bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Minimally Invasive Spine Surgery for Thoraco-Lumbar Fractures in Patients with Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Authors: El-Maghraby Hussien , Nagaraja Sanjoy , Bletechi Radu 
Published: April 2016

Introduction Unstable spine fractures commonly occur in the setting of a poly-traumatized patients. The aim of management is to balance the need for early stabilization with quick patient's mobilization and reduction of additional trauma due to the major open surgery. Material and Methods To assess the operative data, clinical and radiological outcomes of patients undergoing minimally invasive management of Thoraco-lumbar fracture. Design Retrospective review of prospectively collected data. Methods 101 patients underwent minimally invasive percutaneous fixation of Thoraco-lumbar fractures percutaneous fixation with or without vertebroplasty. All patients were post-operatively either neurologically intact or improved. There were 60 males and 41 females with an average age of 44 years. Results The mean follow-up was 18 months (3–44 months). The mean operative time was 100 minutes (range 35–240 minutes) and the mean blood loss was < 100mL. VAS was significantly improved from 8.7 to 1 at last follow-up. No patient worsened his or her neurological condition postoperatively. Conclusion Minimally invasive percutaneous fixation of Thoraco-lumbar fractures in poly-traumatized patients appears to be a safe and effective technique to manage Thoraco-lumbar fractures without neurological impairment and allowing early rehabilitation.
Clinical Outcomes among Patients with Chronic Low Back Pain Treated with Pregabalin Monotherapy in Fort Portal Regional Referral Hospital in Western Uganda: Case Series Report
Authors: Pariyo Godfrey 
Published: April 2016

Introduction Chronic low back pain associated with rediculopathy is a common reason for physician visits but no guidelines are available for management of these patients in Uganda. A placebo controlled trial on efficacy of Pregabaline among patients with lumbosacral radiculopathy in Germany was inconclusive on the benefit of Pregabaline1 in reducing pain. In another study in USA using Pregabaline showed inferior effect of Pregabaline monotherapy to combination with Celecoxib on resolution of symptoms.2 We evaluated clinical response to Pregabaline monotherapy on low back pain associated with radiculopathy at the Orthopedics clinic of Fort Portal Regional Referral Hospital in Western Uganda. Methods In this prospective study conducted from February to July 2015, 15 patients with chronic low back pain associated with rediculopathy exceeding 3 months were seen in the orthopaedic outpatient clinic at Fort Portal Regional Referral and all were treated with a 4 week course of oral Pregabaline (75mg taken once a day) and evaluated for clinical improvement. Visual Analogue Score (VAS) for pain was used to assess the degree of pain among patients after 4 weeks of treatment. Structured questionnaires were used to capture sociodemographic and clinical data. Results Of the 15 patients 10 were females and 5 were males, with age range of 28 -75 years and mean age 53 years. Three patients were unable to walk before treatment due to pain. Before treatment with Pregabaline all the patients had Visual Analogue score of 8–10. After 4 weeks of treatment with oral Pregabaline 13 patients showed significant improvement with reduction in the Visual Analogue score to 0–2 while 2 patients had modest reduction in Visual Analogue score of 6–8. Conclusion Oral Pregabaline has good effect on the treatment of patients with low back pain associated with rediculopathy. However further research is needed with sufficient sample, randomization and longer follow up. References Baron R, Freynhagen R, Cloutier C, et al. The efficacy and safety of pregabaline in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain 2010;150(3):420–427 Romanò CL, Romanò D, Bonora C, Mineo G. Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain. J Orthop Traumatol 2009;10(4):185–191
Radiation Exposure in Single Level Lumbar Fusion: Our Experience in Robotic Guidance Compared to Literature Review of Minimally Invasive Fusions
Authors: Sudarshan Pramod , Panda Aditya , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan 
Published: April 2016

Introduction Lonizing radiation used in fluoroscopy leads to significant radiation exposure to the surgeon, operating room staff, and the patient. Low dose exposure can cause skin burns, nausea, and cataracts where as in sufficient doses increase the lifetime risk of cancer among spine surgeons and patients. Moreover, accumulating low dose exposure over a lifetime may lead to heritable changes at a genetic level. Minimally invasive lumbar fusion, though becoming increasingly popular has significant exposure to radiation. Robotic guidance is the latest tool in spinal fusions and this study focuses on radiation exposure in single level lumbar fusions performed at our institution as compared with literature data. Material and Methods Seventy patients who underwent robotic guided lumbar fusion (Renaissance, Mazor robotics) performed by a single surgeon were analyzed retrospectively for radiation exposure. The age of patients ranged from 38 to 80 (mean, 56 years). Robotic guidance data included execution rate, accuracy of guidance, total surgical time, and time required for robotic guidance. Radiation-related data included the average preoperative computed tomographic effective dose, radiation dosage for calibration, registration, placement of Kirschner wires, and total procedure radiation time. Results Average operative time was 134.7 minutes (82–150). Mean robotic guidance took 16 minutes. Average operative radiation time was 6.2 seconds (5.2–8.6). The screw execution rate was 99%, with an accuracy of 99.5%. Mean radiation exposure dosage to the operating room was 3.7 mgy (3.1–5.2mgy) in robotic guided patients. This exposure is relatively 20 times lesser when compared with published data on radiation exposure in minimally invasive lumbar fusions. Conclusion Radiation exposure to the surgeon and the operating room staff in our series of single level lumbar fusion using robotic guidance was significantly lower than other published results on fluoroscopy guidance and navigated fusion. Robotic guidance reduces the radiation exposure maintaining a high accuracy rate, thereby promising as a safer alternative.
Accuracy of Robotic Guidances in Transpedicular Spinal Screw Placement: A Series of 93 Patients for the First Time in Vietnam
Authors: Le Bao Tien Nguyen , Van Thach Nguyen , Dinh Hoa Nguyen 
Published: April 2016

Introduction The Renaissance Robotic System is a technology used to guide screw placement through thoracic and lumbar spinal pedicle with high accuracy. This research introduces evaluation of the first series of 93 patients used this system in Vietnam for further evaluating the accuracy of the robotic guidance system for spinal surgery. Material and Methods Patients underwent spinal surgery using pedicle screws placement are main subjects of this research. Total 93 patients were divided into 2 groups (MIS group and classic procedure group). Among each group, the first 10 cases were studied and compared with the remaining cases. The accuracy of 1003 pedicle screws inserted in 93 patients was measured via postoperative CT scans system. The result based on the position of screw was evaluated in 3 aspects: axial, lateral and A-P. Results 93 patients under this research include 6 patients of trauma case, 29 patients of scoliosis case, 58 patients of spondylolisthesis case. Measurements derived from postoperative CT scans demonstrated the fact that 98.3% of the screws fell within the safe zone (Group A and B), where 90.3% were completely within the pedicle (Gertbein and Robbins classification). The MIS procedure was performed on 33 patients. Among these 33 patients, there appeared a significantly different accuracy between the first ten patients to the remaining of each group (accuracy change from 80% of Group A to 95.7% of Group B, p = 0.05). Among patients group underwent the classic procedure, the accuracy between the first ten patients to the remaining of the group also showed significant difference (accuracy changed from 96.5% of Group A to 99.3% of Group B, p = 0.05). 7/1003 pedicle screws were reinserted by free hand technique. On axial aspect, 915 (91.2%) screws were totally inserted inside one half of vertebrae and did not pass the middle line. On lateral view, 883 pedicle screws (88%) were inserted at medial position of vertebrae. No neurological deficit was recorded. Average time spent for each screw is 4 minutes. Conclusion The Robotic Guidance enhances performance in spinal surgery by increasing the accuracy for pedicle screws placement and reducing neurologic risks. In addition, 33 cases used a percutaneous approach reported herein remark great contributions of Robotic Guidance in procedures without anatomic landmarks.
The Apifix Automatic Self-Correction Technique for Adolescent Idiopathic Scoliosis at 1 ½ Years Follow-Up: A Preliminary Report
Authors: Sekouris Nick , Pilihou Anastasia , Sovatzoglou Apostolos , Soultanis Konstantinos , Karavidas Nick , Flouda Lito , Vlahos Eugenios 
Published: April 2016

Introduction To present a new system for the treatment of adolescent idiopathic scoliosis and the first outcomes. Material-Methods: The new system (Apifix) is an automatic self-correction system, which is fixed by two transpendicular screws on the convex side of the apex of the curve. This system has been used in 4 adolescents with progressive scoliosis of 32°-42°. No blood transfusion was needed. The surgical time was ~1 hour, and the hospital stay was one day. After three weeks, a special program of physiotherapy was started to expand further the system. The Cobb angle, the parameters of sagittal balance and the vertebra rotation (using Nash-Moe technique), has been evaluated during a follow-up of 1 ½ years. Results The Cobb angle average improved from 37° to 18,2°. Immediately postoperatively a scoliosis improvement of 13,7° (range: 17°-12°) was noted, and after the physiotherapy other 5° (range: 1°-8°) of improvement was achieved. The sagittal balance parameters remained unchanged. A spontaneous vertebra derotation average from 39,1% to 28,6% was noted using Nash-Moe evaluation. Conclusions The first outcomes of the use of this system are encouraging but further research in more patients, and in longer follow-up is needed. This system offers an option between conservative treatment and spinal posterior fusion to be used as an internal brace.
The Impact of Obesity on the Orthopedic Spinal Surgical Operative Time and Hospital Stay at King Khalid University Hospital
Authors: Awwad Waleed , Binown Khalid , Alkadhaib Abdulrahman , Modahi Nawaf 
Published: April 2016

Introduction There is a conflict in the literature regarding the impact of obesity on the duration of surgical operation and the length of hospital stay. Some studies revealed that obesity has no impact on the duration of surgical operation and the length of hospital stay1 and other studies showed the opposite.2 Due to this conflict, we conducted this study to determine whether the obesity has a major role on operation time and hospital stay. Material and Method: The study design is quantitative, observational, and retrospective cohort study on 129 patients who underwent orthopedic spinal surgical operations in King Khalid University Hospital during the years 2013 to 2015. After the exclusion, we reviewed the charts of 106 patients to obtain the duration of the surgical operation, length of hospital stay, the amount of blood loss and the development of postoperative complications. Also, we reviewed the patients’ X-ray and MRI images to measure the space from lamina to skin silhouette and the space from spinous process to skin silhouette. Results 52.4% of the patients who were included in our study were obese. The results revealed that obese patients had a larger space from the lamina to skin silhouette and a larger space from spinous process to skin silhouette on both X-ray and MRI images. There was no statistically significant difference between obese and non-obese patients regarding time of surgery, blood loss and length of hospital stay. There is no statistically significant difference between obese and non-obese patients regarding the development of postoperative complications, in particular DVT, surgical site infection, surgical revision. Conclusion The BMI of the patients who underwent spinal orthopedic surgical operations in King Khalid University Hospital from 2013 to 2015 did not impact the time of surgery, blood loss and length of hospital stay. References Turki AS, Dakhil YA, Turki AA, Ferwana MS. Total knee arthroplasty: effect of obesity and other patients' characteristics on operative duration and outcome. Available at: http://www.wjgnet.com/2218-5836/full/v6/i2/284.htm . Accessed June 6, 2015 McClendon J Jr, Smith TR, Thompson SE, et al. The impact of body mass index on hospital stay and complications after spinal fusion. Neurosurgery 2014;74(1):42–50
Iliac-Cava Complication after L4–L5 Discectomy
Authors: la Villa Juan Fernández , Fernández David Fernández , Asensio Marco Antonio Nogales , Curiel Angel Vega , Pineda Jesús María Herrero 
Published: April 2016

Introduction Lumbar discectomy is one of the most often performed surgical technique at spinal level. The appearance of post discectomy complications is uncommon, being even rarer the vascular ones. Materials and Methods In this paper we present the case of a woman who underwent L4-L5 discectomy, left L5 foraminotomy and interspinous UniWallis implant at this level through posterior longitudinal approach. Four weeks after surgery, the patient presented symptoms of right heart failure and systolic-diastolic murmur on aortic area with abdominal and lumbar clear dominance. The CT scan revealed the presence of a right iliac-cava fistula that was treated by endovascular surgery with success. Results Postdiscectomy vascular complications are very uncommon (from 0.04 to 0.14%). However, they are potentially fatal for patients. For this reason they should be suspected, identified and treated as soon as possible. In this case, the potential cause could had been a damage at baseline wall of the right iliac artery. This could produce a pseudoaneurysm that progressed overtime and eroded the wall of the vein cava adjacent leading to a right iliac-cava fistula formation due to the blood flow pressure. This justifies the start of the characteristic symptoms. However, one of the peculiarities and particularities of this case is that the clinic started 4 weeks after surgery, not having found in the literature publications with these characteristics until this moment. Even though, it has been described the formation of an aneurysm at 5 -6 weeks after trauma in Vascular Surgery. Moreover, postdiscectomy vascular complications have been reported more frequently in the L4-L5 space, being more frequent lesion in the right iliac artery. In this case, the disc level and laterality agree with the most frequent complication, although approaching has been done by left side. On the other hand, the anterior approaching has the highest rates of vascular complication in spine surgery, but in our case the approaching has been done by left posterior incision. Conclusions Postdiscectomy lumbar vascular complications represent a vital risk to the patient. For this reason they must be taken into account for prompt diagnosis and treatment. These complications can be asymptomatic during hospitalization and postoperative and be revealed several weeks later. Posterior approaches in lumbar spine surgery are not exempt from vascular complications, since they frequently occur by anterior approach. This case highlights the importance of taking into account these vascular complications despite the posterior approach as well as after initial satisfactory postoperative course.
The Value of CT and MRI in the Evaluation and Management of Patients with Thoracolumbar Spinal Injuries
Authors: Rajasekaran S. , Vaccaro Alexander R. , Mugesh Rishi , Schroeder Gregory D. , Oner F. C. , Vialle Luiz R. , Chapman Jens R. , Dvorak Marcel F. , Fehlings Michael , Shetty Ajoy Prasad , Schnake Klaus J. , Maheswaran Anupama , Kandziora Frank 
Published: April 2016

Introduction Although imaging has a major role in evaluation and management of thoracolumbar spinal trauma, the exact role of CT and MRI in addition to radiographs for fracture classification and management is unclear. We conducted an online survey base study to evaluate the added value of computed tomography (CT) and magnetic resonance imaging (MRI) in classification, evaluation of stability and management of thoracolumbar injuries. Methods Spine surgeons ( n = 41) from around the world classified 30 thoracolumbar fractures. The cases were presented in a three step approach: first plain radiographs, followed by CT and MRI images. Surgeons were asked to classify according to the AO Spine Classification System, evaluate fracture stability and choose management. Results Surgeons correctly classified 43.4% of fractures with plain radiographs alone; after additionally evaluating CT and MRI images, this percentage increased by further 18.2% and 2.2% respectively. Instability was diagnosed in 68.5% cases with plain radiographs and this percentage increased to 79.3% after CT ( p < .0001) but did not increase significantly after MRI. AO Type A fractures were identified in 51.7% of fractures with radiographs while the number of type B fractures increased after CT and MRI. The number of type C fractures diagnosed was constant across the three steps. Agreement between radiographs and CT was fair for A-type (k=0.31), poor for B-type (k=0.19), but it was excellent between CT and MRI (k > 0.87). CT and MRI had similar sensitivity in identifying fracture sub types except that MRI had a higher sensitivity (56.5%) for B2 fractures ( p < 0.001). Conclusion For accurate classification, radiographs alone were insufficient except for C type injuries. CT is mandatory for accurately classifying thoracolumbar fractures. Though MRI did confer a modest gain in sensitivity in B2 injuries, the study does not support the need for routine MRI in patients without spinal cord injury for classification, assessing instability or need for surgery.
Craniovertebral Junction Meningiomas: Analysis of Clinical and Radiological Results
Authors: Raco Antonino , Pesce Alessandro , Toccaceli Giada , Frati Alessandro , Dugoni Demo Eugenio , Delfini Roberto 
Published: April 2016

Introduction Craniovertebral junction (CVJ) meningiomas are lesions of complex surgical management for the delicate anatomical structures involved and for their tendency to encase/dislocate vital structures such as the vertebrobasilar system and the lower cranial nerves. Matherials and Methods: We analized sex, age, clinical presentation, topography, surgical approach, Simpson Grade Resection, Lower Cranial Nerves postoperative deficit and radiological, histology and clinical follow up at 1, 12 and 24 months of 61 patients affected by CVJ meningiomas, operated on in the Neurosurgical Divisions of the University of Rome “Sapienza” from 1997 to 2013. Results 78.7% of patients were women (mean age 52.85 years); the onset symptom was pain in 65.5% of cases. The mean preoperative Nurick grade of the sample was 3,78; The most frequent histological type was endotheliomatous (42.8%). Twenty-two patients (5 with lateral and 17 posterolateral axial topography) were treated with posterior median approach; in 39 cases (30 anterolateral and 9 anterior) we performed a posterolateral approach. A Gross Total Removal was achieved in 85.2% of cases. We reported an average neurological improvement in this series (average preoperative Nurick 3.81 and at 12 months 2.13). In 29 patients there was a transient deficit of IX, X and XI cranial nerves. No statistically significant association between surgical approach and temporary or permanent postoperative complications has been found. Conclusions In conclusion posterior and posterolateral with/without condilectomy and transposition of VA approaches represents the gold standard for the surgical removal of these tumors and are safe and effective in terms of postoperative morbidity.
Outcome of Kyphoplasty in Vertebral Compression Fractures for Multiple Myeloma
Authors: Debnath Ujjwal K. , Goel Vivek 
Published: April 2016

Introduction The principle symptoms in multiple myeloma result from bone destruction, especially the spine. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps (IBT) into the vertebral body. The purpose of the IBT is to restore the vertebral body back toward its original height, while creating a cavity that can be filled with highly viscous bone cement. The aim was to evaluate clinical and radiological outcome of kyphoplasty in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. Material and Methods 10 (Ten) patients underwent consecutive kyphoplasty procedures in 13 vertebrae for osteolytic vertebral compression fractures resulting from multiple myeloma. Cement leakage and any complications were recorded. Early objective analysis was made by comparing preoperative and latest VAS and ODI scores. Height restoration was estimated by measuring vertebral height on lateral radiographs. Results The mean age of patients was 62years, mean duration of symptoms was 8 months, and mean follow-up was 7.4 (range 6–12) months. There were no major complications related directly to use of this technique. On average, 40% of height lost at the time of fracture was restored. Asymptomatic cement leakage occurred at one level in one patient. Significant improvement in VAS and ODI scores were observed. Conclusion Kyphoplasty was efficacious in the treatment of osteolytic vertebral compression fractures resulting from multiple myeloma. Kyphoplasty is associated with early clinical improvement of pain and function as well as some restoration of vertebral body height.
Cellular uptake and anticancer activity of carboxylated gallium corroles
Authors: Pribisko Melanie , Palmer Joshua , Grubbs Robert H. , Gray Harry B. , Termini John , Lim Punnajit 
Published: April 2016

Significance
Corroles are macrocyclic molecules related to porphyrins that exhibit intense light absorptions in the visible region. They also are very bright emitters, with luminescence quantum yields over 50% in some cases. Importantly, we have discovered that two corroles functionalized with carboxylate groups at different ring locations exhibit anticancer activity superior to cisplatin. Although the synthetic route to direct carboxylation of the tetrapyrrolic framework requires the use of phosgene, installing aminocaproate on the fluorophenyl ring by nucleophilic aromatic substitution uses mild conditions with biocompatible reagents, requiring only simple purification and providing ready access to structurally complex corroles. Carboxylated corroles are very rapidly taken up by cells, with an order of magnitude gain in dark cytotoxicity likely owing to greater cell permeability.