bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Rib Construct (RC) has Provided Secure Proximal Fixation for Management of Patients with EOS and Severe Thoracic Hyperkyphosis
Authors: Ahmad Alaaeldin 
Published: April 2016

Introduction Thoracic hyperkyphosis, described as greater than 20 degrees of kyphosis from T1–5, and/or 40 degrees from T5–12, or greater than 50 degrees of maximum total kyphosis, has been associated with poor outcomes when treating EOS. For such patients, decision making between spine based and rib based proximal fixation has been graded as being among the areas of greatest clinical uncertainty at present for surgeons treating EOS. We address this uncertainty by reporting our results of rib based fixation in patients with EOS and thoracic hyperkyphosis. We chose a minimum of 70 degrees of kyphosis between T5–12 for inclusion, rather than 50, to focus further on the management of severe hyperkyphosis. Material and Methods Ongoing data collection of surgical management of 13 children with EOS and greater than 20 degrees of kyphosis between T1–5 and/or 70 degrees between T5–12, and at least 24 months of followup was compiled. The (RC) was used for proximal fixation in all cases. Results 5 syndromic,5 congenital/structural, 1 idiopathic. 9 had prior spine surgery. Average age at initial surgery 84 months; followup averaged 47 months (24–77). 5 had T1–5 kyphosis, average 29 degrees, postop 26. 9 had T5–12 kyphosis, average 96 degrees, postop 56. Average preop thoracic scoliosis 68 postop 44; preop lumbar scoliosis 39, postop 38. Average preop spine length 22.9 cm, postop 29.2. Average preop coronal balance 11.3 cm, postop 13.1. Average preop sagittal balance 39, postop 27. Complications included 3 proximal hook dislodgments, 5 distal anchors, 1 delayed deep wound infection with removal and subsequent replacement of instrumentation, 3 rod failures, 1 PJK. As a group, there were 63 subsequent planned procedures, and 18 unplanned. Conclusion The RC provides reliable proximal fixation for EOS patients with severe thoracic hyperkyphosis, especially for those with hyperkyphosis from T5–12.
Radical Debridement and Spinal Reconstruction using Titanium Mesh Cages (TMC's) in Pediatrics Patients with Pott's Disease and Vertebral Osteomyelitis
Authors: Mushkin Alexander , Naumov Denis 
Published: April 2016

Introduction TB spondylitis and vertebral osteomyelitis frequently occur in the patients of early ages. The tendency to the multilevel damage with total or subtotal lesions of several vertebral bodies leads to the spine collapse and early kyphosis. Radical debridement and autogenous strut-graft fusion have become the “gold standard” for surgery. The introduction of the TMC in adult's spinal surgery has opened up a variety of applications that are realizable as a result of the versatility of the implant. But the use of TMC in pediatrics spinal surgery is controversial, and results have not been published to date. Patients and Methods Study design: cohort analysis. 74 children aged from 7 months till 17 years underwent spinal reconstruction: 5 (10%) in the cervical spine, 32 (46%) in the thoracic spine and 37 (44%) in the lumbar spine. Clinical series include 18 early age patients under 3 years old. Group 1 (n1 = 25) – tuberculous (TB) spondylitis; group 2 (n2 = 49) – chronic nonspecific spondylitis (CNS) and its consequences, including 16 patients with spondylodiscitis. Disease duration in all patients was at least 4 months prior ineffective antimicrobial therapy. The indications for surgery were destruction with vertebral deformity progression, neurological disorders and ineffective chemotherapy with continuing abscesses. All patients had debridement with anterior column reconstruction, posterior instrumentation and fusion by TMC's with bone auto-grafts. The rate of the fusion was assessed by CT at 6 and 12 months after surgery according to the new rating scale graded from 1 (incorrect implant position) to grade 5 (solid fusion with a structural bone block). Results The number of stabilized spinal segments ranged from 2 to 5. Etiology of spondylitis was identified due to bacteriological, molecular genetics and morphological studies of the operational material. No operative complications and no implant-related complications were recorded in the postoperative period. The fusion rate corresponded to grade 3 in 91,1% ( n = 68) at 6 mns post-op and as grade 4 in 93,2% ( n = 69) at the 12 mns post-op. Till the final follow-up (M 36 - mns, min 12 - mns, max – 4 years) a mean segmental loss of correction was 3,7 (0 ÷ 7) degrees. Destabilization of TMC's was detected after surgery only in two cases due to the late infection's reactivation. Conclusion The anterior interbody fusion by TMC's with bone auto-grafts in pediatric spine reconstruction provides reliable spinal stability in both the short-term and long-term period and does not increase the risk of infectious complications in cases of infectious spondylitis' surgery. TMC produce the early anterior fusion and provide the possibility to earlier removing of posterior instrumentation before the disk degeneration inside the instrumented zone in growing spine.
Functional Outcome after Anterior Decompression and Stabilization using Locally Made Stand-alone Titanium Cage with Bone Graft in Caries Spine: An Experience of 600+ Cases at Ghurki Hospital
Authors: Khan Ahsan Akhtar , Aziz Amer 
Published: April 2016

Introduction Tuberculosis is the leading cause of death in third world countries, from a single infectious disease. It paralyses the society when it affects the spine due to its residual neurological deficit in the form of Quadriplegia, paraplegia, loss of bladder and bowel control, bedsores, as well as from continuous financial burden it exerts on the affected family and whole society. Early spinal decompression and stabilization with a locally made stand alone cage have dramatic results in terms of improvement in neurology, relief of pain and correction of deformity as well as improvement in the patient's quality of life. Methods The objective of the study is to determine the outcome after Anterior Decompression and Stabilization with locally made stand alone Cage & Bone Graft in caries spine in terms of improvement of neurology, relief of pain, improvement of Kyphotic angle as well as quality of life improvement. It is a prospective case series study including 600 cases, which were treated at GTTH from 2005–15. After pre-operative assessment of pain, neurology, measurement of angle of deformity, and QOL analysis using the SF-36®, all patients were treated with Ant. Decompression and then stabilization was achieved using morcellized bone graft with a locally made stand alone cage. After surgery patients were followed at 06 weeks, 03 months, 06 months & 01 year to assess neurology, relief of pain and Kyphotic angle and their SF-36® scores. Results Neurology improved in 88% of patients, pain was relieved in 92% of cases and there was mean correction of 18° in Kyphotic angle at the end of 01 year follow up with a significant improvement in the patient's quality of life. Conclusion Early diagnosis and early intervention gives excellent results in Tuberculosis of the spine. After anterior decompression, stabilization with cage and bone graft results in significant improvement of neurology, relief of pain and correction of Kyphotic deformity, as well as the patient's quality of life. There is no need for added instrumentation.
Surgical Treatment of Burst Fractures of the Dorsolumbar Spine by Short Segment Posterior Instrumentation. To Fuse or Not to Fuse?
Authors: Koptan Wael , El-Sharkawi Mohammad , ElMiligui Yasser 
Published: April 2016

Introduction The concept of ‘Ligamentotaxis’ using short segment posterior instrumentation and fusion is widely accepted for managing unstable burst fractures of the dorsolumbar spine. The aim of this work is to study the possibility of performing this procedure without fusion. Materials and Methods This is prospective randomized study included 54 patients with burst fractures of the dorsolumbar spine treated with short segment posterior instrumentation without fusion (Group 1); compared with a similar group of 47 patients that were treated by the same technique with posterolateral fusion using iliac crest autograft. Patients were followed up for an average of 5y. Results In Group 1, all patients with neurological impairment improved 1 to 2 Frankel grades; the VAS improved from an average of 7.8 to 1.3 and the overall complications were 4/54. The kyphotic deformity was corrected from an average of 22.6 degrees to an average of 3.1 degrees; the average anterior height of the fractured vertebrae was corrected from an average of 65% to an average of 92% and the compromise of the spinal canal improved from an average of 42% to 14%. Implant failure occurred in 2 patients. There was no significant difference in these parameters between Groups 1 and 2. In Group 2 there was significantly more operative time, blood loss, hospital stay and 10/47 complications including 2 implant failures. Conclusion Short segment posterior instrumentation without fusion is a safe efficient procedure with significantly less operative time, blood loss, hospital stay and complications than when fusion was performed.
Direct Spondylolysis Repair in Young Adults
Authors: Negm Mohammad 
Published: April 2016

Introduction Spondylolysis is a common problem affecting all ages but in adolescent and young adult specially the athletes it represent a significant dilemma as most of them starting their life and need a stable free spine, a minority of old people affected by this disease need medical care, and only a few require surgery but in athletes and young adult surgery usually the role. Reconstruction of the pars interarticularis is an alternative to segmental fusion; this technique has the advantage of preserving segmental motion. Most authors report good results for young patients without intervertebral disc or facet affection Material and Methods In this study the fixation of the isthmus was done with a pedicle screw hook system. This stable and strong device is easy to use, allows an anatomic pars interarticularis reconstruction and avoids a postoperative bracing and allow early ambulation. 9 patients were assessed in this study, the mean age at operation was 24 (range 16–32 years) and the average follow-up was for 24 months (range 6–36 months). 7 patients showed no preoperative degenerative disc disease and 2 patients had grade 1 changes. The visual analogical scale, the Oswestry disability index (ODI were used for assessment of pain and clinical outcome before and after surgery. Results The results were from “excellent” to “good” for 8 patients and “fair” for one of them. The fusion rate was observed in all cases. Among patients results are from “good,” to “excellent” in all cases and consolidation was always observed. All of them showed normal disc height after the surgery. Conclusion Direct spondylolsis repair by pedicle screw hook system is an excellent and reliable method in management of spondylolysis especially in intact disc in young adults
Long Segment Posterior Instrumentation with Interbody Fusion using Locally Harvested Bone Graft for Fracture Dislocations of Thoraco Lumbar Spine: An Outcome Study of 60 Cases
Authors: Farooque Kamran 
Published: April 2016

Material and Methods Sixty (60) cases of Fracture Dislocations of thoraco lumbar spine were treated at JPN Apex level one Trauma Center, A.I.I.M.S., New Delhi, from Jan. 2008 to April 2014. All the cases were treated by long segment pedicle screw constructs, two levels above and below the dislocation level, from a posterior approach. A combined posterior and postero lateral decompression from posterior approach was done in 56 cases. In 3 cases, only posterior decompression by complete laminectomy was done. In one case only, additional anterior decompression from anterior approach was done along with posterior approach. Partial corpectemy and interbody fusion using Harms type mesh cage was done in 20 cases. Complete Discectomy at the dislocation level and Interbody Fusion, using locally harvested bone graft(Spinous process and Lamina) from the posterior decompression was done in 32 cases. A partial corpectemy and interbody fusion using the TLIF banana type cages was done in 4 cases. In Situ postero lateral fusion was done in 3 cases. In one case, additional anterior surgery along with posterior surgery was done to achieve anterior reconstruction with expandable cage. Results Follow up of cases ranged from one year to six years. There was no case of implant failure or loss of fixation, in any of the 60 cases. Fusion was achieved in all cases, as evidenced by direct and indirect markers. All patients achieved at least a sitting balance. 20 patients were ambulating on wheel chair, while 40 patients achieved independent mobilization, with or without the help of calipers and braces. Neurologic recovery of one ASIA grade was seen in 15 patients, and two ASIA grades was seen in 20 patients. There was no neurologic recovery seen in 25 patients. There was deep seated infection, in two cases, which resolved with debridement and antibiotics. Sacral bed sores developed in six cases, which were treated by local flaps. Conclusion Long segment posterior fixation, two levels above and below the injury from a posterior only approach is sufficient and adequate treatment for fracture dislocation injuries of thoraco lumbar spine. Interbody Fusion using locally harvested bone graft is a novel technique to enhance the fusion rate and minimize instrumentation failures.
Posterior Spinal Fixation with Fusion versus without Fusion in Treatment of Dorsolumbar and Lumbar Fractures
Authors: Elkhateeb Tameem , Mahmoud Abdelrady 
Published: April 2016

Introduction Operative treatment in the form of posterior fixation with or without fusion has moved to the forefront of fracture management as it helps decreasing morbidity and mortality with better return to work and satisfactory functions. The aim of the study is to compare the results of posterior spinal fixation with fusion versus without fusion in cases of dorsolumbar and lumbar fractures both clinically and radiologically. Material and Methods A randomized clinical trial conducted on 60 patients in Ain Shams University Hospitals in two groups: Group (A): posterior spinal fixation with fusion (30 patients); Group (B): posterior spinal fixation without fusion (30 patients). All patients have dorsolumbar and/or lumbar spine fractures and are candidates for posterior spinal fixation. Inclusion criteria: Age group (<45 years). Both sexes. Neurologically intact patients with kyphotic angle more than 20° or decreased vertebral body height more than 50% or a canal compromise more than 50%. Single or multilevel spinal injury. Exclusion criteria: Any patient who will need anterior fusion according to load sharing classification (≥7). Incomplete or complete neurological deficit. Advanced spondylosis. Fracture of pars interarticularis. Fracture of facet joints. Preoperative evaluation includes history, examination, and radiological evaluation. All patients were done under general anesthesia in prone position. A standard midline posterior approach was used to expose the desired levels for fixation. Posterior instrumentation using pedicular screws (in non-fusion group, only top loading rod systems were used as side loading and plate systems may damage facet joints). Posterior and intertransverse fusion was used in fusion group. Results Operative time was shorter in non-fusion group (107.5 minute) than fusion group (140.83 minute). Intraoperative blood loss was less in non-fusion group (330.33 ml) than fusion group (368.33 ml). The mean of lost correction of vertebral body height % in fusion group was 7.9 while the mean of lost correction of vertebral body height % in non-fusion group was 8.07. This is statistically not significant with P-value  > 0.05 (0.917). The mean of lost correction of Cobb angle in fusion group was 6.7° while the mean of lost correction of Cobb angle in non-fusion group was 8.65°. This is statistically significant with P-value < 0.05. The mean segmental motion after removal in fusion group was 1.73° while the mean segmental motion after removal in non-fusion group was 11.62°. This is statistically significant with P-value < 0.001. Conclusion Posterior spinal fixation without fusion yielded satisfactory results similar to those of posterior spinal fixation with fusion in patients with dorsolumbar fractures with a load sharing score < 7.
A Novel Technique to Reconstruct Anterior Cervical Spine after Total Removal of C2 and C3 Vertebrae
Authors: Haghnegahdar Ali , Sedighi Mahsa 
Published: April 2016

Introduction Reconstruction of C2 body in cases who need removal of C2 body and Axis is a challenging issue, due to difficult approach and small area for instrumentation and grafting, especially in pediatric age group. Material and Methods Our patient underwent a two-stage surgery. During the first operation via a posterior approach, a subtotal resection of a C2 bony mass was performed. C3 was also subtotally resected due to tumor extension. Posterior fixation of C1–C5 was performed by C1 sublaminar hooks and C4 and C5 lateral mass screws. Ten days later, a total resection of the residual bony mass was performed through an anterior approach (between the sternocleidomastoid muscle and carotid sheath). Reconstruction of C1–C3 was performed with C1 anterior sublaminar wiring and an expandable titanium cage. Results Successful reconstruction of C2–C3 vertebral bodies was achieved. At 2-year follow-up, the child was symptom-free. Imaging studies revealed no recurrence of tumor or instability. Conclusion A novel technique for reconstruction of C2–C3 vertebral bodies is demonstrated for the youngest case (a 6-year-old boy) of osteoblastoma in the literature. We recommend this approach for cervical spine reconstruction in patients who have an intact C1 arc and resected lower bodies.
Cell Salvage Use, Benefits, and Costs at Ipswich Hospital Spinal Unit UK
Authors: Marjoram Tom , Kaleel Saajid , Cumming David , Lovell Robert , Bhagat Shaishav , Hudd Alisair , Sharp David , Powell John 
Published: April 2016

Introduction Blood Transfusions cost £122 per unit in the UK but they have other costs including 1:13000 incorrectly transfused. 1:7000 risk of adverse reaction. Infection in the UK overall is 1:1.2milliion for hepatitis B and 1:7million for HIV with a risk of 1:28million for hepatitis C. Methods We analyzed the use of cell saver and blood transfusion in the Ipswich Spinal Unit (UK). Identifying all cases in which cell saver might be used. Looking at the volume collected and re-infused to the patient, the pre- and post operative haemoglobin and the need for blood transfusion Results We found that Cell saver was being used for a variety of cases including Trauma, Revision surgery, Deformity Correction, Anterior Lumbar fusions, Trans-laminar interbody fusions and tumor work. Revision surgery alone did not have a significant need for blood transfusion and cell saver use in these cases was often (66%) of the time not required. ALIF surgery only utilized salvaged blood in 10% of cases but the bleeding in this case was significant and therefore the unit decided cell salvage would continue to be routine. Overall we found that the average drop in haemoglobin was comparable between those patients who had cell salvage technology utilized during their surgery compared with those who did not, this was echoed in the post operative blood transfusion rates. A cost analysis based upon the cost of cell salvage use vs the cost that would have theoretically been incurred if the same volume of donated blood had been used showed cell salvage to cost 43% more that the use of donated blood products. Conclusion Cell salvage is a more financially costly technology than transfusion from the blood bank. There are some procedures in which the routine use of cell salvage should be reserved for specific cases and some where the use in a small percentage is so beneficial that cell salvage will continue to be used despite a low overall re-infusion rate. The additional costs to the patients is to be considered when discussion donated blood transfusion. The Ipswich Spinal Unit believes more judicious use of cell salvage technology concentrating on the cases in which we found utilization to be highest would make it more cost effective.
Epidemiolgy of Multiple Contiguous and Non-contiguous Thoracolumbar Fractures in a Level 1 Trauma Center in Upper Egypt
Authors: Abdo Mohamed , Elmorshidy Essam 
Published: April 2016

Introduction Multiple level fractures of the thoracolumbar spine are not uncommon nowadays particularly after increased magnitude of trauma and the availability of screening facilities. However only few studies have reported its descriptive epidemiology. The aim of this study is to analyze the incidence, the characteristics of the patients, surgical incidence and mortality rate among hospitalized patients with multiple level thoracolumbar fractures in a level 1 trauma center in upper Egypt Material and Methods Out of 471 patients with thoracolumbar fractures admitted in Assiut University Hospital during the year (2014), there were 50 patients with multiple level fractures. The epidemiology of these 50 patients was described and analyzed including the method of treatment, complications and mortality rate. Results There were 21 males and 29 females. The mean age was 28.9+12.8 years. The commonest associated injury was fracture calcaneus in 20 patients. 43 patients had contiguous thoracolumbar fractures while 7 only had non contiguous fractures. The commonest mechanism of injury was falling from height in 41 patients.42 patients were neurologically free. 6 patients were treated conservatively while 44 patients received surgical treatment. Conclusion Treatment for the multilevel thoracolumbar fractures must follow the same guidelines for treatment as for the isolated fracture in the majority of circumstance; however, it requires particular attention and must be individualized.
Test Score (SI5): Assess Diagnostic of Sacroiliac Joint Dysfunction
Authors: Acevedo Juan , Quintero-Oliveros Silvia 
Published: April 2016

Objective The sacroiliac joint dysfunction is a known cause of low back pain. We think that a test score (SI5) may be performed to assess diagnostic utility of clinical signs of sacroiliac joint dysfunction. The primary aim of the present study was to conduct conducting the pilot study of our new test score SI5. Methods After reviewing the literature about of clinical characteristic, diagnostic test and imaging of the sacroiliac joint; we evaluated diagnostic utility of these aspects and developed the SI5 test score. The SI5 test score was performed in 22 patients with low back pain including completion of a standard questionnaire, history, physical examination performed by a physician, and evaluation of the results. Results The most sensitive clinical tests for diagnosing of sacroiliac joint dysfunction were Laguerre Test, sacroiliac rocking test and Yeomans test (Greater than 80% sensitivity). The tests with greater specificity ( > 80%) were Lewitt test, Piedallu test and Gillet test. The test score SI5 showed sensitivity of 73% and specificity of 71%. Conclusions Sacroiliac joints have been shown to be capable of producing pain in the low back; however, the diagnostic value of examination tests for sacroiliac joint pain has been questioned previously by other authors. The pilot study of SI5 test score showed good sensitivity and specificity. This study required statistical procedures that yield appropriate results.