bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting Factors for Patient Reported Satisfaction after Transforaminal Lumbar Interbody Fusion: A Two-Year Follow-Up
Authors: Lim Beng Teck Jason , Chen Li Tat John 
Published: April 2016

Introduction Transforaminal lumbar interbody fusion (TLIF) is an effective treatment of degenerative lumbar spine conditions, to reduce pain and improve function. Understanding predictors of post-operative patient satisfaction is important for better management of patient groups at high risk of dissatisfaction. This study aims to determine the pre-operative predictors of post-operative satisfaction in TLIF surgery. Material and Methods We retrospectively reviewed prospectively collected data on patients who underwent open TLIF for degenerative scoliosis, spondylolisthesis and spinal stenosis from the database of a tertiary hospital between 2008 and 2012 with 2 years follow-up. Clinical outcome was evaluated using Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom Score (NSS), SF-36 (mean Physical and Mental Health scores), numerical pain rating scale (NPRS) for back and leg pain and two questions from NASS Questionnaire: ((1) Has the surgery met the patient's expectations? (2) How would the patient rate the overall results of treatment?). Paired t-test was used to compare the clinical scores pre-operation and post-operatively at 6 months and 2 years. Univariate and multivariate analyses were conducted to determine significant pre-operative predictors of patient satisfaction at 2 years. Results 217 patients underwent TLIF by a single surgeon during the 5-year period. Mean pre-operative age was 61 and BMI was 25.9. 182 and 35 patients underwent primary TLIF and revision TLIF respectively. 140, 68 and 9 patients underwent single-level, two-level and three-level TLIF respectively. Significant improvement was seen in the post-operative ODI ( p < 0.001), NSS ( p < 0.001), SF-36 (mean physical score; p < 0.001 and mean mental health scores; p < 0.001) and NPRS (back pain; p < 0.001 and leg pain; p < 0.001) scores at 2 years follow-up. 86.8% of patients had their expectations of surgery met and 94.7% of patients were satisfied with the results of treatment at 2 years. Possible indicators identified by univariate analysis for post-operative patient satisfaction ( p < 0.2) were pre-operative scores (NPRS leg pain score, SF-36 Physical Function score, mean Physical Health score and ODI). From multivariate regression model, patients with higher pre-operative NPRS pain score (OR, 1.323; 95% CI, 1.071–1.633; p = 0.009) was more likely to be satisfied at 2 years. Conclusion TLIF surgery provided significant health-related quality of life scores and symptoms improvement in terms of SF-36, ODI, NSS and NPRS (both back pain and leg pain). However, patient reported satisfaction is multi-factorial and their post-operative satisfaction may be largely influenced by expectations of surgery being met and improvement of pain. This highlights the importance of managing patients' expectation pre-operatively as a means of improving post-operative patient satisfaction.
Annulo-Nucleoplasty using Disc-FX® in the Management of Lumbar Disc Pathology: Early 2 Year Results
Authors: Kumar Naresh 
Published: April 2016

Introduction Back pain due to Lumbar Disc Disease is a major clinical problem. The treatment options range from physiotherapy to fusion surgery. Several minimally invasive procedures have also been developed in the recent past for its management. Disc-FX® is a new minimally invasive technique that combines percutaneous discectomy, nuclear ablation and annular modification. Methods We studied 22 consecutive patients who underwent Disc-FX for lumbar disc pathology non-responsive to non-operative treatment for at least 6 months. Based on MRI, these patients fell into 2 groups – 11 with degenerative disc disease (DDD) and 11 with a contained lumbar disc herniation (CLDH). They were evaluated using Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Short Form-36 (SF-36) scores preand postoperatively. Results Overall rate of re-intervention for persistent symptoms was 18.18% (4/22) - all in CLDH subgroup (4/11, 36.36%). At 6 months, mean pre-op VAS improved from 6.1 (2–8) to 3.42 (0–7), ODI reduced to 28.21 (2–68.9) from 37.64 (2–71.1) and SF-36 improved from 35.57 (24.1–56.8) pre-op to 40.463 (24.1–56.8). 9 (42.85%) patients (4 with CLDH, 4 with DDD and 1 with both) said that they were not satisfied with the treatment and would not recommend it. 8 (38.09%) patients (5 with DDD, 2 with CLDH and 1 with both) who had partial to complete pain relief were satisfied and would recommend the procedure. 4 (19.04%) patients (1 with DDD and 3 with both) were not sure. 3 were advised fusion or disc replacement. The only complication of this procedure was inability to access the L5-S1 disc space in 3 patients. Conclusions Our study suggests thatDisc-FX®is a reasonable treatment option for patients with back pain due to lumbar disc disease, especially with DDD who fail conservative treatment. It could be an alternative to procedures like fusion or disc replacement. Longer term prospective studies are needed to prove its role in treatment of patients with CLDH.
Risk Factors for Adverse Events and Reintervention after Surgery for Lumbar Spine Stenosis. A 10-Year Experience of Clinical Practice in a Third Level Hospital from Bogotá, Colombia
Authors: Alvarado Fernando , Saenz Luis Carlos Morales , Munera Andres Rodriguez , Farfan Miguel Andres , Buitrago Andres Felipe Rodriguez , Victoria Daniela Tafur , Viana Luis Jesus Vásque , Rodriguez Camilo Gutierrez 
Published: April 2016

Introduction Degenerative lumbar spinal stenosis is present in patients around 50 to 60 years old. It is the most common spinal surgical indication in patients over 65 years old. The aim of this study was to determine the risk factors associated with adverse events and reintervention after surgery for degenerative lumbar spinal stenosis, based on a 10-year retrospective analysis of clinical records in a third level hospital in Bogotá, Colombia. Material and Methods An analytical prevalence study was developed through 429 clinical records of patients who underwent surgery for degenerative lumbar spinal stenosis. Results 429 clinical records were reviewed. 55% were female; the mean age was 55 years +/−16,5. The average follow up was 33,8 months. Adverse events were present in 17,2% of patients. Dural lesion was the most frequent complication (9.8%). Multivariate analysis showed a relation between complications and BMI (OR 1,8; p = 0,029), duration of symptoms (OR 1,08; p = 0,047), length of stay (OR 1,67; p = 0,023) and multi level surgery (OR: 2.99; p = 0,015). 4.7% of patients required early reintervention after surgery and 16,1% required it during follow-up. The most common late reintervention cause was re-stenosis of the same segment (7%). Adjacent segment disease was present in 6,1% of patients. Conclusion BMI, duration of symptoms, length of stay and multi level surgery were identified as risk factors for adverse events and reintervention after surgery for degenerative lumbar spinal stenosis. Mitigation of these risk factors before surgery for degenerative lumbar spinal stenosis, may decrease the proportion of complications and reinterventions in our institutions.
A CT-Based Analysis of Implant Position of Sacroiliac Joint Fusion: Is There a Learning Curve for Safe Placement?
Authors: Herseth Jonathan , Ledonio Charles , Polly David W. 
Published: April 2016

Introduction Diagnosis of degenerative sacroiliitis and surgical interventions are increasing. Open and minimally invasive sacroiliac joint (MIS SIJ) techniques exist. Optimal rod placement requires adequate training to minimize risk of breaching vital structures such as sacral anterior cortex (AC) and neural foramina (NF). CTbased image guidance navigation increases accuracy of rod placement. This study describes a retrospective singlesurgeon postoperative assessment of implant position in navigated MIS SIJ fusion procedures over a 5-year period. Materials and Methods Early (1st 3 years) versus late (past 2 years) cases were evaluated to assess learning curve of implant placement accuracy. Grading scheme was created to assess SIJ fusion rod placement and potential risk of guide pin breaching either AC and/or NF. Grade 1 denotes least risk of breach; Grade 2 denotes partial risk of breech by the implant but not the guide pin; Grade 3 denotes risk of breach of both pin and implant; Grade 4 denotes actual breach. Rod fixation grading was based on bony purchase ratio between iliac and sacral side of the joint where: Grade 1: > 50% of rod occupies sacral side; Grade 2: 50% of rod is fixed on sacral side; Grade 3: < 50% of rod is fixed on sacral side and Grade 4: rod does not cross SIJ. Results From 2010 to 2014, 110 implants in 39 SI joint fusions in 33 patients were assessed. Of these 55% were placed atS1 level, 40% were S2 and 5% were in S3. Majority of rods were placed in optimal position (Grade 1 40%68%). The position of 48 rods in 1st 3 years were compared 62 rods in past 2 years. Greater percentage of rods were classified as Grade 1 in the last two years (68%, 65%) compared with the first 3 years (56%, 33%, 25%) indicating a learning curve and improved safety profile of rod placement over time. Conclusions This study demonstrates that a learning curve exists with the use of 3D CT guidance for SI joint implant placements. This proposed grading system can be used to aid in optimal placement of SI joint implants.
Sacral Bone Mineral Density Using Opportunistic CT Scans: A Retrospective Cross sectional Analysis
Authors: Hoel Ryan , Ledonio Charles , Polly David W. 
Published: April 2016

Introduction Sacral bone mineral density may play a role in the rate successful sacroiliac and lumbosacral fusions. There are currently no easy methods for evaluation of sacral bone mineral density. Lumbar CTattenuation has previously been shown to relate to bone mineral density as assessed by DXA. This study aims to establish an accessible method for sacral bone mineral density analysis. Study Design/Setting A retrospective review of renalprotocol CT scans performed for any indication over a three-month period in 2014. CTattenuation was analyzed at several regions of interest within each scan. Materials and Methods A retrospective review of renalprotocol CT scans performed for any indication over a three-month period in 2014. A series of 223 consecutive renalprotocol CT scans were analyzed using basic image viewing software. Sacral CTattenuation at multiple regions of interest (ROI) were compared with the L1 attenuation to determine if a correlation existed. The sacral ROI were analyzed to determine regions of higher and lower attenuation. Sacral attenuation was also analyzed by age and sex. Results All sacral ROI had strong correlations with lumbar spine attenuation values, and these values became even stronger when transitional vertebrae were excluded. Sacral attenuation values varied predictably by location. Sacral attenuation was inversely related to age. No difference was found in sacral attenuation by sex. Conclusions Sacral CTattenuation can be used in opportunistic CT scans to determine sacral bone mineral density. This method can be used in the future to evaluate the impact of sacral bone mineral density on successful sacroiliac and lumbosacral fusions.
Evaluating Sagittal Balance with Lumbopelvic Parameters: A Single-Center Performance Improvement Project
Authors: Chiappini Alessio , Cunningham Michael , Mariani Luigi , Jost Gregory 
Published: April 2016

Introduction Neutral sagittal balance is key for painless upright posture and a large offset of sagittal balance may cause low back pain and correlates with impaired quality of life. Lumbar sagittal balance can easily be assessed on a standing X-ray, however, it is still a new concept to many spine specialists and radiologists. Materials and Methods A performance improvement program was developed to enable radiologists and neurosurgeons to quickly assess lumbar sagittal balance. Baseline knowledge and reporting were analyzed. Clinical tools to measure lumbar sagittal balance were taught with a 30-minute presentation. Following this, a spine surgeon helped colleagues measure their first patients. Results At baseline, 42% of 75 patients showed problems with lumbar sagittal balance but basic knowledge of sagittal balance was low: only 10% of pre- and post-treatment X-ray reports and only 1% of neurosurgical reports included information on sagittal balance. The 30-minute presentation empowered the target audience with the clinical skills to measure, interpret, and report lumbar sagittal balance on a standing X-ray. Intermittent encouragement and support from a spine surgeon helped colleagues to evaluate lumbar sagittal balance in their patients. In the first three months following the presentation, the neurosurgeons documented pelvic parameters in 48% of patients (14 of 29) and the radiologists reported the pelvic parameters on all new lumbar X-rays. Assessing and reporting sagittal balance has become a routine procedure beyond the study period and has led to more profound understanding of deformity induced pain and disability, not only by doctors, but also by patients to whom the origin of their back pain can be explained. Conclusions A short teaching presentation on a poorly known yet important clinical concept enables radiologists and spine specialists to easily measure and interpret heretofore underused information from the standing lumbar X-ray. Performance improvement programs are a valuable educational intervention for surgeons and to engage teams in interdisciplinary learning.
Spinopelvic Parameters Evaluation in a Brazilian Population Sample: A Systematic Review
Authors: Junior Charbel Jacob , Maia Thiago Cardoso , Brazolino Marcus Alexandre Novo , Cardoso Igor Machado , Junior José Lucas Batista 
Published: April 2016

Introduction The morphology of the spine is variable within a population and its maintenance in appropriate values implies a decrease in the energy expended. We need to know their normal values in population. This study aims to carry out a literature review and evaluate published papers on spinopelvic parameters in a Brazilian population sample. Methods 11 potentially eligible papers were initially identified for inclusion in this review: 3 papers from Pubmed and 8 from Medicine®. Out of these, only 5 papers contained methodology and relevant significance level, and therefore they were included in the final analytical run. Results According to a Brazilian study, Pratali mentions no significant difference in the average values of spinopelvic balance in the Brazilian population and those found in the literature; there was also no significant difference comparing Brazilian and Korean population, however, was found difference in comparison with European population regarding PI parameters and SS, but the latter with higher values. According to Kulcheski in 2013, the values of pelvic tilt in the Brazilian population evaluated in his research were 19° (10–35°) and the sacral inclination was 38° (30–55°), presenting similar values concerning the European population. In another Brazilian paper, Oliveira reports that the researched population had PI average of 45° (41.9 to 48.1°). Conclusions The values obtained are relatively minor when compared with the European population. However, all of these are within the normal margin considered in the worldwide literature.
Comparative Analysis of Evaluation of Lumbar Lordosis Measured in the Standing Positions Radiography and Magnetic Resonance Imaging
Authors: Junior Charbel Jacob , Cardoso Igor Machado , Junior José Lucas Batista , Maia Thiago Cardoso , Brazolino Marcus Alexandre Novo , Debom Tadeu Gervazoni , Roncaglio Bruno 
Published: April 2016

Introduction Research of degenerative diseases of the spine it is recommended performing radiographs and magnetic resonance imaging (MRI). Physiological curvature of the lumbar spine varies from 35 to 50. Changes sagittal alignment can lead to changes in the lumbar spine kinematics, having influence on the support and load distribution on the spine, causing low back pain. Methods 100 patients with chronic low back pain (51 men and 49 women), being evaluated degree of lumbar lordosis by three independent examiners by radiography in the standing position and MRI in supine position with flexed lower limbs. Measurement of lumbar lordosis by the Cobb method (L1 to L5 levels) in lumbar radiographs in profile and in the sagittal plane in lumbar MRI. Results Average of lumbar curvature on X-rays and the MRI cushion was 42,2° and 31,5°, respectively (p value < 0.001). Average angles of lumbar lordosis by MRI underestimates by 25% compared with lumbar radiographs. Conclusion MRI is insufficient for evaluation of lumbar lordosis, it underestimates the true lumbar lordosis. Thus, the lumbar radiological evaluation is essential in assessing the true lumbar lordosis.
Sacro-pelvic Tilt as a Predictor for Optimal Lumbar Lordosis
Authors: Mukhtar khalid , Baco Abdul Moeen , Khan Nasser , Alhammoud Abduljabbar , Arbash Mahmoud 
Published: April 2016

Introduction Spino-pelvic parameters are crucial to address the spinal sagittal balance; such measurements require standardized lateral x-ray views that include the spine as well as the hips, which are not always available upon referral of cases, where instead, shorter films for the lumbo-sacral spine are requested. We aimed to describe a pelvic radiological reference points that could provide comparatively sound sagittal balance estimates, from conventional lumbo- sacral lateral x-ray views. The iliopectineal line was addressed as a radiological reference in the pelvis, that along with the horizontal line, and the upper endplate of the first sacral vertebra, provide two angles, the Iliopectineal inclination (Doha angle; DA), and the Sacro-pelvic tilt (Baco angle; BA), respectively. Material and Method: Radiological images for 96 adult subjects, aged between 20 – 80 years, with suspected or established diagnosis for spine problem. Readings were taken from the institute's digital radiology library, blinded to personal and clinical data. Frequency tables, correlations and test of difference were tested, taking (p-value < 0.05) as cut-off for significance. Correlation to the conventional Pelvic Incidence (PI), Pelvic tilt (PT), and the Sacral slope (SS), measured for the same patients, and from the same standardized standing lateral views that include the femoral heads. Results Readings of the new angles were found to be practically easy and reproducible. The iliopectineal inclination (Doha angle) readings averaged 61 +/- 9 degrees, indirectly proportional to the pelvic tilt (r = −0.46, P-value 0.000), along with its averaged 7 degree difference from the mean Pelvic incidence (54 +/- 8.9 degrees), DA (practically the sum of SS + BA) corresponded to the described lumbar lordosis values in the literature, as well as the estimated lumbar lordosis by Schwab's formula for the study sample. On the other hand; the Sacro-pelvic tilt (BA) had readings of 24 +/- 8 degrees, and a highly significant, yet weak negative correlation with the sacral slope (P-value = 0.001, r = −0.266). Having the Sacral slope as a common component for both DA and PI; those 7 degrees difference seem to reflect an actual upper sacrum retroversion, relative to the pelvis, which had a significant difference in age terms; those with sacral retroversion >7 and <7, for average age of 31 yrs, 40 yrs, respectively (P-value = 0.000) and seem to contribute to maintaining the spinal sagittal balance, that becomes more profound by the age of 50 years (averaged 2 degrees for over 50 years, in comparison to 8 degrees for youngers). Conclusion The iliopectineal lines provide reproducible readings, closer values to the lumbar lordosis, and addresses sacroiliac contribution to the sagittal balance, that regresses by middle age.
Kyphotic Deformity Associated with Acute Tubercular Spondylodiscitis Treated by Single Stage Posterior only Surgery
Authors: Rajasekaran S. , Shetty Ajoy Prasad , Dian Arief , Das Gurudip , Kanna Rishi 
Published: April 2016

Introduction Acute tuberculous spondylodiscitis with thoracic kyphosis is conventionally treated by anterior or combined reconstruction techniques. Posterior based sagittal correction in active tubercular infection is an emerging alternative technique. Our aim was to evaluate posterior only deformity correction technique in acute tuberculosis kyphosis for safety and outcomes. Methods Sixty-seven patients with acute thoracic kyphosis due to tuberculosis were treated by all-posterior deformity correction with or without an anterior cage. Peri-operative complications, neurological improvement, pain scores, kyphosis correction, final deformity at last follow up and fusion were studied pre-operatively, immediately after surgery and at last follow up. Results The mean age was 47.6 ±12.2 years. Indications for surgery were persistent pain ( n = 12), neurological deficit ( n = 27) and kyphosis ( n = 28). The mean follow-up was 36.4 ± 12.1 months. The mean VAS improved from 7.2 ±1.2 to 1.6 ±0.9. The mean kyphotic angle improved from 26.4 ±4.6° to 12.4 ±2.4°. There was loss of correction by 2.7° and the final kyphosis was 15.2 ± 1.8°. Neurology improved in all patients by at least one ASIA grade. The mean vertebral body loss was 0.8 ± 0.4 (where 1=one vertebral body). Thirty seven patients with vertebral loss > 0.5 or pre-operative kyphosis > 30 degress had transpedicular/transformaninal reconstruction of anterior column with a cage while the remaining thirty had posterior shortening only. Bony fusion was obtained in all patients. There were no implant failures. Post-operative complications included dural tear ( n = 2), temporary neural deficit ( n = 2), wound infection ( n = 4), girdle paresthesia ( n = 3), lumbar hernia ( n = 2), disease recurrence ( n = 1). Conclusion All-posterior single stage kyphosis correction and global reconstruction in acute tuberculous kyphosis is a safe technique with good functional and radiological outcomes. The use of titanium cages and pedicle screws in the infected vertebral body milieu was observed to be safe.