrumentations (4 levels or more). Fractures were defined according to the AO classification; vertebral body index [VBI], vertebral body angle [VBA] and Cobb's angle [CA] were measured before, immediately after operation (i.e., in the first two post-op days) at 1 month- and at 12 month-follow-up. All data were drawn from multi-slice high-definition CT-scans. Local ethical committee approved the study design. Results were also stratified according to the class of fracture and number of blocked levels (3, 4 or more). Results In the SPPI-cases we found preop the following mean values: VBI 0,67, VBA -16,5, CA -9,5; at 12 months follow-up (26 patients out of 35) mean values were: VBI 0,84,VBA -14,8 and CA -5,4 with changes statistically non significant between immediate post-op and 1 year follow-up. Conclusion In our hands SPPI proved to be an effective therapeutic option. No significant kyphotic worsening was observed during the first year post-op. Parallel sections of the present study and prolongement of the observational time will allow us to compare SPPI with longer posterior instrumentations in non spinal cord-lesioned thoraco-lumbar fractured patients.