bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior Transpedicular Approach for Circumferential Decompression and Anterior Reconstruction Using Trabecular Metal Mesh Cage in Patients with Metastatic Spinal Tumor
Authors: Yang Shih-Chieh 
Published: April 2016

Introduction The goal of surgical management for metastatic spinal tumors is to remove the tumor mass, restore the spinal stability and alignment, and provided better quality of life. Posterior transpedicular approach for circumferential decompression and reconstruction was proposed in concern of the morbidity related to anterior approach. We used this unique technique with trabecular metal (TM) mesh cage for anterior reconstruction to treat the patients with metastatic spinal tumor. Our purpose is to evaluate the feasibility and efficacy of this method as an alternative procedure for managing metastatic spinal tumors. Methods From January 2009 to December 2012, we performed single stage circumferential debridement and reconstruction with TM mesh cage through single posterior approach to treat 20 patients with metastatic spinal tumors. The visual analog score (VAS), neurologic status, vertebral body reconstruction, operation time, blood loss, and complications were recorded. The patient's conditions were evaluated on the basis of modified Brodsky's criteria which categorized them as excellent, good, fair, or poor. Results The average VAS score was 8.2 (range, 7 to 9) before surgery, which was significant decreased to 3.2 (range, 2 to 4) after surgery ( p < 0.001). The average cobb's angle correction was 12 degree (range, 3 to 29). The neurologic status which classified by Frankel's scale was significant improved after surgery ( p < 0.001). No one experienced severe complication such as deep infection or neurologic deterioration. Three patients experienced long-term paresthesia around nerve roots territory. Eighteen patients could achieve good or excellent outcome based on modified Brodsky's criteria and the improvement showed significant difference after surgery ( p < 0.001). The blood loss and operative time in the last 10 cases was significantly decreased while comparing to the initial 10 cases ( p = 0.007 for blood loss and p = 0.005 for operative time). No significant difference in clinical outcome which classified by Macnab criteria between the initial and last 10 patients ( p = 0.654). Conclusions In our case series, good functional outcome and low complication rate could be achieved by single-stage posterior transpedicular approach. It could be an alternative method to manage the patients with metastatic spinal tumors.
Management of Spinal Degenerative Stenosis in Patients with Spinal Tumors
Authors: Smekalenkov Oleg , Ptashnikov Dmitry , Zaborovskii Nikita , Mikhaylov Dmitry , Masevnin Sergei 
Published: April 2016

Introduction The evolution of conservative treatment, such as radiation therapy, chemotherapy has prolonged significantly life expectancy of patients with spinal tumors. Paradoxically, the complexity of decision making for this patient population increased due to chronic disease management. The purpose of our research is evaluation of health-related quality of life (HRQOL) parameters in patients with spinal tumors and degenerative spinal stenosis. Material and Methods Retrospective data were collected for 17 patients with spinal tumors (multiple myeloma ( n = 7), metastasis of breast cancer ( n = 5), renal cell carcinoma ( n = 4), bladder cancer ( n = 1)). Inclusion criteria were the following: spinal tumor lesions with 0–6 scores in Spinal Instability Neoplastic Score (SINS), degenerative spinal stenosis with neurological deficit (Frankel grade C-D), unsuccessful nonoperative treatment of degenerative disease (VAS 7–9). According to revised Tokuhashi scoring system, patients were divided into two groups. The first group included 11 patients with 0–8 scores (good prognosis). The second group consisted of 6 patients with 9–11 scores (moderate prognosis). All patients underwent degenerative stenosis surgery using foraminotomy and instrumentalization. Groups were evaluated with HRQOL-scales including VAS, ODI and Frankel. HRQOL-parameters and complications were analyzed and compared between two groups. The comparisons were done by using independent sample Student t-test. A p-value of less than 0.05 was accepted as significant. Results HRQOL-scores (VAS, ODI, Frankel) of the patients were increased after operation in both groups. The HRQOL-scores after 18 months are slightly higher in the first group, but we did not get significant difference between groups (p > 0.05). The number of complications in the form of implant instability, proximal and distal junctional disorders was comparable (p > 0.05). No patients had progression of oncology disease or new metastasis of tumor during follow-up in the first group. In the second group tumor came out of remission in 1 case (new visceral and bone metastasis). Conclusion Management of spinal degenerative stenosis in patients with spinal tumors provides to increase quality of life. We believe that degenerative stenosis surgery does not affect on progression of oncology disease.
Defining Normative Quality Metrics in Complex High-Risk Deformity Cases: Results from the Scoli-Risk 1 Study
Authors: Berven Sigurd , Saigal Rajiv , Lafage Virginie , Kelly Michael , Kopjar Branko , Smith Justin , Dahl Benny , Cheung Kenneth M. C. , Carreon Leah Y. , Schwab Frank , Espinoza-Rebmann Kathrin , Shaffrey Christopher , Fehlings Michael , Lenke Lawrence , Ames Christopher 
Published: April 2016

Introduction Quality metrics are a component of the value calculation, and reflect the risk of care. There is significant variability in complication rates, and quality metric standards in spinal surgery. Case complexity or surgical invasiveness is an important predictor of perioperative complications, and normative standards for quality metrics should be stratified by case complexity. The purpose of this study is to define normative quality metrics for complex, high-risk spinal deformity cases, and to provide a standard and baseline data that may guide quality improvement in comparative research. Material and Methods Secondary analysis of a prospective, international multicenter observational study (Scoli-Risk1) The study cohort included adults with spinal deformity in the cervicothoracic or thoracolumbar regions. Quality metrics include cumulative readmission and reoperation rates (30, 90, 180 days), wound infection, and DVT rates. Chi Square analysis is used to measure the relationship between osteotomy type and readmission and reoperation. Linear regression is used to determine the association of age and procedure with readmission and reoperation. Results 273 patients from the Scoli-Risk 1 study were included in the analysis. Cumulative readmission rates were 7.7 (4.8;11.5), 13.2 (9.4;17.8), 16.5 (12.3;21.4) percent at 30, 90 and 180 days after index surgery. Reoperation rates were 14.7 (10.7;19.4), 17.6 (13.3;22.6), 20.1 (15.6;25.4) percent at 30, 90 and 180 days after index surgery. Age was a significant predictor of readmission during the first 180 days after surgery (OR1.388 (1.068;1.803)), but not a significant predictor of the need for reoperation (OR=1.109 (0.903;1.361)). Osteotomy type (PSO/VCR vs SPO) was not a significant predictor of the need for readmission ( p = 0.986) or reoperation ( p = 0.753). The overall infection rate was 7.0%, including 3.3% deep infections. The rate of DVT was 3.7%. Conclusion Normative quality metrics are not established for complex deformity surgery in adult patients. This paper demonstrates that readmissions and reoperations in complex spinal reconstruction in adults occur at a higher rate than expected rates in less complex spine procedures. Age is an important independent predictor of readmission, but not the need for reoperation. For each decade older, patients are 1.4 times more likely to be readmitted within 6 months of surgery. This data may be useful to provide normative data for comparative studies of surgical outcomes with similar magnitude of deformity treated with operations of comparable invasiveness.
Correlation between Lumbopelvic and Sagittal Parameters and Health Related Quality of Life in Adults with Lumbosacral Spondylolisthesis
Authors: Gussous Yazeed , Theologis Alekos , Demb Joshua , Berven Sigurd 
Published: April 2016

Introduction The impact of sagittal plane imbalance has been demonstrated for adult deformity and pediatric spondylolisthesis. The association between lumbopelvic parameters, global sagittal balance, and health status has not been well-defined in adults with lumbosacral spondylolisthesis. The role for deformity reduction in lumbosacral spondylolisthesis in the adult has not been well-defined. The purpose of this study is to evaluate the impact of sagittal alignment and lumbosacral parameters on health status in adults with L5-S1 spondylolisthesis. Methods Secondary analysis of data from a multicenter, prospective study. Health status measures included SF-12 and SRS-30. Radiographic predictor variables included: C7 sagittal vertical axis deviation (SVA), T1 and T9 spinopelvic inclinations, pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), slip angle, Meyerding slip grade, and Labele classification. Pearson's correlations were calculated between each radiographic parameter and health status measure. Results Forty-five patients were included (male 15, female 30; average age 40.5 ± 18.7) as summarized in Table 1 . For low-grade slips, SVA had strong negative correlations with SF12-MCS, SRS-30 appearance, mental, and satisfaction domains (−0.57, −0.60, −0.58, −0.53, respectively; p < 0.05). PI had strong negative correlations with SRS-30 total, mental, and subscore domains (−0.57, −0.53, −0.57, respectively; p≤0.05). SS also had a strong negative correlation with SF12-MCS (−0.61; p = 0.02), while thoracic kyphosis had a strong positive correlation with SRS-activity (0.62; p = 0.02). For high-grade slips, slip angle had a moderate negative correlation with SF12-MCS (−0.36; p = 0.05). SVA had strong negative correlations with SF12-PCS, SRS-30 appearance, activity domains (−0.48, −0.48, 0.45; p < 0.05) and a moderate negative correlation with SRS-30 subscore (−0.37; p < 0.05). T1PI had a moderate negative correlation with SF12-PCS and SRS-22 appearance (−0.37, −0.36; p≤0.05). Conclusion Lumbosacral spondylolisthesis in adults negatively impacts mental and physical HRQoL. While HRQoL are similar between patients with low- and high-grade slips, multiple global and local radiographic sagittal parameters negatively impact HRQoLs for both groups. Improvement of global sagittal balance and lumbopelvic parameters in adults with lumbosacral spondylolisthesis may be useful in improving health status in adults. [Table: see text]
Maximal Access Surgery for Posterior Lumbar Interbody Fusion (PLIF) with Divergent, Cortical Bone Trajectory (CBT) Pedicle-screws
Authors: Pecoraro Michele Federico , Marengo Nicola , Vercelli Giovanni , Zenga Francesco , Garbossa Diego , Ducati Alessandro 
Published: April 2016

Introduction First advocated by Santoni et al. in 2009, the cortical bone trajectory (CBT) pedicle screw technique is an alternative to the traditional, convergent technique that shows comparable biomechanical features and potentially requires less aggressive tissue retraction. Aim of this therapeutical note is to describe this new technique focusing on main advantages and limitations. Material and Methods The authors provide a detailed description of the surgically relevant anatomy focusing on the positioning of the cortical trajectory screws. The surgical technique is then described in a precise step-by-step manner, stressing complication avoidance. Results and Conclusion: The maximal access surgery PLIF approach is a safe, reproducible procedure allowing for a traditional lumbar spine approach with the benefits of minimal facet joint manipulation and potentially preserving part of their neural innervation and a large part of the paraspinous musculature. A dedicated self-retaining retractor and directional neuromonitoring may guide surgeons during the procedure. Nevertheless, the surgeon's knowledge of anatomical landmarks, response to visual and tactile cues and intraoperative decision-making skills remain of paramount importance.
Outcome of Posterior Stabilisations for Metastatic Spinal Lesions
Authors: Julian Harriet , Thomson Stacey , Verzin Eugene , Darwish Nagy , McLorinan Greg , Hamilton Alistair , Eames Niall 
Published: April 2016

Introduction The objective of this study was to determine whether posterior only stabilization of metastatic spinal lesions provides adequate stability over the life span of the recipient patient. There are no gold standards for surgical stabilization of metastatic spinal lesions however National Institute of Clinical Excellence guidelines (UK) state that anterior reconstruction should be considered in patients with metastatic spinal cord compression who are likely to survive a year. Standard practice in our regional unit has been to stabilize metastatic spinal lesions through a posterior only approach. Our rationale is that posterior stabilization provides sufficient stability while avoiding the additional risks, time, and cost of anterior stabilization. Materials and Method Retrospective review of all cases of posterior only spinal stabilization performed for metastatic disease over a 5 year period. Patient demographics, pathology and metal work construct including number of levels stabilized was recorded. All post-operative imaging was reviewed. Failures and revisions were recorded. Clinical notes were reviewed for surviving patients. Results Of the 94 cases 49 were male, average age at time of surgery was 62. 77 (81.9%). Of the patients who were deceased by the study end date mean time from surgery to death was 504 (15 to 1865) days. 72 (93.5%) of constructs remained stable until death. 5 patients required further surgery. 3 had broken rods requiring revision and 2 required anterior decompression and stabilization for disease progression. None of the 17 alive patients required further surgery and all remained neurologically intact. Conclusion This case series revealed very low rates of posterior construct failure or need for further surgery for disease progression. This indicates that posterior only stabilization is a safe and effective surgical management option for metastatic spinal lesions.
Characteristics of Patients who Survived Less than Three Months or Greater than Two Years after Surgery for Spinal Metastases: Can We Avoid Inappropriate Patient Selection?
Authors: Verlaan Jorrit-Jan , Choi D. , Oner F. C. 
Published: April 2016

Introduction The survival of patients with metastatic cancer has improved at the cost of increased presentation with metastatic spinal disease. For patients with (impending) pathological spinal fractures and/or spinal cord compression, surgical intervention may relieve pain and improve mobility and quality of life. It is generally accepted that surgery is inappropriate if anticipated survival is less than three months, and survival greater than two years is uncommon. The aim of this international multicenter prospective cohort study was to analyze data from surgical patients who died within three months, or after two years from surgery, to identify any preoperative factors which might be associated particularly with poor survival, to avoid inappropriate selection of patients for surgery in the future. Patients and Methods A total of 1266 patients were treated surgically for (impending) pathological fractures and/or neurological deficits and were prospectively followed. Data collected included tumor characteristics, preoperative fitness (ASA), neurological status (ASIA), performance status (KPS), and quality of life (EQ-5D). Primary outcomes were survival at three months and two years postsurgery. Univariate and multivariate logistic regression analysis were used to find preoperative factors associated with short- and long term survival. Results In univariate analysis age, emergency surgery, KPS, EQ-5D, ASA, ASIA, and Tokuhashi/Tomita scores were all significantly associated with short survival. In multivariate analysis, however, only KPS was significantly associated with short survival (OR 1.40; CI 1.18–1.67). Associated with longer survival in univariate analysis were age, number of spinal levels included in the surgery, KPS, EQ-5D, ASIA, and Tokuhashi/Tomita scores. In multivariate analysis, only the number of affected spinal levels included in the surgery was significantly associated with longer survival (OR 1.21; CI 1.03–1.41). Conclusion Poor performance status at presentation is the strongest indicator of poor survival (less than 3 months), whereas a low disease load with fewer involved spinal levels is strongly associated with longer term survival.
Percutaneous Decompression and Fixation on Complex Spinal Metastases
Authors: Silva Alvaro , Illanes Juan Cristobal 
Published: April 2016

Materials and Methods Retrospectively analyzed the postoperative results of a series of 6 patients with vertebral metastases, with complicated mechanical pain and neurological involvement using a decompression technique and percutaneous fixation. Discuss the results with the literature. Results Total of 6 cases, 3 men and 3 women. Average age: 67.8 years (66–85), all with known primary tumor: 2 lungs tumor, 2 breast tumor, 1 prostate tumor and 1 renal tumor. Neurological compromise: L5 radicular pain paresis and one progressive thoracic myelopathy. SINS: 8,9,10,12,13,13. Tomita: 3,5,5,6,10,10. Surgical technique: posterolateral decompression, tube 5 Kapener decompression tube type 1, all percutaneous pedicle fixation. Complications: 1 patient L5 lumbar epidural hematoma resolved with surgical evacuation. Five of six went to early radiotherapy Evolution: In all of them neurological recovery and relief of mechanical and radicular pain. Conclusions Conventional treatment of patients with neurologic involvement secondary to vertebral metastasis is surgical decompression and open setting, this depending on the vital prognosis and patient status as mayor surgeries. The high rate of complications and fixing decompression percutaneous seem to offer an effective alternative in the management of the complication with minimal complications.
Multicolumn Spinal Cord Stimulation for Significant Low Back Pain in Failed Back Surgery Syndrome: A National, Multicentre, Randomized, Controlled Health Economics Study (Estimet)
Authors: Roulaud Manuel , Monlezun Olivier , Lorgeoux Bertille , Rigoard Philippe , Estimet Group 
Published: April 2016

Introduction Many studies have demonstrated the efficacy of spinal cord stimulation (SCS) for chronic neuropathic radicular pain over recent decades. But despite global favorable outcomes in Failed Back Surgery Syndrome (FBSS) with leg pain, the back pain component remains poorly controlled by neurostimulation. Technological and scientific progress has led to the development of new SCS leads, comprising a multicolumn design and a greater number of contacts. Their efficacy of multicolumn SCS lead configurations for the treatment of the back pain component of FBSS has recently been suggested by pilot studies. However, a randomized controlled trial must be conducted to confirm the efficacy of new generation multicolumn SCS. ESTIMET is a multicentre, randomized study designed to compare the clinical efficacy and health economics aspects of mono vs multicolumn SCS lead programming in FBSS patients with radicular pain and significant back pain. Material and Methods FBSS patients with a radicular pain VAS score ≥ 50mm, associated with a significant back pain component were recruited in 14 centers in France and implanted with multicolumn SCS. Before the lead implantation procedure, they were 1:1 randomized to monocolumn SCS (group 1) or multicolumn SCS (group 2). Programming was performed using only one column for group 1 and full use of the 3 columns for group 2. Outcome assessment was performed at baseline (pre-implantation), and 1, 3, 6 and 12 months post-implantation. The primary outcome measure was a reduction of the severity of low back pain (bVAS reduction ≥ 50%) at the 6-month visit. Additional outcome measures were changes in global pain, leg pain, paraesthesia coverage mapping, functional capacities, quality of life, neuropsychological aspects, patient satisfaction and healthcare resource consumption. Results Trial recruitment started in May 2012 and closed in October 2013. The 14 study centers have been initiated. The last visit last subject was performed in January 2015. This study received funding in 2012 from the French government NHS program “PSTIC 2011” (Program de Soutien aux Techniques Innovantes et Coûteuses). Each patient provided informed consent and approval was requested and obtained from the Poitiers University Hospital Ethics Committee (CPP Ouest III), the French National Agency for Medicines and Health Products Safety (ANSM) and the French Data Protection Authority (CNIL, No. 70108724P). Conclusion Preliminary results are expected to be analyze for the end of 2015 and published at the start of 2016.
Thoracic Volume Modeling in Virtual Sagittal Curve Progression
Authors: Ledonio Charles , Lee Po-Chih , Polly David W. , Jones Kristen E. , Erdman Arthur 
Published: April 2016

Introduction Scheuermann's kyphosis is a primary sagittal plane deformity that manifests in adolescence. The wedged vertebrae cause increased thoracic kyphosis and a foreshortened thoracic length. The effect on the thoracic volume has been less well studied. With the ability to accurately model thoracic volumes, we are now capable of virtually modeling the effect of increasing kyphosis on thoracic volume. Virtual modeling may allow us to determine the point of diminishing returns in deformity correction when trying to improve pulmonary status. We hypothesize the computed thoracic volume measured from a 3D virtual model decreases with progression of kyphosis from 50 to 100 degrees. Methods Blender software was used to create a threedimensional thorax model with normal coronal and sagittal balance. Virtual wedging of vertebral bodies was performed for the model to be progressively deformed by 10 degrees from 50100 degrees of kyphosis. Thoracic volume was calculated via shrinkwrap modifier applied to an uvsphere within the thoracic cavity. Results Virtual wedging of vertebral bodies was necessary to achieve virtual progression of sagittal curve. As kyphotic angle increased, more vertebral segments had to be wedged (>5 degrees). Thoracic volume in the virtual adult thorax with a 50degree kyphosis was 1679cc. This volume decreased in a linear fashion by a mean of 5.4% for every 10 degrees more of kyphosis. The final volume was 1218cc at 100 degrees of kyphosis, which was a 27% decrease in volume from baseline. Conclusion As the deformity progresses from 50 to 100 degrees there is a 27% decrease in the thoracic volume. The decrease appears linear. While there is not a direct relationship between thoracic volume and pulmonary functions, adequate thoracic volume is necessary for adequate pulmonary function. This study helps to establish the relative magnitude of volume decrease based upon the sagittal Cobb angle.