bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reoperation Rates following Single-Level Discectomy
Authors: Heindel Patrick , Tuchman Alexader , Hsieh Patrick , Pham Martin , Patel Neil , Jakoi Andre , Liu John , Buser Zorica , Wang Jeffrey C. 
Published: April 2016

Introduction Lumbar discectomy is the most commonly performed procedure for treatment of radiculopathy due to lumbar disc herniation. Randomized trials have demonstrated the advantage of surgical removal of herniated disc material over non-surgical treatment options, allowing for a more rapid reduction in symptoms and return of function. Many small-size studies suggest that long-term outcomes for patients treated with discectomy and non-operative management are similar. Additionally, treatment of recurrent lumbar disc herniation is not standardized. Population-level data regarding reoperation following single level hemilaminotomy and discectomy is limited. Material and Methods Data was collected and analyzed for 13,654 patients undergoing single-level lumbar discectomy between January 2007 and December 2010 using the commercially available PearlDiver software (PearlDiver, Inc., Fort Wayne, IN, USA). The nationwide Humana private insurance database was queried for patients billed with the Current Procedural Terminology (CPT) code for our index procedure, hemilaminotomy and removal of disc material (CPT-63030). Patients receiving concurrent lumbar surgeries were excluded from the index group. The index group was then followed in retrospective cohorts for 3 months, 6 months, 1 year, 2 years, and 4 years for recurrent lumbar surgery, including spinal fusion, laminectomy, and additional discectomy. Results Patients received additional lumbar surgeries following single-level discectomy at a rate of 3.95% (539/13654) within 3 months and 12.2% (766/6274) within 4 years of the index procedure. Lumbar spinal fusion was performed on 5.90% (370/6274) of patients within 4 years, with interbody fusion in 75.4% (279/370) of cases and multi-level fusion in 47.0% (174/370) of cases. Reoperation for re-exploration discectomy at the same level as the index procedure with no subsequent surgeries occurred in 2.71% (170/6274) of patients followed out to 4 years. Patients who received a re-exploration discectomy at the same intervertebral level within 2 years of the index procedure went on to receive lumbar fusion at a rate of 38.4% (48/125) within the 4 years following the re-exploration discectomy. Conclusion Data in our study demonstrated a reoperation rate of 12.2% after single level discectomy, a routinely performed procedure for the treatment of symptomatic lumbar disk herniation. Moreover, we show that the rate of progression to lumbar fusion after a re-exploration discectomy was 38.4% within 4 years of reoperation. These data should help surgeons in their operative decision-making and counseling recommendations to patients. To our knowledge, this is the largest population study delineating reoperation rates across the US after single-level lumbar discectomy. Further studies are needed regarding the best treatment algorithm in patients with re-herniation or iatrogenic instability following lumbar discectomy.
Morphometric Measurement of the Lumbosacral Spine for Minimally-Invasive Cortical Bone Trajectory Implant Using Computed-Tomography
Authors: Zhang Hua 
Published: April 2016

Introduction The cortical bone trajectory (CBT) is a novel lumbar pedicle screw trajectory. There is a dearth of literature on CBT screw insertion techniques. The aim of this study was to conduct a detailed morphometric measurement of the lumbosacral spine for CBT pedicle screw starting point, trajectory, length and diameter, using the inferior facet of the cephalad level as a bony landmark. Methods The 3-dimensional reconstruction computed tomography (CT) scans of 86 adults who underwent examination of the lumbosacral spine were studied. The junction of the inferior and medial border of the smallest coronal section of the lumbar pedicle was traced in lumbar segments while the junction of the medial border of the sacral 1 (S1) pedicle and the inferior border of the L5 inferior facet was traced in S1 segments. The starting point was defined to be the projective point on the vertebral plate by this junction. The distances from the starting point to the inferior, lateral and medial border of the inferior facet of the cephalad level, and the inferior border of the transverse process were measured. The trajectory of pedicle screws for the lumbar and S1 segments was determined in the axial and sagittal planes. The angle formed between this trajectory and a line from the vertebral midline was defined as the transverse angle (TA). The angle formed between this trajectory and a line from superior margin of the vertebral body was defined as the cephalad angle 1 (CA1). Cephalad angle 2 (CA2) was defined as the angle formed between the same trajectory on the sagittal plane and a line from the posterior margin of the pars interarticularis. The maximum pedicle screw diameter, as well as the maximum pedicle screw length of the lumbosacral segments was measured on axial and sagittal CT scans, respectively. Results The distances from the inferior border of inferior facet to the starting point from L1 to S1 were 8.9, 6.3, 4.1, 2.9, 1.4 and 0 mm, respectively. The distances from the medial border of the inferior facet to the starting point from L1 to S1 were between 3 to 4mm. The percentages of the distance from the starting point to the medial border of the inferior facet from L1 to S1 were 80.5, 70.1, 61.6, 48.6, 40.8 and 29.3%, respectively. TA from L1 to S1 were 9.0, 9.6, 11.3, 13.5, 15.5, and 8.2 degrees, respectively. CA1/CA2 from L1 to S1 were 26.7/38.7, 26.0/38.7, 26.9/38.0, 24.4/37.2, 22.9/35.1 and 18.4/47.8 degrees, respectively. The maximum diameters of the trajectory from L1 to S1 were 4.8, 5.1, 6.1, 6.8, 7.8, and 6.1mm, respectively. Twenty-five mm was a safe border as the maximum length of the pedicle screw from L1 to S1. Conclusions The inferior facet of the cephalad level is an attractive bony landmark for establishing a starting point of CBT for minimally-invasive spine surgery.
Better Height Restoration and Kyphosis Correction of Osteoporotic Vertebral Compression Fractures Using Intravertebral Reduction Devices (SpineJack): One Year Follow Up
Authors: Lin Jiann-Her , Wang Sheng-Hao , Chiang Yung-Hsiao , Lin En Yuan 
Published: April 2016

Background Transpedicular cement augmentation has became a significant treatment for osteoporotic vertebral compression fractures with the evident effect of pain-relief. However, height restoration and kyphosis correction of the spinal column following transpedicular cement augmentation are not satisfying. SpineJack, one of intravertebral reduction devices, has been proved to has better height restoration and kyphosis correction in a cadaveric study. It also has been reported to has good outcomes for treating spine trauma. However, for treating osteoporotic vertebral compression in the elderly, the role of SpineJack is still unknown. This clinical study was conducted to compare the radiological and clinical outcomes between transpedicular cement augmentation with/without SpineJack for osteoporotic vertebral compression fracture in the elderly. Materials and Methods 75 patients with osteoporotic vertebral compression were included and treated with transpedicular cement augmentation with/without SpineJack during Sep. 2013- May. 2015. The radiological outcomes, including the anterior, central, posterior body height, and kyphotic angle, were measured on flexion/extension lateral lumbar X-ray at the time points of pre-operatively, post-operatively 1 week, 3 month, 6 month, and 1 year. The clinical outcomes, including VAS for pain, SF-36, complications were recorded by reviewing the charts retrospectively. The incidences of adjacent and non-adjacent fracture in both groups were also recorded. Results 36 patients was treated with SpineJack and 39 without SpineJack (Vertebroplasty group). The age, bone marrow density, body mass index, sex ratio, fracture level, the use of steroid and anti-osteoporosis medication were comparable in two groups (p > 0.05). The pre/post- VAS for pain, SF-36, or complication was similar in two groups(p > 0.05). The incidences of adjacent and non-adjacent fracture were also comparable in both group (p > 0.05). The restoration of anterior/middle body height and kyphotic angle in SpineJack group were significantly better than that in Vertebroplaty group at post-op 1 week, 3m, 6m, and one year (p > 0.05). The restorations maintained at least for 1 year in SpineJack group (p > 0.05), while the restorations in Vertebroplasty groups only maintained for 3 months. Conclusion Based on this study, height restoration and kyphosis correction were significantly better in the SpineJack group at least for one year for treating osteoporotic compression fractures in the elderly.
Minimally Invasive Spine Surgery for Intracanal Tumor Resection. Clinical Study and Surgical Results
Authors: Diaz Roberto , Berbeo Miguel , Quintero Tatiana 
Published: April 2016

Introduction Neuroimaging technology, micro-surgical instruments and minimally invasive techniques have allowed the development of new approaches that maintain favorable neurological outcome obtained by conventional techniques in resection of spinal neoplasm. Our work describes a new surgical technique for patients with spinal intra-canal neoplasms in order preserve muscle tension band posterior ligamentous and assessed the results. Material and Methods Our surgical technique proposes a para-median posterior minimally invasive approach from linear incision of 2.5 cm ipsilateral to the site of the lesion trough an expandable tubular retractor. Patients were followed prospectively with visits at one, three, six and twelve months after surgery. Surgical time, blood loss, intra-operative and post-operative complications, hospital length of stay, pre and post-operative neurological status were assessed. Results We describe the surgical treatment technique in twenty one patients diagnosed with spinal intra-canal compressive lesions, which underwent surgical resection between January 2010 and July 2015. The Meningioma was the most frequent neoplasm. The means surgical time was 148 minute. The average intraoperative bleeding was 217 ml. Patients experienced minimal postoperative pain and they were discharged in average 31 hours after surgery. There were no intraoperative complications; though two patients developed complications in the late postoperative period. A patient had cerebrospinal fluid leak and other patient developed myelopathy secondary to non-infectious arachnoiditis. Conclusion This type of approach technique provides adequate visualization and microsurgical resection of the intra-canal tumor lesions, with reduced muscle denervation and devascularization by preserving the tension of the ligament complex. These results correlate with previous studies of minimally invasive techniques for spinal neoplasms.
Perioperative Morbidity in Overweight or Obese Patients after Minimally Invasive Lumbar Spine Surgery
Authors: Diaz Roberto , Berbeo Miguel , Uribe Rafael 
Published: April 2016

Introduction Obesity is a known risk factor for many medical complications. Spinal surgery in overweight or obese patients poses specific challenges related to technical difficulties and risks of complications. Minimally invasive spinal (MIS) surgery has been developed with the purpose of decreasing post operative pain, operative blood loss and to promote early ambulation while offering the same outcomes of traditional open techniques. Nonetheless, there is a paucity of information as to whether these techniques are safe and their results reproducible in overweight or obese patients. We report perioperative outcomes in a retrospective cohort of overweight or obese patients after minimally invasive lumbar spine surgery. Material and Methods Retrospective chart analysis of patients treated with minimally invasive techniques for lumbar spinal pathology was performed, starting from January 2007 to December 2011. Fifty – seven patients with a body mass index (BMI) greater than or equal to 25 kg/m2 were included for analysis. 40 patients with a BMI lower than 25 kg/m2 were included for comparison. Multivariate logistic regression analysis was performed. Results Out of the 97 patients included in the study, 9 presented complications. These were distributed by BMI groups as follows: Two patients in the group below BMI 25 kg/m2; five patients in the group between 25 and 29.9 kg/m2, and two patients in the group above BMI 30. There were no reported mortality cases. After multivariate logistic regression analysis, none of the variables observed (BMI, age, gender, type of fusion) demonstrated a statistically significant increase in morbidity. Conclusion MIS surgery doesn't appear to have a higher risk of perioperative complications in overweight or obese patients with lumbar spine pathology.
Frailty and Postoperative Outcomes in Patients Undergoing Surgery for Degenerative Spine Disease
Authors: Charest-Morin Raphaële , Flexman Alana , Ryerson Chris , Stobart Liam , Street John 
Published: April 2016

Introduction Frailty is defined as a state of decreased reserve and susceptibility to stressors. The relationship between frailty and outcomes after degenerative spine surgery has not been studied. Objectives (1) Determine prevalence of frailty in the degenerative spine population; (2) Describe patient characteristics associated with frailty; (3) Determine the ability of frailty to predict postoperative outcomes. Material and Methods We analyzed 52,671 patients in the National Surgical Quality Improvement Program who underwent degenerative spine surgery. A modified frailty index (mFI) was used to determine the prevalence and severity of frailty as previously described. The association of frailty with postoperative outcomes was determined using multivariate logistic regression. Results Frailty was present in 2,041 patients within the total population (4%), and 8% of patients older than 65 years. Frailty severity increased with increasing age, male sex, African-American race, higher body mass index, recent weight loss, paraplegia or quadriplegia, ASA score, and pre-admission residence in a care facility. Frailty severity was an independent predictor of major complication (OR 1.15 for every 0.10 increase in mFI, 95%CI 1.09–1.22, p < 0.0005), and specifically predicted re-operation for post-surgical infection (OR 1.3, 95%CI 1.16–1.46, p < 0.0005). Prolonged length of stay and discharge to a new facility were also independently predicted by frailty severity ( p < 0.0005). Frailty severity predicted 30-day mortality on unadjusted (OR 2.05, 95%CI 1.69–2.47, p < 0.0005) and adjusted analysis (OR 1.44, 95%CI 1.15–1.81, p < 0.005). Conclusions Frailty is an important predictor of postoperative outcomes following degenerative spine surgery. Preoperative recognition of frailty may be useful for perioperative optimization, risk stratification and patient counseling.
Assessing Transverse Ligament Integrity Throught a New CT Based Alternative
Authors: Pérez-Orribo Luis , Brage Liberto , Kalb Samuel , Roldán-Delgado Héctor , Crawford Neil Robert , Newcomb Anna Sawa 
Published: April 2016

Objectives The Rule of Spence for assessing integrity of the transverse atlantal ligament (TAL) suffers from poor specificity and sensitivity, frequently incorrectly reflecting the condition of the TAL. Since CT scans are quickly and easily obtained in trauma centers, we propose using a special sequence of two CT scans for more accurate diagnosis of injury to the TAL. We sought to assess the sensitivity of the CT method for TAL injury diagnosis in a laboratory setting. Materials and Methods Ten human cadaveric specimens were mounted horizontally in a supine posture with wooden inserts attached to the back of the skull to maintain neutral or slightly flexed (10°) postures. Specimens were scanned in neutral and flexed postures in four conditions: intact ( N = 10), after simulated Jefferson fracture with TAL intact ( N = 5), after TAL disruption without fracture ( N = 5), and after TAL disruption with simulated fracture ( N = 10). Atlanto-dens interval (ADI) from sagittal slices of the CT image was measured to assess anteroposterior instability of C1-C2; cross-sectional canal area was measured to assess canal encroachment caused by the flexed posture. Results In going from neutral to slight flexion, ADI increased by 0.02 mm (2.5%) in intact spines, 0.08 mm (6.25%) after Jefferson fracture without TAL disruption, 0.4 mm (34%) after TAL disruption without fracture, and 0.42mm (25%) after TAL disruption with fracture (Fig. 1). ADI increases from neutral to flexed were not significant (p > 0.33, paired Student's t-test) in normal condition or with fracture.without TAL disruption. However, ADI increases were significant with TAL disruption or TAL disruption+fracture ( p < 0.035). Increases in canal area were < 0.8% and were not significant (p > 0.74). Conclusions This study explores the possibility of utilizing two CT scans to evaluate TAL integrity. The change in ADI between these two postures was very sensitive in distinguishing TAL injury from atlas fracture. The results of this study indicate that this method should be more sensitive than the Rule of Spence for evaluating TAL integrity. By the conclusion of this session, participants should be able to identify tranverse ligament injury with a new proposed CT based method.
Surgical Management of Spinal Osteoblastomas
Authors: Versteeg Anne , Boriani Stefano , Varga Péter Pál , Luzzatti Alessandro , Fehlings Michael , Bilsky Mark , Rhines Laurence , Reynolds Jeremy , Dekutoski Mark , Gokaslan Ziya , Germscheid Niccole , Dea Nicolas , Fisher Charles 
Published: April 2016

Introduction Primary spinal osteoblastomas are rare benign neoplasms which often behave more aggressively than other benign tumors and can present as malignant transformations. Optimal surgical treatment strategies and risk factors for local recurrence and mortality of spinal osteoblastomas remain unclear. The aim of this multicenter cohort study was to assess rates of local recurrence and mortality following surgical intervention for spinal osteoblastomas and to evaluate whether the application of the Enneking classification in the management of these tumors influences local recurrence and mortality. Methods The AOSpine Knowledge Forum Tumor developed a multicenter ambispective database of patients who underwent surgical intervention for spinal osteoblastoma. Patient demographic, diagnosis, treatment, cross-sectional survival, and local recurrence data were collected. Patients were analyzed in two cohorts based on the Enneking classification of the tumor: Enneking appropriate (EA) and Enneking inappropriate (EI). EA was defined by the final pathology margin matching the Enneking recommended surgical margin, if otherwise, it was defined as EI. Results Between November 1991 and June 2012, a total of 102 patients diagnosed with a spinal osteoblastoma were identified. Twenty-eight patients were omitted from the analysis due to insufficient follow-up (<12 months) or incomplete survival data, leaving 74 patients for final analysis. The mean follow-up was 4.3 ± 2.8 years in the EI and 4.5 ± 3.3 years in the EA group. Thirteen (18%) patients suffered a local recurrence and six (8%) patients died during the study period. Local recurrence was strongly associated with mortality with a relative risk of 9.4 ( p = 0.007). When adjusting for Enneking appropriateness, the result was not significantly altered. Significant differences were not found between the EA and EI groups for local recurrence and mortality. Conclusion Upon evaluating the largest multicenter cohort of spinal osteoblastomas to date, the application of the Enneking classification as treatment guide for spinal osteoblastomas could not be confirmed. Considering the consequences of a local recurrence and the strong association of local recurrence with mortality even after adjusting for Enneking appropriateness, en bloc or marginal resection is nevertheless the recommended surgical treatment strategy for spinal osteoblastoma.
The Prevalence of Vitamin D deficiency in Elective Spine Surgery: A Study in Three Orthopaedic Centers
Authors: Diaremes Panagiotis , Christodoulou Evangelos , Maier Gerrit Stephen , Maus Uwe Martin , Matzaroglou Charalampos , Drees Philipp , Kafchitsas Konstantinos 
Published: April 2016

Introduction Decreased bone mineral density due to osteoporosis and osteomalacia pose a significant risk for instrumentation failure and adjacent fractures in elective spinal surgery. The purpose of this study was to evaluate serum levels of 25hydroxyvitamin D (25OH D) in patients presenting for elective spine surgery and to determine whether patients with degenerative spinal disease and spinal instability need a perioperative treatment with Vitamin D substitution. Material and Methods Serum 25-OH vitamin D levels were evaluated postoperatively (<72 hours) in patients undergoing elective spinal fusion in three orthopaedic centers, in Germany and in Greece. Patients with diagnosis of spinal instability as well as with degenerative spine disease were treated with spinal fusion. Results 369 consecutive patients (mean, 68.3 ± 15.4 years) were admitted for elective spine surgery. Mean 25-OH vitamin D level was 19,44 ± 11,52 ng/mL (range, 4–71,8 ng/ mL). 228 (62.0%) patients were diagnosed with vitamin D deficiency and 87 (38.9%) were diagnosed with vitamin D insufficiency (20–30 ng/mL). There was no statistically significant difference between men and women. There was also no significant difference between the patients of the three centers. Conclusion Vitamin D deficiency is very common in patients with spinal instability as well as with degenerative spine disease. Therefore an algorithm of treatment as well as a preoperative control of the Vitamin D values is required before spine fusion surgery is performed, to enhance bone mineral density and thus better pedicle screw fixation.
Spondyloptosis Reduction and Fixation in 25-Year-Old Male
Authors: Refai Omar 
Published: April 2016

Introduction Spodyloptosis is a quite difficult situation to be confronted with. All it is solutions are very challenging ranging from non-anatomical insitu fusion to hard and hazardous anatomical reorientation. Material and Methods Male patient 25 years old with spodyloptosis of L5 vertebral body was treated all from posterior by disc exaction, nerve release, reduction and fixed with transpedicular screws augmented by S2 iliac screws. Results Reasonable reduction of L5 over S1 was achieved from the posterior aspect and realignment of the spine with good fixation. Conclusion Still reduction of spodyloptosis from posterior is ideal option in treatment with attention for the neural tissues and good release and fixation.