bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relation between Spinal Instability and Response to Palliative Radiotherapy for Symptomatic Spinal Metastases
Authors: Versteeg Anne , van der Velden Joanne , Verkooijen Helena , Fisher Charles , Oner F. C. , van Vulpen Marco , Weir Lorna , Verlaan Jorrit-Jan 
Published: April 2016

Background and Purpose Up to 70% of cancer patients with terminal illness have bone metastases, with the spinal column being most affected. The standard local treatment for painful spinal metastases is conventional external beam radiotherapy. However, ~30–40% of the patients do not achieve adequate pain relief. It is not well understood why some patients respond and others do not. Considering the limited life expectancy of these patients it is crucial to optimize treatment selection to ensure fast, effective and lasting symptom relief. We hypothesized that pain resulting from mechanical instability of the vertebra responds less well to radiotherapy than pain originating from local tumor effects. The aim of this study was to investigate the relationship between spinal instability, defined by the Spinal Instability Neoplastic Score (SINS), and the response to palliative radiotherapy for symptomatic spinal metastases. Material and Methods A prospective international multicenter observational study of patients who underwent irradiation of symptomatic spinal metastases was performed between January 2013 and December 2014. Patients were excluded if they were diagnosed with multiple myeloma, if they had previous surgery on the same level or if they had substantial neurological deficits (ASIA ≤C). The SINS was calculated by an observer blinded to outcome using the radiotherapy planning computed tomography scans. Pain response was rated using the International Bone Metastases Consensus Working Party Endpoints. The association between SINS and response was estimated by multivariate logistic regression analysis. Results A total of 155 patients were included, 91 male and 64 female (mean age 66 ± 11 years). Thirteen patients (8%) died within four weeks following treatment, 18 (12%) patients were lost to follow-up. Neither median nor mean SINS was significantly different for patients with or without response. In multivariate analysis, the SINS was not significantly associated with response (adjusted odds ratio 0.94; 95% confidence interval 0.81–1.10; p = 0.449). The WHO performance score, however, was related to radiotherapy response. Conclusion No significant relationship was observed between degree of mechanical spinal instability, as reflected by the SINS, and response to radiotherapy. Trying to explain our findings, it can be argued that some components of SINS reflect current mechanical instability while other components are indicative of impending instability. Future studies should aim to optimize the definition of instability to better predict treatment outcome.
Surgical Treatment of a C3-osteoblastoma with Cord Compression and Encompassing the Vertebral Artery via Combined Approach
Authors: Samadian Mohammad , Hallajnejad Mohammad , Nejad Ali Mousavi , Zadeh Kaveh Ebrahim , Rezaei Omidvar 
Published: April 2016

Background Osteoblastoma is a rare and benign osteoid-producing primary bone tumor that affects mainly the long bones. 36% of these tumors are observed around the spine and the vast majority arises around the posterior. Case Presentation: This report describes a case of C3 osteoblastoma occurring in a 22-years old male. He represented with cervical pain and quadriparesia. Cervical CT and MRI demonstrated an osteolytic mass that invade anterior and posterior elemant of C3 and cause severe cord compression. Because of the close proximity of the osteoblastoma to the vertebral artery canal and cord total resection of tumor was a challenging decision. To prevention of vertebral artery injury, laminectomy and partial resection of tumor was done with posterior approach and bilateral vertebral arteries preserved and then fussed with lateral mass screw. For best reconstruction and stability, total C3 corpectomy and anterior fusion with allograft and plate was done via anterior cervical approach. Conclusions Osteoblastoma in cervical spine with involvement of anterior and posterior part of vertebrae is a rare pathology and can encase vertebral artery. This case has favorable prognosis after 2 sessions surgery and adequate rehabilitation.
Polymer-based Silver Nanoparticle Coated Pedicle Screws Inhibits Biofilm Formation-a Novel Experimental Model in Rabbits
Authors: Hazer Derya Burcu , Sakar Mustafa , Dere Yelda , Altinkanat Gulsen , Ziyal Mustafa Ibrahim , Hazer Baki 
Published: April 2016

Introduction Infection in spinal implant is of great concern. Anti-infection strategies must be tested in relevant animal models that will lead to appropriate clinical studies. A novel spine implant model was designed to study the antimicrobial effect of a modified Titanium (Ti) pedicle screws with methiciline resistant Staphyloccoccus Aerous (MRSA) in multiple surgical sites in the lumbar spine of a rabbit. Material and Methods Twenty two New Zealand White rabbits were divided into two groups: group 1: infected unmodified Ti screw group ( n = 10), group 2: infected polyethylene glycol grafted polypropylene based Silver nanoparticle (PP-g-PEG-Ag) covered Ti screw group ( n = 10), and two rabbits as control-sterile group. In all groups left L4- right L6 vertebra levels were exposed and screws were drilled to transverse processes after contamination of burr holes with 0.1 ml of 106 CFU MRSA solutions in group 1 and 2. After 21 days, samples were collected and infection was analyzed via light and scanning electron microscopy and culturing. Silver nanoparticles (Ag-NP) on the screws and tissues were assayed pre and postoperatively. Results The bacterial colony count for modified-Ti screw group was lower compared with unmodified Ti screw (17,2 vs 200 × 103 CFU/mL, p = 0,029) with less biofilm formation. There was no difference in duration of surgery among groups and within the surgical sites. Ag-NPs were detected on the screw surface postoperatively. Conclusion This novel experimental design of implantation in rabbits is easy to apply and resembles human stabilization technique. Modified Ti screws were shown to have antimicrobial effect with especially inhibiting the biofilm formation. This anchored Ag NPs which remained after 21st day of implantation shows that it is resistant to tapping forces of the screw.
An In-vitro Study on the Effects of Spinal Canal Curvature on Cord Interstitial Pressure during Spinal Cord Distraction
Authors: Jarzem Peter , Bassi Mahdi , Mansi Mohammed 
Published: April 2016

Study Design This is an in-vitro study examining the effect of spinal canal curvature on spinal Cord Interstitial Pressure (CIP) during porcine spinal cord distraction. In this study we examined CIP developed in spinal cords during distraction in three conditions: 1) linear cord distraction (stretch) 2) simulated 45 degree scoliotic curve and 3) simulated 90 degree scoliotic curve. Summary of Background Data Spinal cord distraction is a known cause of spinal cord injury (SCI). Several papers published on the pathophysiology of the cord distraction injury suggest that the underlying mechanism of injury is a micro-vascular ischemic event4. We have previously described an increase in CIP with spinal cord distraction,12,18 and have shown that spinal cord distraction can lead to spinal cord injury in live animal experiments13. Distraction spinal cord injury is known in scoliosis correction but rare in other spine injuries. With this experiment we wish to determine if simulated spinal curvature may potentiate the spinal cord distraction elevation in CIP noted during our experiments. Objectives To determine if increasing degrees of spinal curvature lead to increasing CIP during in-vitro spinal cord distraction. Methods Ten freshly thawed porcine spinal cords were tested in a saline bath in linear, 45° degree and 90° degree curved surfaces while CIP was monitored using the modified Whitesides technique27. Multiple linear regressions were then performed. Results We noted a close correlation between applied tension (T) and CIP. The greatest pressure elevations were noted for the 90° curve mode, intermediate elevations were noted for the 45° curve modes and the smallest pressure elevations were noted for the linear mode of distraction ( p <  = 0.05). Conclusion High CIP can be achieved through spinal cord distraction. This CIP is not only directly proportional to tension, but also proportionally increased by the degree of spinal curvature. This may suggest that spinal curvature may tend to increase generated CIP during distraction, and be a potentiating factor for spinal cord injury during scoliosis correction.
Effect of Treatment Complications on the Outcomes in Adult Spinal Deformity: A Decision Analysis Approach
Authors: Acaroglu Emre , Güler Ümit Özgür , Yavuz Aysun Çetinyürek , Yavus Yasemin , Ayhan Selim , Sabat Montse Domingo , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Alanay Ahmet , Obeid Ibrahim , Kleinstuck Frank 
Published: April 2016

Introduction Treatment of adult spinal deformity (ASD) is known to be associated with a fairly high rate of complications whereas the impact of these complications on treatment outcomes is less well known. Aim of this study is to analyze the impact of treatment complications on outcomes in ASD using a decision analysis (DA) model. Material and Methods From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical –NS), 164 surgical –S), constitute the population of this study. DA was structured in two main steps of: 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference –utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Complications were analyzed as life threatening (LT) and non-life threatening (NLT) and their probabilities were calculated from the database as well as a thorough literature review. Outcomes were analyzed as improvement (decrease in ODI > 8pts), no change and deterioration (increase in ODI > 8pts). Death/complete paralysis was considered as a separate category. Results All 535 patients (371 NS, 164 S) could be analyzed in regard to complications. Overall, there were 78 NLT and 12 LT complications and 3 death/paralysis. Surgical treatment was significantly more prone to complications (31.7% versus 11.1%, p < 0.001) (Table 1 a). On the other hand, presence of complications did not necessarily decrease the chances of improvement, surgical patients tending to rate better in this respect (Table 1b). Likewise, QALE was not particularly affected by the presence or absence of complications regardless of the type of treatment (Table 1c). Conclusion This study has demonstrated that surgical treatment of ASD is more likely to cause complications compared with non-surgical treatment. On the other hand, presence of complications neither has a negative impact on the likelihood of clinical improvement nor affects the QALE at the first year detrimentally.
Multilevel XLIFs, TLIFs and Grade 2 Posterior Osteotomies for Surgical Correction of Compensated Sagittal Imbalance: Outcomes in 25 Consecutive Adult Degenerative Deformities at Minumum 2 Years Follow-up
Authors: Ramieri Alessandro , Costanzo Giuseppe 
Published: April 2016

Introduction Sagittal imbalance in the adult degenerative spine requires surgical correction to improve pain, mobility and quality of life. Aim of our surgery is to obtain a harmonic, balanced sagittal profile operating a series of adult degenerative kyphoscoliosis by means of XLIFs, TLIFs, SPOs and posterior pedicle screws. Actually, XLIF seems to be the less invasive alternative to PSO to restore LL and achieve anterior fusion, while Grade 2 posterior osteotomies can be useful to further decrease kyphosis. Material and Methods We treated by XLIFs, SPOs and pedicle instrumentations 25 thoraco-lumbar and lumbar degenerative deformities, characterized by a sagittal compensated imbalance (SVA < 50mm), with or without coronal deformity, and distinguished according to the SRS-Schwab classification. All patients were submitted to X-ray screening during pre, post-operative and follow-up periods. Results Mean age was 64 (50–74; M/F 1: 4). Sixteen deformities were type L and 9 type N. Loss of LL was moderate (+) in 14 cases and marked (++) in 11. We performed 50 XLIFs, 15 TLIFs, 48 SPOs. Complication rate was minimal. PT, LL, SVA and TK improved ( p < 0.05), post-operative values were similar to those pre-operatively calculated in 90% of cases and clinical follow-up (mean 29.5; range 24–36), scored using VAS and ODI, was satisfactory in all cases, except for two due to sacro-iliac pain. Conclusion Current follow-up does not allow definitive conclusions. However, the surgical approach proposed seems to be a viable choice usable in these compensated adult deformities, avoiding risks and complications of aggressive PSOs.
Sagittal Plane Correction Using Lateral Transpsoas Approach: Effect of Cage Angulation and Surgical Technique on Segmental Lordosis
Authors: Yoon S. Tim , Melikian Rojeh , Kim Jin Young , Park Kun Young , Yoon Caroline , Hutton William 
Published: April 2016

Introduction Lordotic cage insertion through lateral transpsoas approach is being used increasingly for restoration of sagittal alignment. However, the degree of correction achieved by varying cage angle as well as ALL release and posterior element resection is not well defined. The objective of this study is to determine the degree of segmental correction which could be achieved through lateral transpsoas approach by varying cage angle as well as adding anterior longitudinal ligament (ALL) release and posterior element resection. Material and Methods Thirteen human cadaveric lumbar motion segments between L1 and L5 were dissected into single motion segments. Segmental angles and disk heights were measured under both 50N and 500N loads under the following conditions: Intact specimen, discectomy (collapsed disk simulation), insertion of parallel cage, 10° cage, 30° cage with ALL release, 30° cage with ALL release and spinous process (SP) resection, 30° cage with ALL release, SP resection, facetectomy and compression with pedicle screws. Results Segmental lordosis was not increased by with either parallel or 10° cages as compared with intact disks, and contributed small amounts of lordosis when compared with the collapsed disk condition. Placement of 30° cages with ALL release increased segmental lordosis by 10.5°. Adding SP resection increased lordosis to 12.39°. Facetectomy and compression with pedicle screws further increased gains in lordosis to 26.4° in the 50N group and 25.8° in the 500N group. Neither group experienced a decrease in either anterior or posterior disk height. Conclusion Insertion of parallel or 10° cage has little effect on lordosis. 30° cage insertion and ALL release resulted in an increase of lordosis by ~10.5°. The addition of SP resection and facetectomy allowed increases in correction of up to 26.4°. No interventions resulted in decrease in either anterior or posterior disk height suggesting gains were achieved without causing foraminal stenosis.
Vertebroplasty and Kyphoplasty for Metastatic Spinal Lesions: A Systematic Review
Authors: Sadeghi Mohsen , Janani Leila , Aarabi Shahram , Shokraneh Farhad , Rahimi-Movaghar Vafa 
Published: April 2016

Introduction The spine is the most common site of bone metastases, with 33–70% of cancer patients acquiring spinal metastasis during the course of their disease. Vertebroplasty (VP) and Kyphoplasty (KP) have been proposed as potential minimally invasive therapeutic options for metastatic spinal lesion (MSL) pain. However, the efficacy of VP and KP on MSL pain is currently unclear. The Objective of the present review was to assess the effects of VP and KP on pain, disability and quality of life following MSL. Material and Methods We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) assessing VP or KP for the treatment of pain following MSL without cord compression. We searched MEDLINE, EMBASE and CENTRAL with no limitation in terms of study status (ongoing or completed), publication date, type or language. Results The literature search revealed 387 citations. Of these, nine trials met all eligibility criteria and included in the qualitative analysis. In total, there were 622 patients enrolled in the trials and of these 432 were in surgical treatment group (92 received KP, 97 received VP, 134 received VP and chemotherapy, 68 received VP and radiotherapy and 41 received KIVA implant) and 190 were in non-surgical treatment group (83 received chemotherapy, 46 received radiotherapy and 61 received other treatment). Using the grade approach, there is low quality of evidence that VP plus chemotherapy improve MSL pain and functional score more than chemotherapy alone (Pain: mean difference (MD): -3.01; 95%CI: -3.21 to -2.80; functional score: MD: 15.46; 95%CI: 13.58 to 17.34) Conclusion Pain and functional score improved more in VP plus chemotherapy group than in the chemotherapy group. Based on the analysis of published trial data, it is not known whether VP for MSL provides benefits over KP.
Posterior Spinal Osteotomies for Sagittal Imbalance
Authors: El-Sharkawi Mohammad , Tammam Hamdy , El-Sherif Essam , Adam Faysal , Refae Hesham 
Published: April 2016

Introduction Surgical treatment of spinal deformity offers superior clinical and radiographic outcomes than non operative approaches. This prospective study aimed at assessment of outcomes of posterior only spinal osteotomies in treatment of sagittal imbalance. Patients and Methods Thirty cases of symptomatic sagittal imbalance were managed with posterior spinal osteotomy in Assiut University Hospitals. Half of them were males, age ranged from 5–57 years (20 ± 12.9). Eleven cases were congenital (36.7%) and five cases were Scheuermann kyphosis (16.7%), with other causes (46.7%) including degenerative, junctional, ankylosing spondylitis, post tuberculous, neuromuscular and Idiopathic types. Curves were angular in 14 cases (46.7%) and smooth in sixteen (53.3%). Ten cases (33%) were thoracic, eight (27%) were thoracolumbar, six (20%) were lumbar and six cases were diffuse. VAS, ODI, SRS-22, neurology, and radiological parameters (SVA, TK, LL T1SPA, PI, PT and SS using Surgimap 2.0.8.4664) were compared pre, post and at last follow up visit. Operative time, bleeding amount, and correction achieved were compared. The mean follow up was 21 months (12–60 months). Results Seventy five osteotomies (59 Ponte Osteotomies “PO” in 19 cases, Six Pedicle Subtraction Osteotomies “PSO” in 4 cases and ten Posterior Vertebral Column Resections “PVCR” in10 cases) had been done. Thirty nine osteotomies (52%) were thoracic, 17 thoraco-lumbar and 19 were lumbar. The VAS, ODI and total SRS-22 were improved ( p = 0.001) with no difference between the three osteotomy types. The local kyphosis improved from 61° to 10.57° ( p = 0.001) with 82.7% final correction and no difference between PVCR and PO ( p = 0.017). TK improved from 43.86° to 30.47 ° ( p = 0.020). The mean SVA improved from 54.68 mm preoperatively to 33.48 mm postoperatively and was 35.16 mm at final follow up ( p = 0.023). The amount of blood loss and the mean operative time was less with PO than PSO and VCR ( p = 0.001 and p = 0.039). Two cases developed deep infection and were successfully managed with debridement and antibiotics. Four cases developed asymptomatic proximal junctional kyphosis. Two cases with postoperative neurological complications were encountered. One of them recovered spontaneously during the follow up. The other one had proximal junctional failure and atraumatic subluxation of the upper dorsal spine. Urgent reduction and proximal extension of the fixation and fusion was done. Complete neurological recovery was observed during the follow up. Conclusion Posterior only spinal osteotomies appear to be highly effective in correcting sagittal imbalance and may avoid the morbidity of anterior or combined approaches.
Incidence of Cancer and Infertility, in Patients Treated for Adolescent Idiopathic Scoliosis 25 Years Prior
Authors: Simony Ane , Carreon Leah Y. , Christensen Steen Bach , Andersen Mikkel Ø. 
Published: April 2016

Introduction Adolescent females with idiopathic scoliosis are exposed to substantial amounts of radiation during treatment and follow-up for AIS. The purpose of this study was to determine the amount radiation exposure patients received during treatment for AIS and report the incidence of infertility and cancer in adulthood. Material and Method: 219 consecutive AIS patients treated at Rigshospitalet, Copenhagen between 1983 and 1990 were identified and requested to return for clinical and radiographic examination. The incidence of cancer was determined through chart review and follow-up interviews. In addition, the subjects and age-matched controls were queried regarding infertility, age at first pregnancy and spontaneous abortions. Using X -ray reports that included patient position, mAs and kV used and the number of X-rays taken, a radiation physicist calculated the total radiation dose during treatment and follow-up adjusted for BMI and sex. Results 159 (78%) patients participated in the follow up study, and medical charts were available in 209 patients. 2 patients had passed away, one due to cardiac arrest and one to breast cancer. 8 patients had emigrated. Radiation information was available in 211 patients. The mean calculated mean total radiation exposure was 1.58 mSv (0,44–6,9). An average of 16.3 (range, 8–34) X-rays were taken during treatment. The rate of infertility (10%) and spontaneous abortion (23%) is similar to the normal controls. The AIS patients had an average of 1.4 children, which is 1 child less than the 2.5 children in the control cohort. Nine (4.3%) AIS patients developed cancer, mostly breast (3) and endometrial (4). Risk Ratio for cancer = 20.93 (95% CI:2.67–164.19) p = 0.000132. The patients with endometrial cancers have a low BMI 16.4 (15.9–16.6) at first radiation exposure, and the patients with breast cancers were older with BMI 20.4 (18.0–22.4). The incidence of cancer in this cohort is 17 times greater than the incidence of 0.25% in an age-sex matched cohort from the Danish Cancer Society Annual Report. Conclusion The infertility and spontaneous abortion rate was similar between AIS patients and an age matched cohort. The cancer rate in the AIS patients is 17 times higher than expected compared with the age-matched Danish population. [Table: see text][Table: see text]