bluuebunny/crossref_metadata_2025_split huggingface dataset:
Socio-Economic Impact of Cervical Spinal Cord Injury Operated in Patients with Lower Income Group
Authors: Goel Shakti Amar , Modi Hitesh N. , Dave Bharat R. , Patel Pankaj R. 
Published: April 2016

Introduction None of study reviewed on socio-economic impact after cervical spine surgery in patients with cervical spine injury or myelopathy. Aim was to study clinico-radiological results and socio-economic impact even after radiologically successful surgery. Methods After board approval, 104 participants (56 traumatic, 48 myelopathy) were included. All patients were operated at a single institute between 2007 and 2014 with anterior cervical approach. Patients who were expired after surgery and other pathology were excluded, as aim was to study socio-economic aspect. Nurick scale was used to assess the degree of loss of function in individuals and roentograms for fixation assessment. Results The average age of study group was 46.65 years with 58% comprising of males( n = 63). About 46.7% of the study group were laborers or farmers, majority of whom lost their jobs (47%) post injury. None of the patient had medical or life insurance. Average expenditure per family of < 40USD per month. About 19% of the monthly expenditure was spent on their illness; still majority (56%) had aspirations to get the government support in form of financial help or rehabilitation. The Nurick scale did not show any significant change in pre and post operative periods (3.06 v/s 2.83, p > 0.05). Despite good radiological results; the socioeconomic burdens in study group had little impact. Conclusion Study shadowed socioeconomic impact after cervical spine injury and are first of its kind in lower income group. Such studies may further throw light in future management of cervical spine injuries in developing versus developed world.
Epidemiology of Traumatic Spinal Cord Injury in Tehran, Iran: A Hospital-based Study
Authors: Sharif-Alhoseini Mahdi , Rahimi-Movaghar Vafa 
Published: April 2016

Introduction Spinal cord injury (SCI) is a devastating condition with enormous personal and social costs. To develop preventive strategies, the determination of epidemiological features and causes is required. The aim of this study was to describe the hospital-based incidence of traumatic spinal cord injury in Tehran, Iran. Material and Methods In a retrospective study in Tehran hospitals, the records of traumatic SCI patients, admitted between March 2010 and July 2011 were surveyed. Results 138 cases of traumatic spinal cord injury were identified. The majority of patients were male (84.8%). The mean age was 33.2 ± 14.3 years. 54.3% patients were residing in Tehran and the others were referred from other cities. The mean annual incidence of hospitalized traumatic spinal cord injury patients of Tehran was 10.5/1,000,000/year (95% confidence interval: 9–12). Fall was the leading cause of injury (45.7%), followed by road traffic crash (40.6%). The most common cause of tetraplegia (cervical traumatic spinal cord injury) was road traffic crash. The duration of hospital stay for tetraplegia and paraplegia (thoracic and lumbar traumatic spinal cord injury) was 22.7 ± 23.7 and 12.5 ± 7.5, respectively ( p < 0.001). Early surgery (surgical decompression within 24 hour) was done for 19% of the patients. The median day of hospitalization for early and late surgery was 7.5 and 12, respectively ( p = 0.044). Conclusion Preventing traumatic spinal cord injury should focus on males, age group of 21–30 years, falls and road traffic crash. More studies are suggested to evaluate the incidence of non-hospitalized traumatic spinal cord injury patients.
A Novel Approach to Navigated Implantation of Thoracic and Lumbosacral Pedicle Screws Using Inertial Measurement Units
Authors: Jost Gregory F. , Walti Jonas , Mariani Luigi , Schären Stefan , Cattin Philippe 
Published: April 2016

Introduction A novel method of intraoperative navigation with inertial measurement units was developed to implant pedicle screws in the thoracic and lumbosacral human spine. This was compared with a freehand technique. IMUs house accelerometers and gyroscopes to measure acceleration and angular rotation. Among the many applications, IMUs control and detect motion and orientation of tablet computers and smartphones. Material and Methods The study was done on 9 human cadavers. A preoperative CT was performed to measure the axial and sagittal tilt angles of the pedicle screw trajectories from T1 to S1. After defining the entry points on the exposed spine, the IMU-equipped pedicle finder and screwdriver were used to reproduce these tilt angles and implant one half of the screws. The other half was implanted with a freehand technique. Fluoroscopy was not used in any of the procedures. In addition to adhering to anatomic landmarks, the entry points of the last 216 screws of the study were found by intraoperatively reproducing the distance between the left and right pedicle with a divider. The screw trajectories were analyzed and compared on postoperative CTs. Results 162 screws were implanted with use of the IMUs and 162 screws were implanted with a freehand technique. In relation to the preoperatively planned trajectories, the IMU-guided technique performed significantly better than the freehand technique (axial tilt p = 0.000001, sagittal tilt p = 0.0000000003): With the IMU-guided technique, the mean offsets between the planned and postoperatively measured tilt angles of the screws were for the axial plane 3.3 ° ±3.5° (median 2°, range 0° - 23°) and for the sagittal plane 3.4 ° ±3° (median 3°, range 0° - 13°). For the freehand techniques the mean offsets between the planned and postoperatively measured tilt angles of the screws were for the axial plane 5.6° ±4.5° (median 5°, range 0° - 31°) and for the sagittal plane 6.7° ±5.4° (median 6°, range 0° - 33°). Evaluation of the overall screw position showed that the IMU-guided technique in combination with the divider scored significantly better than the freehand technique plus divider ( p = 0.006). Conclusion Inertial measurement unit–based intraoperative navigation may provide a more reliable implantation of pedicle screws in the thoracic and lumbosacral spine than a freehand technique. Furthermore, adding a divider to intraoperatively reproduce the interpedicular distance of a given level may further improve this novel technique. Translating this rather low-cost technology from consumer electronics to a clinical spine scenario may assist implanting thoracic and lumbar pedicle screws with minimal to no fluoroscopic guidance, yet at no loss of precision.
The Establishment of a Predictive Model for Major Postoperative Complications in Spine Deformity Surgery and Evaluation of Its Clinical Application
Authors: Hai Yong , Zhao Hui 
Published: April 2016

Introduction Spinal orthopedic surgery is a risky method for the treatment of spinal deformity. Over the past years, despite of the remarkable progress in the field of spinal surgery, the major complications from spinal surgery still occur. The aim of this study was to establish a predictive model (The Chaoyang risk score) for major complications after surgery to treat spine deformity disease and evaluate its effect for clinical application. Methods Data were collected retrospectively from 245 consecutive patients who underwent surgery for spine deformity disease. We defined the major postoperative complications as the occurrence of infection, nerve injury, organ dysfunction, or death after surgery. The logistic coefficient, and the additive score by odds ratio was used to calculate logistic score. The Chaoyang risk score were applied to predict Postoperative Complications. A C statistic (receiver operating characteristic curve) was used to test discrimination of the model. Calibration was assessed by Hosmer-Lemeshow goodness-of-fit statistic. Results The result of logistic regression showed that preoperative nerve injury, medical history of spine deformity( > 10years), time of surgery(>5 hours), Maximal voluntary ventilation observed/predicted < 50%, intraoperative osteotomy were independent factors for the complications. The simple logistic model of the Postoperative Complications risk score showed very good discriminatory ability (C statistic = 0.866 > 0.75) and calibration (Hosmer-Lemeshow, p = 0.978 > 0.05) in predicting Postoperative Complications. Conclusion The logistic algorithm of the Postoperative Complications risk score is a simple, objective, convenient and accurate scoring system which may be used to predict Complications after surgery to treat scoliosis disease.
Transforaminal Lumbar Interbody Fusion or Posterior Lumbar Interbody Fusion: Which is Better? A Single-Centre Study
Authors: Ashouri Feras , Khan Shoaib , Bahtia Chandra , Aneiba Khaled 
Published: April 2016

Introduction The first lumbar spinal fusion was introduced over 70 years ago and techniques have been evolving since then. Two popular techniques are Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Lumbar Interbody Fusion (PLIF). However, it is still controversial which is better. The aim of this study was to compare the clinical and radiological outcomes of those techniques. Material and Methods We retrospectively reviewed our spinal unit database to identify the patients who underwent TLIF and PLIF over the last 1 year. A hundred and ten patients were identified (54 TLIF, 56 PLIF). Demographics, Visual analogue score for leg and back pain and SF36 scores were analyzed preoperatively, at six weeks, six months and twelve months postopertively. Two independent reviewers assessed the X-rays for fusion at twelve months postoperatively using the Brantigan-Steffee classification. Results With regards to the clinical outcomes, TLIF patients had significantly better outcomes at six weeks with lower visual analogue scores (VAS) and better SF36 scores. The difference between the two groups has significantly reduced after one year. Both TLIF and PLIF patients had excellent lumbar spine fusion on X-rays at one year with good interobserver reliability (Kappa = 0.95) Conclusion Both TLIF and PLIF are excellent techniques for lumbar spinal fusion. There are no significant differences in the clinical and radiological outcomes between the two techniques at one year.
The Outcome of Using Closed Suction Wound Drains in Patients Undergoing Lumbar Spine Surgery: a Systematic Review
Authors: Waly Feras , Alzahrani Mohammad , Abduljabbar Fahad H. , Landry Tara , Ouellet Jean , Moran Kathryn , Dettori Joseph R. 
Published: April 2016

Introduction Wound suction drains have been used to decrease the rate of post-operative hematoma formation and thus wound infections for many years throughout all surgical subspecialties. In spine surgery, controversy is profound as on one side it decreases the rare but devastating complication of post-operative epidural hematoma, while it may have a hypothetical increase in the risk of infection. In the spine literature the incidence of epidural hematoma in the post-procedural period ranges from 0.2–2.9%, while post-operative wound infection is in the 0.7–16%, thus identifying a method that can decrease the incidence of these complications would be of uttermost benefit. To help address this debate, we conducted a systematic review discussing the use of these drains and to extensively explore the efficacy and safety of closed suction wound drainage in spine surgery in the post-operative period. Materials and Methods Electronic databases and reference lists of key articles were searched up through January 22nd 2015 to identify studies comparing the use of closed suction wound drains with no drains in spine surgery for lumbar degenerative conditions. Outcomes assessed included the cumulative incidence of epidural hematoma, superficial and deep wound infection and postoperative blood transfusion. The overall strength of evidence across studies was based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. Results Five heterogeneous studies, three randomized controlled trials (RCT) and two cohort studies, form the evidence basis for this report. There was no difference in the incidence of hematoma, superficial wound infection, or deep infection in patients with or without closed suction wound drains after lumbar surgery. The upper bounds of the 95% confidence interval for hematoma ranged from 1.1 to 16.7%; for superficial infection, 1.0 to 7.3%; and for deep infection, 1.0 to 7.1%. One observational study reported a 3.5-fold increase in the risk of blood transfusion in patients with a drain. The overall strength of evidence for these findings is considered LOW or INSUFFICIENT. Conclusions Conclusions from this systematic review are limited by the quality of included studies that assessed the use of closed suction wound drains in lumbar spine surgeries for degenerative conditions. We believe that spine surgeons should not routinely rely on use of closed suction wound drains in lumbar spine surgery until higher level of evidence becomes available to support its use.
Assessment of Postoperative Epidural Hematoma after Lumbar Microendoscopic Surgery
Authors: Manabe Hiroaki , Mishiro Takuya 
Published: April 2016

Introduction Symptomatic postoperative spinal epidural hematoma (SEH) is observed occasionally but rarely gets into serious complication after lumbar spinal surgery. It is also known that SEH occurs even in the endoscopic surgery. The purpose of this study is to assess characteristics and outcome of those cases which had SEH treated surgically after the initial microendoscopic surgery in the lumbar spine. Method From 2003 to 2015, total of 1249 patients with lumbar disc herniation or canal stenosis underwent microendoscopic discectomy or laminectomy in our institution. Traditional open spinal surgeries were compared with those microendoscopic surgeries. Six patients after microendoscopic surgery in the series required evacuation of SEH after the initial surgery were included in this study. Preoperative characteristics of the patients, clinical outcome and postoperative course were assessed. Result The incidence of SEH after microendoscopic surgeries required additional treatment was 0.48% (6 of 1249). The incidence of SHE after open spinal surgeries were 0.77% (11 of 1421). The initial procedure was microendscopic discectomy in three cases and microendoscopic laminotomy in three cases. One patient had hypertension, two patients had prediabetes and one patient had thrombocytopenia (12.110*3/μl) by hepatitis. Three cases were treated in the acute stage (within 24 hours after the surgery) and three cases were treated in the subacute stage (between 3 and 7 days after the surgery). In all cases, severe leg pain was appeared in short time. Two patients got muscle weakness. After the surgical evacuation of hematoma, all cases recovered from neurological symptoms and leg pain immediately. But one patient had repetitive leg pain after the evacuation with local anesthesia or general anesthesia. Finally Blood transfusion and factor VIII were required to stop SEH. Factor VIII activity of the patient was 58% at two days after the initial surgery. The patient fully recovered at six months after the initial surgery. Conclusion The incidence of SEH was not significant in comparison with a conventional method. It was considered that narrow epidural space by microendoscopic surgery affected dural compression by even a little bleeding. Basically, in preventing SEH, preoperative bleeding tendency, intraoperative bleeding, postoperative blood pressure and drainage should be confirmed. Even though, it was very difficult to detect the crucial factor of the symptomatic SHE, patient factor like bleeding and cerebrospinal pressure or iatrogenic factor like redundant invasion may lead to symptomatic SHE. Prompt treatment for symptomatic SEH was necessary.
Prospective Multicenter Assessment of Intraoperative and Perioperative Complication Rates Associated with Adult Spinal Deformity (ASD) Surgery in 558 Patients
Authors: Klineberg Eric , Smith Justin , Lafage Virginie , Shaffrey Christopher , Bess R. Shay , Schwab Frank , Gupta Munish Chandra , Hart Robert , Protopsaltis Themistocles , Mundis Gregory , Kim Han Jo , Burton Douglas , Scheer Justin , Ames Christopher ,   International Spine Study Group
Published: April 2016

Introduction Few previous studies have focused on early (intraoperative and perioperative) complication rates for ASD surgery, with reported overall rates ranging from ~10% to 75%. However, most available studies are relatively small single- center series and likely underestimate complication rates due to retrospective design and lack of rigorous collection of complications. Accurately defining the early complication rates is particularly important for patient counseling with regard to the risks and benefits of surgical treatment. Material and Methods As part of a prospective ASD database, standardized collection forms, on-site coordinators and auditing helped ensure complete capture of complications. Intraop and periop (<6 wks) complications were collected for all patients with these available data, regardless of subsequent length of available follow-up. Results 558 patients underwent surgical treatment for ASD and had a mean age of 57 years, mean Charlson Comorbidity Index of 1.5 and previous surgery in 48%. The majority (98%) of patients had treatment including a posterior instrumented approach and included a 3-column osteotomy in 22% of patients. A total of 171 intraoperative complications (69 major, 102 minor) affected 127 (22.8%) patients, and a total of 272 perioperative complications (133 major, 139 minor) affected 185 (33.2%) patients. Collectively, 443 early complications (202 major, 241 minor) were reported, with 264 (47.3%) patients experiencing one or more complication. The overall mean numbers of intraoperative, perioperative and total complications per patient were 0.31, 0.49 and 0.79, respectively. Conclusion ASD surgery is associated with high rates of early complications, with 47.3% of patients having at least one complication. These rates are substantially higher than previously reported. These finding may prove useful in treatment planning and patient counseling.
Management of Cervical Lateral Mass Fractures
Authors: Razzaq Ashfaq 
Published: April 2016

Introduction Cervical lateral mass fractures are frequent injuries encountered in a spine trauma practice. The aim of this study was to define outcomes for operative versus non-operative management by reviewing our experience with these injuries. Material and Methods The design of this study was retrospective. It was conducted at University of Alabama Hospitals, USA. Institutional Review Board approval was duly obtained. We used electronic records and ICD codes to identify 34 consecutive cases, presenting to this hospital in the year 2011. Results The age range was 22–88 years (mean=45). Most injuries were due to motor vehicle accidents. C7 facets were the most frequently injured ( n = 22). The injuries were grouped by fracture orientation into: Coronal split fracture n = 19, sagittal split n = 8, comminuted n = 4, floating (fractured pedicle and lamina) n = 3. Surgical intervention was performed in 16 patients (47%) and non-surgical (rigid collar/halo) in 18 patients (53%). Of surgical cases, 14 received ACDF and 2 received posterior constructs. The follow-up duration was 2 weeks to 12 months (mean 3.2 months). In the surgical group 8 patients were asymptomatic at follow-up, and 8 patients had neck pain. In the non- surgical group 11 patients were asymptomatic and 2 patients had neck pain. In the surgical group definite evidence of fusion was seen on follow-up radiographs in 7 patients and a further 6 patients did not have any movement on flexion extension views. One patient in the surgical group had post-op movement on dynamic X-Ray. In the non-surgical group, 10 patients had no movement on flexion extension views, one patient had minor movement, and no X-Rays were available in the remaining cases. Conclusion Clinical outcomes were similar in both surgical and non-surgical groups of facet fractures, with about half in each group being pain free at follow-up. Similarly radiological studies demonstrated good spinal stability in the majority of both surgical and non- surgical groups. There is no clear consensus in the literature regarding the treatment paradigms for cervical facet fractures. Our retrospective data suggests equivalent outcome with both surgical and non-surgical treatment modalities. Further randomized prospective studies are warranted.
Anterior Cervical Decompression, Fusion, and Stabilization by Cervical Plate and Screw for Traumatic Lower Cervical Spinal Injury: A Series of 62 Patients
Authors: Jonayed Sharif Ahmed , Alam Shah , Karim Rezaul , Chakraborty Shubhendu , Alam Tashfique 
Published: April 2016

Introduction Acute cervical spinal injury is one of the most common causes of severe disability and death following trauma. Though treatment of cervical spine injury is controversial but anterior cervical surgery has still a better outcome then any other method. Material and Methods A prospective study was done in NITOR and other private clinics at Dhaka from July 2009 - September 2014. Discectomy or corpectomy was done for decompression, tricortical bone graft or cage with bone graft was used for fusion. Cervical plate was used in all. Total case was 62 (M-46, F-16). Age ranging from 14 – 52 years. Total follow up time was 3 Months to 48 Months. Quantification of deficit and neurological outcome was rated by ASIA impairment scale. Results The results shows that peak incidence was in 3rd decade. Falling due to slip while carrying heavy load on head was the most common cause. The commonest skeletal level was C5/C6. Among 62, during the pre operative period, 6 patients had ASIA impairment scale A, 25 patients had ASIA impairment scale B, 28 had ASIA impairment scale C & 3 had ASIA impairment scale D. At follow up, 22 of ASIA B changed to ASIA D, 3 of ASIA B changed to ASIA E, 18 of ASIA C changed to ASIA D, 10 of ASIA C changed to ASIA E, 3 of ASIA D changed to ASIA E & 6 of ASIA A remain unchanged. None had worsening of neurodeficit due to surgery. Conclusion For better outcome, proper selection of case is very important. As no neurological recovery occurs in complete lesion but for early mobilization and prevention of further complication- surgery may be considered.