bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Correlation of Anchor Density and the Curve Correction of Adolescent Idiopathic Scoliosis Surgery
Authors: Yeh Yu-Cheng , Lai Po-Liang , Chen Wen-Jer , Niu Chi-Chien , Chen Lih-Huei 
Published: April 2016

Introduction Pedicle screw instrumentation has been shown to provide better curve correction with solid three-column fixation in adolescent idiopathic scoliosis (AIS) surgery. The levels of spinal segments to be fused are based on Lenke classification. However, the optimal anchor density of fixation points in AIS surgery to achieve cost effective curve correction remains unclear. The purpose of the study is to analyze the correlation between curve correction and anchor density in pedicle screw based posterior fusion of AIS. Material and Methods From Jan. 2003 to Dec. 2008, 121 consecutive AIS patients underwent primary posterior fusion with pedicle screw based fixation and followed up for a minimum of 24 months were reviewed. Anchor density was defined as the number of screws per fused spinal segment. Radiographs were assessed at preoperative, postoperative 0, 3, 6, 12 and every 12 months until last follow up. The relation between anchor density and correction rate in Lenke subgroups were analyzed. Results There were 14 male and 107 female patients enrolled and aged 14.1 years old at the time of surgery. The number of Lenke type 1, 2, 3, 4, 5 and 6 curve patients were 67, 22, 9, 2, 14 and 7 respectively. For all patients, the mean correction rate was 63.1 ± 15.8% in all structural curves and 67.0 ± 12.0% in major curves only. The mean anchor density was 1.30 ± 0.18. There was no correlation between anchor density and major curve correction rate (r=0.24, p = 0.01). Patients of anchor density >1.30 (=mean anchor density of all patients) had similar correction rate with patients of anchor density <=1.30 in the major curves (67.9 ± 13.2% vs 66.0 ± 10.4%, p = 0.38). For Lenke type 1, 2 and 3 curves, there was no correlation between major curve correction rate and anchor density (Lenke 1: r=0.02, p = 0.88; Lenke 2: r=0.30, p = 0.18; Lenke 3: r = −0.20, p = 0.60) with mean anchor density of 1.29 ± 0.15, 1.23 ± 0.17 and 1.23 ± 0.10 respectively. For Lenke type 5 curves, the major curve correction rate was positively correlated with anchor density (r=0.61, p = 0.02) with mean anchor density of 1.51 ± 0.23. Conclusion There was no significant correlation between curves correction rate and anchor density in pedicle screw based instrumentation of adolescent idiopathic scoliosis surgery. Although for major thoracolumbar/lumbar curves, anchor density may play a role in curve correction, further investigation is still needed.
VEPTR: Single Centre Experience of 9 Years
Authors: Wimmer Cornelius , Siam Ahmed Ezzat , Pfandlsteiner Thomas 
Published: April 2016

Introduction The operative treatment of scoliosis with vertical expandable prosthetic titanium rib (VEPTR) implants has been established in Europe since 2002. Between 2005 and 2014, we have treated 72 scoliosis patients with VEPTR implants. Methods This is a prospective uncontrolled study in a single scoliosis center. Of 72 cases; 51 were females and 21 males, with a mean age of 7.5 years (3–13 years). The underlying pathology was congenital scoliosis in 39 cases, neuromuscular scoliosis in 21 and early-onset scoliosis in 12. The grade of the deformity has been measured according to Cobb method of anteroposterior radiographs; pre- and postoperatively, and after every distraction of the rods. This took place every 6–9 months until post-pubertal end-fusion operation. The evaluation included patient (or parents') satisfaction score, complication rate and growth of the patient. Of 72 children, 10 have been already operated before. Results The primary deformity ranged from 45° to 130° with a mean of 65°. After the first correction, the mean Cobb angle was 32° (25°- 75°). No complications occurred during the instrumentation surgery. The mean operative time was: 95 minute. (65–175 minute.), with a mean blood loss of 125 ml. In all cases, intraoperative neuromonitoring with SEP and MEP has been performed. In 29 cases, a “rib-to-lumbar spine-hybrid” has been used, and combined with a “rib-to-rib” in 32 cases. In the other 11 cases, a “rib-to-pelvis” construct has been used. Delayed wound healing occurred in 4 patients, another patient had pneumonia, that was successfully treated. Proximal hook dislocation occurred in 14 cases after distraction. Skin perforation complicated 10 cases and needed partial removal of implant. No neurological complications or deep spinal infection occurred. The mean hospital stay was 18 days after first implantation (14–31). One to 12 distraction operations have been done in 52 patients. A deformity correction with a mean of 15,7° grades have been achieved (19.8%). In 20 cases, the secondary scoliosis have been later instrumented. In 12 cases, the implant has been removed and replaced by pedicular-screw growing rod system. The end-fusion operation has been already performed in 12 cases. Conclusion The early results have been considerable. Yet after 9 years of experience with the VEPTR systems, some major problems occurred with the proximal junctional kyphosis and with implant-related complications. Like other growth-sparing systems, the VEPTR implant showed a complication-rate of 29%
Treatment of Early Onset Scoliosis - An Early Experience of Growing Rod Insertion and Lengthening
Authors: Khan Ed Simor Khan Mor Japar , Ayu Paul Ngalap , Goh Jin Hee , Singh Manmohan , Rashid Mohd Zakhiri Mohd , Amir Dzulkarnain , Mohamad Fazir 
Published: April 2016

Introduction Early onset scoliosis normally found in children from the age of birth till 10 years old with female preponderance. Any lateral spinal curvature of 10 degrees or more by reference to Cobb's angle measurement is diagnosed as scoliosis. The deformities is three dimensional thus affecting spinal growth in multiple planes. Scoliosis has been classified based on it's underlying causes such as congenital, idiopathic and also secondary causes as neuromuscular scoliosis or syndromic scoliosis. Material and Methods A retrospective study of patients seen in Orthopedic and Traumatology department of Hospital Kuala Lumpur. The age of patients ranges from 8 to 13 years old and are diagnosed with scoliosis regardless of the etiology. Twenty two patient (nine males, thirteen females) whom underwent surgical intervention are the subjects of this study. Spine correction details includes Cobb'sangle, T1-S1 length, Coracoid Height Difference (CHD), Clavicle Ribcage intersection point Difference(CRID), Clavicular Tilt Angle Difference(CTAD), Vertebral height, Apex distance from CSVL and rate of lengthening were collected. Data were then statistically analyzed. Results The results obtained after data analysis were as followes: Mean age of surgery is 11.1(between 13 and 7.7). Improvement of Cobb's angle immediately post op is 33.71%(between 54.55 and 15.56). Final improvement is 48.66 (between 69.09% and 27.59%). T1S1 length improved immediately post operatively by 12.28% and at final lengthening was 26.41%. An improvement of shoulder CHD immediately post op by 38.33% and at final by 51.96% was observed. Balance CRID improve post operatively 35.21% and final 31.86%. Balance CTAD showed improvement post operatively by 24.38% and final by 23.64%. Overall shoulder balance improved post operatively by 32.64% and final was 35.72%. Reduction of coronal distance immediate postoperatively by 36.30% and final at 54.89%. Conclusion Growing rod is not only one of the best option to prevent the progression of curvature, it is also a good method in correcting the co-existing curvature. With a good correction of curvature, it will facilitate in achieving the maximal correction for definitive fusion later. The outcome of our center is comparable with the results published by other international studies. Treatment of Early Onset Scoliosis with growing rod technique is safe and effective.
A Clinical Prediction Rule for Functional Outcomes in Patients Undergoing Surgery for Severe Degenerative Cervical Myelopathy: Analysis of an International AOSpine Prospective Multicentre Dataset of 254 Subjects
Authors: Tetreault Lindsay , Kopjar Branko , Cote Pierre , Arnold Paul , Fehlings Michael 
Published: April 2016

Introduction Patients with cervical spondylotic myelopathy (CSM) may be severely impaired, have reduced quality of life and present with deleterious signs and symptoms. Patients with severe myelopathy (mJOA < 12) often improve following surgery; however, some may not achieve a minimum clinically important difference (MCID), whereas others may have exceptional outcomes. Due to varying prognoses among this group, it is important to predict outcome in these patients and use this knowledge to manage expectations. This study aims to determine the most important clinical predictors of surgical outcome in patients with severe CSM. Material and Methods Of the 757 patients enrolled in the CSM-North America or International studies, 254 (33.55%) presented with severe myelopathy as classified by a mJOA < 12 points. A prediction model was developed to distinguish between patients who improve to mild or moderate myelopathy postoperatively (mJOA≥12) and those who remain significantly impaired (mJOA < 12). Univariate analyses evaluated the relationship between this outcome and various clinical predictors. Multivariate Poisson regression was used to formulate the final prediction model and to compute the relative risks. A secondary model was constructed to predict which patients would achieve a MCID on the mJOA, defined as a change score of three or more points in patients with severe disease. Results Our cohort consisted of 153 men and 101 women with ages ranging from 28 to 86 (mean: 60.09 ± 12.06 years). The mean preoperative mJOA was 9.42 ± 1.67. One hundred and fifty-four (60.63%) patients improved to a score ≥12 at 1-year postoperative, whereas 145 (57.09%) achieved a MCID on the mJOA. Baseline severity score (RR: 1.07, 95%C.I.: 1.02–1.13), hyperreflexia (RR: 0.83, 95%C.I.: 0.72–0.96), lower limb spasticity (RR: 0.75, 95%C.I.: 0.65–0.86), and age (RR: 0.97, 95%C.I.: 0.95–0.99) were significant predictors of a mJOA≥12 following univariate analysis. The final model consisted of three statistically significant variables and one clinically relevant predictor: baseline severity score (RR: 1.09, 95%C.I.: 1.03–1.15), duration of symptoms (RR: 0.94, 95%C.I.: 0.89–0.99), co-morbidity score (RR: 0.96, 95%C.I.: 0.91–1.00) and the sign lower limb spasticity (RR: 0.76, 95%C.I.: 0.66–0.87). The AUC for this model was 0.75 (95%C.I.: 0.67, 0.83). Improvement by the MCID could not be effectively predicted by a combination of clinical variables. Conclusion Severe patients were more likely to achieve a score ≥12 on the mJOA if they had a higher preoperative mJOA score and a shorter duration of symptoms; a lower co-morbidity score (fewer and less severe concomitant disease); and did not have lower limb spasticity.
C5 Palsy after ACDF: Topographic Correlation with Chassaigne's Tubercle (C6)? A Fresh Cadaveric Study
Authors: Rajabian Ali , Quraishi Nasir A. 
Published: April 2016

Introduction Our aim was to explore the possible topographic correlation of C5 nerve root with regards to its course and regional relation to C6 tubercle. We hypothesized that etiologic mechanisms proposed thus far in the current literature although may have some plausible explanation, however they still cannot explain why C5 and not any other adjacent level suffer a post-operative palsy. Materials and Methods Fresh cadaver had extensive layer by layer dissection performed by 2 surgeons (one of whom has extensive experience as an anatomy demonstrator and dissector). Roots of Brachial plexus were exposed in relationship cervical transverse processes. Photographs were taken at each stage of the exposure. Results We observed a close relation of path of C5 root with the C6 tubercle bilaterally, moreover we noted a sharper decent of C5 in comparison with the other adjacent roots. Conclusion Sharper angle of C5 nerve root, variations in intra-operative neck position and shoulder pull may play a role in predisposing the nerve root to neuropraxia against this most prominent lateral cervical boney element. We speculate that C5 nerve palsy may be related to the close association of the C5 nerve with Chassaigne's tubercle (C6). We would suggest a closer analysis of the C5 nerve in this region using finite element analysis with emphasis on the close proximity of the nerve and changes due to cervical motion. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Anterior Coloumn Reconstruction with Stand Alone Titanium Cage, without Anterior Plating in Tuberculosis Cervical Spine. An Experience of 47 Patients
Authors: Qazi Qazi Muhammad Amin , Imran Muhammad , Akram Rizwan , Javed Shahzad , Ahmad Naeem , Aziz Amer 
Published: April 2016

Introduction Tuberculosis is a common problem specially in under developed countries. Tuberculosis of the vertebral column constitutes nearly 50% of all lesions of osteoarticular tuberculosis. The commonest site for the disease is in the peridiscal region. Treatment option usually is anti tuberculous chemotherapy but in some patients usually with severe pain and involving neurology, instability, large abcess, surgery is recommended. To our knowledge there is not a single publication in literature in which standalone titanium cage and bone graft without anterior plating is used in the treatment of TBS. The aim of this study is to evaluate the efficacy of standalone titanium mesh cages in TB cervical spine. Material and Methods A retrospective study of 47 patients with cervical tuberculous spondylitis (TBS) was performed at Ghurki trust teaching hospital. This study approved by the Institutional Review board and the ethics committee, included 47 patients with TBS of cervical spine who gave their informed consent to be included in the research. All patients had radical debridement, decompression, anterior coloumn reconstruction and instrumentation with standalone titanium cage without anterior plating filled with autologous iliac bone graft. The diagnosis of TBS was based on clinical correlation including night fever, loss of weight, fatigue and neck pain, laboratory investigations including ESR, CRP and tuberculin test were done in all patients. Visual analogue score (VAS) and frankel scoring system was used to score pain severity and grade neurological status. ATT was started preoperatively. The radiographic assessment included preoperative standard anteroposterior and lateral views. Cobbs methos was used to measure the sagittal profile. Results 61.6% patients fell in age group 3–35 years and 28.4% fell in group 36–70 years of age. 26 were men and 21 were women. Out of all patients 26 had pre op frankel grade E and 4pts had grade D and 10 pts had grade C and 2 pts had grade B and five pts had grade A preoperatively. Post operatively one patient of grade A remained same while other four improved to grade C in follow up and rest of all pts. improved to grade E in two year follow up. Pre-op cob's angle was 39.06 ± 10.92 (Mean±SD) which improved to -5.51 ± 4.77 (Mean±SD). P value is < 0.05. In comparison of visual analogue score there is also statistically significant difference in pain improvement. All patients had single stage radical debridement, decompression and instrumentation. Anterior coloumn reconstruction was done in all patients using standalone titanium cage. Conclusion The use of titanium cages effectively restores the sagittal deformity in TB spine with no donor site morbidity.
Single Stage Anterior Corpectomy and Posterior Instrumentation in Tuberculous Spondylitis with Varying Degrees of Neurological Deficit
Authors: Debnath Ujjwal K. , McConnell Jeffrey R. 
Published: April 2016

Introduction The study is an outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity, who underwent single stage anterior corpectomy and posterior decompression with instrumented fusion Material and Methods 20 (6M:14F) patients with spinal TB and varying degrees of motor deficits underwent surgery during the past 7 years. The range of age was from 2 to 65 years old (mean age of 34.8 years). The average duration of symptom was seven months (ranging from 3 months to 1 year). Anti-tuberculosis chemotherapy was initiated in all patients and continued for more than four weeks until ESR < 40mm/H before surgery. All had a minimum of 12 months of follow up (mean follow-up period 16 months). One patient had upper cervical disease, 10 patients had thoracic disease and 8 patients had lumbar or lumbo sacral involvement. The disease in 7 patients was characterized by Frankel Grade A/B (Medical Research Council Grade 0/5), in 8 patients by Frankel Grade C (unable to walk even with support) and 4 patients had Frankel Grade D (walk with support but weak legs) on admission. The kyphotic angle ranged from 5° to 40° before operation, with an average of 18° ± 12°. Three children below 10years of age underwent anterior corpectomy and debridement with rib or fibular grafts and posterior instrumented fusion. All the 17 patients underwent anterior corpectomy, debridement with cage insertion and posterior instrumented fusion. Physiotherapy was instituted in all patients. Results Local symptoms of pain were relieved significantly by three weeks postoperatively (mean VAS scores reduced from 6.8 to 2.7). 17/19 patients (89.4%) neurological deficit had excellent or good clinical results (P > 0.05). 6/7 patients improved from Frankel A/B to Frankel E (normal activity), ⅞ patients improved from Frankel C to Frankel E and all 4 patients with Frankel D became normal to Frankel 5. The average ESR was normal (10 ± 5mm/h) within 6 months in all patients. The average kyphotic angle decreased to 7 ° ± 5° postoperatively. Solid fusion was achieved in all cases. No significant loss of deformity correction was noted in these patients. Only one patient with lumbo-sacral disease showed recurrence after 18months of disease free interval. Conclusion Single stage anterior corpectomy with autogenous rib grafts or cage insertion and posterior instrumentation are safe and effective methods in the surgical management of spinal tuberculosis with neurological deficit. Combined single stage surgery helps to correct and maintain the deformity, foci clearance, spinal-cord decompression and pain relief in the treatment of tuberculous spondylitis.
A Five-year Prospective Clinical and Radiological Review of a Semi-constrained Ceramic-Ceramic Cervical Disc Replacement
Authors: Swamy Girish , Mitsiou Konstantinos , Burget Filip , Nanjayan Shashi , Bommireddy Rajendranath , Klezl Zdenek 
Published: April 2016

Introduction Artificial cervical disc replacement [CDR] has emerged as a viable treatment alternative to fusion for the management of symptomatic compressive radiculopathy and / or myelopathy. This paper evaluates the clinical and radiological outcomes of patients treated with a second generation semi-constrained CDR with a ceramic-ceramic articulation. Material and Methods We conducted a prospective cohort study of all patients undergoing a cervical disc replacement for cervical disc pathology, during the period from April 2007 to April 2010 using the Discocerv ceramic disc replacement. 42 patients were available for final clinical and radiological follow-up. Both, clinical and radiological evaluation was performed at each clinical visit at 6 weeks, 6 months, 12 months and 2 years and 5 years. Results Three patients were lost for follow-up. C5-C6 was the commonest level. There were 34 single level cases and 8 two level cases. The NDI improved significantly ( p < 0.05) from a mean preoperative score of 56% to a score of 20% at final follow-up. The mean preoperative mobility at the index level unit was 12.2 ± 4.5°, this decreased to 7.9 ± 3.2° at six weeks, but slightly increased to 12.9 ± 2.9° at 1 year (gain not significant). Heterotrophic ossification [HO] was noted in 10 [23%] patients. Conclusion Based on our study of cervical disc replacement with a ceramic-ceramic bearing surface, this appears to be a viable option in the treatment of variety of cervical pathologies. This ceramic-ceramic interface eliminates potential problems like metallosis but further longer-term results should be reported.
The Physical and Mental Health in the Conservative Treatment of the Idiopathic Scoliosis
Authors: Diaremes Panagiotis , Christodoulou Evangelos , Kafchitsas Konstantinos , Christodoulou Anastasios , Symeonidis Panagiotis 
Published: April 2016

Introduction Idiopathic scoliosis may lead to physical and psychosocial impairment as it mostly appears before and/or during puberty. Both ability of young patients to confront the stress of a chronic disease and self esteem, affect their psychosomatic development and their future quality of life. Purpose of this study was to describe and evaluate health associated quality of life in patients with idiopathic scoliosis. Material and Methods In this study the physical and mental health of 69 young patients with idiopathic scoliosis was compared with a control group of the same age. The patients were treated with a Cheneau brace because of Idiopathic scoliosis with Cobb angles between 15°and 40°. We used a modified short form 36 questionnaire. We evaluated the eight sections of the SF-36 questionnaire in both groups (vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, mental health). The statistical analysis was performed with the Sigma Plot software. Results In comparison to the coeval control group (mean age 17,9 years) the group with idiopathic scoliosis (mean age 18,1 years) showed significant higher bodily pain levels. We did not observe any significant differences between the two groups in the sections of vitality, physical functioning, general health perceptions, physical role functioning, emotional role functioning, social role functioning and mental health. Conclusion According to our results, bodily pain is more intense by conservative treated patients with idiopathic scoliosis as in the control group. Nevertheless, psychological and psychosocial adjustment of these patients is the same as their contemporaries without significant differences.