bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Shilla Growth Guidance Technique for Paediatric Scoliosis at 3-year Follow-up: a Preliminary Report
Authors: Sekouris Nick , Pilihou Anastasia , Vlahos Eugenios , Soultanis Konstantinos , Sapkas Giorgos , Flouda Lito 
Published: April 2016

Introduction To present the technique and the outcomes of the use of the Shilla system in children scoliosis. Materials and Method The Shilla system has been used in 4 children of 5 ½ -8 years old to treat scoliosis of 60°-70°. To place the system, a subperiosteal approach of the apex and a percutaneous approach of the curve extremities had been performed. In that way, a spontaneous spinal fusion is avoided. The edging screws can slip on the rod and permit spine to grow-up. Cobb angle, screw slipping, T1-S1 lengthening, and complications had been recorded. Results The Cobb angle average improved to 22° from (65°) and the T1-L1 lengthening average was 6,8 cm. No spontaneous spinal fusion has been noted. In 2 children, a revision surgery to replace the upper thoracic screw and the rod had been performed. A left leg neurapraxia happened, which resolved after 1 week. A preserved sagittal balance of the spine was observed during the 3 years of follow-up. Conclusion The percutaneous placement of the thoracic screws is used to avoid spontaneous fusion, but this is challenging and increases the risk of complications. Despite the complications, in all the children, a good surgical correction of the scoliosis was done, a normal grow-up has been noted, and the sagittal balance was preserved instead of other expandable systems, which are fixed only at the curve extremities.
Damage Control Surgery for Thoracolumbar Spine Fractures by Percutaneous Pedicle Fixation in Polytrauma Patients: Initial Experience
Authors: Valencia Manuel , Leiva Andres , Novoa Felipe , Riera Jose , Contesse Ivan , Illanes Juan Cristobal 
Published: April 2016

Introduction Spine fractures in polytrauma patients are relatively common. About one third require surgical treatment. Open surgical stabilization in these patients may increase morbidity and mortality associated with prolonged surgical time, bleeding and hypothermia. Internal fixation with minimally invasive techniques is an alternative for the treatment of vertebral fractures in polytrauma patients, diminishing local and systemic risks associated with open techniques. Material and Methods Polytrauma patients with unstable thoracolumbar spine fractures, treated by percutaneous pedicle fixation techniques, between June 2013 and March 2015. Results 5 patients. Injury mechanisms involved: height fall, height fall associated with extensive skin burn of dorsal region and motor vehicle accidents. Fracture level where between T6 to L5. According to AOSpine trauma classification: 3 B2, 1 B3 and 1 A4. Surgery was performed on an average of 5 days since trauma. 2 levels were fixated in 2 patients, 3 in other 2 patients and one patient had a lumbopelvic fixation. The average of intraoperative bleeding was 70 ml and of operative time was 100 minutes. No patient had postoperative local infection or complications from surgery. No patients required revision surgery or deferred anterior column stabilization surgery. All patients had at least 6 months follow-up. Conclusion Percutaneous pedicle fixation is an alternative for treatment of unstable vertebral fractures in polytrauma patients with poor general or local conditions. The results in this series are encouraging in the sense of accomplishing stabilization without increasing the morbidity and mortality associated to basal conditions.
Spinal Canal Decompression and Neurological Outcome in Thoracolumbar Burst Fractures; A Review of Evidence- Based Data
Authors: Elwardany Omar 
Published: April 2016

Background The association between neurologic recovery and initial compromise of spinal canal has not been frequently documented and the controversy persists regarding the management of bone fragments within the spinal canal after thoracolumbar burst fractures. Although, the surgical clearance of the spinal canal, either by direct removal of bone fragments or by ligamentotaxis, is generally accepted as the treatment of choice for burst fractures, debate persists as to whether surgical decompression is necessary to treat burst fractures. Objective To better understand whether the degree of neurologic recovery from thoracolumbar burst fractures is affected and predicted by initial compromise of spinal canal and to which extent the decompression is helpful, via reviewing the evidence-based data of the literature. Methods Up-to-date, the experimental and clinical literature concerning the role of, and the biological rationale for, surgical decompression after acute Spinal Cord Injury (SCI) were reviewed. Evidence from clinical trials was categorized as Class I (well-conducted randomized prospective trials), Class II (well-designed comparative clinical studies), or Class III (retrospective studies). Conclusion Although, there is a biological evidence from experimental studies in animals that decompressive surgery may improve neurological recovery after SCI, the role of surgical decompression in patients with SCI is only supported by Class III and limited Class II evidence. Accordingly, decompressive surgery for thoracolumbar burst fractures can only be considered a practice option.
Low Back Pain- How Significant are the Spinopelvic Parameters?
Authors: Sai Krishna M. L. V. , Sharma Deep , Menon Jagdish , Barathi Deepak 
Published: April 2016

Introduction Since the discovery of pelvic incidence by Legaye et al. in 1998, many other sagittal spinopelvic radiographic parameters have been described as determinants of good sagittal balance. Alteration in these parameters has been linked to various spinal ailments producing degeneration to deformity. This have been proved by Roussouly et al. in his landmark paper, which showed a positive correlation between PI and Low Back Pain (LBP). However in the subsequent studies the same correlation could not be derived. Thus, we aim to study the role of high PI as a causative variable for Low back pain in our population. Materials and Methods: The study was approved by our institute review board and the ethical committee. We included all the patients visiting our OPD with complaints of LBP for more than three months and giving consent for the study. All patients underwent a thorough clinical and radiological examination, to rule out any apparent cause of LBP. We excluded patients with spinal deformity, fracture, infection, malignancy and with a history of previous spine surgery. A total of 67 patients were thus included in the study. Another age and sex matched group of asymptomatic volunteers ( n = 75) were also recruited as a control group. All the patients and volunteers underwent a standardized lateral sagittal digital radiograph of the whole spine including the base of the skull till the proximal ⅓ thigh (subject naturally standing up, looking horizontally, hands resting on a vertical support, upper limbs relaxed and elbows half bent). All the subjects were at a specific distance from the radiographic source and a single shot of x- rays have been used centering around D12. The sagittal spinopelvic parameters were measured using the Surgimap spine software version 2.1.2 by a single observer. The parameters measured were pelvic incidence PI, pelvic tilt PT, sacral slope SS, thoracic kyphosis TK, lumbar lordosis LL, lordotic and kyphotic vertebra. The comparisons were drawn between the patients and controls using appropriate statistical methods. Results The mean values obtained in patients with low back pain were PI-48.04, PT-12.61, SS-35.5, LL-50.57 and TK-26.79. Corresponding values in healthy volunteers were PI-47.85, PT-13.03, SS-34.8, LL-54.68 and TK-24.03. We have found no statistically significant difference in the values of any sagittal spinopelvic parameters measured between the two groups. Conclusion Based on the results derived from our study we conclude that there is no statistically significant correlation between any of the measured sagittal spinopelvic radiographic parameters and the occurrence of LBP.
Psychological Distress can be Determined before Lumbar Surgeries with a Clinically Applicable, Easy-to-use Tool: the Short form of the DRAM
Authors: Lazary Aron , Sziat Julia , Szövérfi Zsolt , Kiss Laszlo , Varga Péter Pál 
Published: April 2016

Introduction The Distress and Risk Assessment Method (DRAM) is a tool for measuring the psychological risk factors in low back pain patients. In our previous study, the DRAM scale, its categories as well as its components (Zung Depression Scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ)) proved to be significant predictors for global treatment outcome in routine lumbar degenerative surgeries. On the other hand, the original DRAM has to be calculated from 45 items making that a long and clinically impractical tool. The aim of the study was to develop and validate a short form of the DRAM (sDRAM) and to determine the prognostic power of the new version in terms of the global treatment outcome. Material and Methods Classic Test Theory were applied for item reduction after the exploratory factor analysis of ZDS and MSPQ on the dataset of a large ( N = 1837) cohort of surgically treated low back pain patients. Internal consistency and the correlation of the shortened DRAM (sDRAM) with the original scale were analyzed. After that, a two-step cluster analysis of sDRAM was applied to determine the cut-off scores. The prognostic value of the scale and its categories was tested on a prospective cohort of routine lumbar degenerative surgeries ( N = 445) where global treatment outcome was assessed two years after the surgery by a Likert scale. Results The sDRAM consisted of five ZDS items (1, 6, 7, 12, 18) and three MSPQ items (3, 9, 11) preserving the original item-distribution ratio. sDRAM scale (range: 0–24) was highly correlated with the DRAM scale (range: 0–99) (r=0.88). Cluster analysis of the patients showed a four-cluster structure in the cohort similarly to the original questionnaire. Cut-off scores (sZDS > 6, sMSPQ > 2) were used to formulate the sDRAM categories (Normal, At risk, Distressed). The sDRAM scale showed a significant association with the global treatment outcome in a logistic regression model ( p < 0.001, B=0.258, OR=1.3) and in ROC analysis (AUC=0.744, p < 0.001) and it was similar to the original DRAM ( p < 0.001, B=0.066, OR=1.07 as well as AUC=0.72, p < 0.001). Risk for poor outcome was significantly associated with the suggested categories of sDRAM (6%, 20%, 39% of poor outcome in “Normal,” “At Risk” and “Distressed” subgroups, Chi-square=38.9, df=2, p < 0.001). Conclusion A shorter, clinically applicable method for the assessment of DRAM has been developed. The sDRAM consists of 8 items and correlates with the original questionnaire. sDRAM and its categories proved to be significantly associated with global treatment outcome. The tool can be used for preoperative risk assessment and reduction strategies, however, further validation is needed to show its utility in different, wider patient-groups.
Predictive Factors for the Outcome of Surgical Treatment of Lumbar Spondylolysis in Young Sporting Individuals
Authors: Debnath Ujjwal K. , Goel Vivek 
Published: April 2016

Introduction Only few sporting individuals with symptomatic lumbar pars injuries require surgical repair and it is often difficult to predict the outcome following surgery. The results on predictive factors of outcome after direct repair of pars defect have not been studied. Material and Methods 52 consecutive young sporting individuals with a mean age of 19 years (range 8–35years) were treated surgically for lumbar pars defect confirmed on imaging studies (i.e., SPECT, CT and MRIscans). 50 patients completed the VAS (visual analogue scores), ODI (Oswestry Disability Index) and SF-36 (Short Form) questionnaires as a part of their assessment. Preoperative background variables were used in a multiple regression model to find the strongest predictor of post-operative outcome as measured by ODI. Results Buck's screw repair of the pars defect was performed in 44 patients (33M: 11 F). Unilateral in 8 patients (7M: 1F) and bilateral in 36 patients (26M: 10F). Although age at surgery showed linear co-linearity (ρ=0.32, p < 0.05), it was not significant in the model. The most consistent association with the preoperative VAS score were the pre and post operative ODI scores i.e., ρ =0.51 ( p < 0.01) and ρ =0.33 ( p < 0.05) respectively. In the bilateral group, with Buck's repair at a single level i.e., 33/36 (93%) patients had returned to sports at a mean time of 7.5 months (range 6–12months). Overall, 44/52 (84%) individuals had returned to their sports with post-treatment ODI score of < 10. The stepwise regression modeling suggested six independent factors (pre-operative ODI, pre-operative SF36pcs, Buck's repair, multiple operations, professionalism and pars defect at L3), as the determinants of the outcome (i.e., post-operative ODI.) in 80.9% patients (R2=0.809). Conclusion The outcome after direct repair of pars defect below 25 years of age runs a predictable course. Professionalism in sports has a high impact on the outcome. Preoperative ODI and SF-36 pcs scores are significant predictors of good functional outcome. The regression equation can predict the outcome in 80.9% sporting individuals undergoing Buck's repair.
Transpedicular Screw Placement for Subaxial Cervical Trauma with Neuronavigation. Experience in a Third World Country. Hospital Santo Tomas. Panama
Authors: De Leon Alvino , Villarreal Orlando , Hermida Jose , Altafulla Juan 
Published: April 2016

Introduction Hospital Santo Tomas is a tretary trauma center in Panama. Subaxial cervical trauma represents a major issue in the care of patients admitted to the neurosurgery department. Lateral mass screw placement is commonly used for posterior fixation. The aim of this abstract is to present our experience not only with transpedicular screws but also doing this with a neuronavigation system and to evaluate the associated risks. Materials and Methods 19 patients in need of posterior fixation with subaxial cervical trauma were stabilized by transpedicular screws from 2010 to 2012 were included. The patients were all male between 20 and 34 years of age. After hemodynamics parameter were assessed and other major trauma was ruled out the neurologic assessment was made. We used the Frankel grading scale and 10 patients were graded A, 4 graded C, 3 graded D an 2 graded E. By this moment a whole body CT was already done. 12 patients have C4-C5 subluxation and the remain had subluxation elsewhere in the subaxial cervical spine. 13 patients needed closed reduction which was assessed by plain films. All patiens had thin cut CT and navigation was planned. All patients were induced by a nueroanesthesiolgy. A three pin head holder was applied and the patients were put in a down face position. Calibration of the navigation system was performed and a standard posterior cervical spine with laminectomy was done. Our hospital does not count until that moment with the aid of intraoperative neurophysiological monitoring. The average surgical time was 3 hours and the blood loss was 750 cc in average. In total 52 screws were placed. All the patients went to a immediately postoperative CT scan. And the screws placement was assessed. No screw mal placement was and no complications during the placement were recorded. The patients were managed in the neurosurgical ward and were discharge 48 hours after the operation with a cervical collar. They were assessed one week after the intervention to review the surgical wound and to preformed a neurological exam. All patients were follow in the outpatient clinic and all were given physical therapy that initiated in the immediately postoperative period. Results Of the Frankel a group three of went on to have grade C, two were graded B and the remain did not improve. One patient in the Frankel C and one in the Frankel D group did better during follow up. No surgical wound infections were recorded. Only one of the patients died from and unrelated cause of pneumonia. All patients were assessed with dynamic films and show no movement. The follow up was up to a year. No patients were lost during that time in the follow up. Conclusion Tanspedicular screw placement is a safe option for posterior fixation. Neuronavigation is and excellent tool for avoiding complications.
Does the Position of the Spacer in Tlif have an Influence on Anatomical Parameters Such as Segmental Lordosis, Foraminal Height? A Prospective Randomized Study
Authors: Ronai Marton , Varga Péter Pál 
Published: April 2016

Introduction In a prospective randomized trial we aimed to validate PMMA spacer in TLIF. Compared with standard, preformed PEEK spacer we didn't find significant difference regarding the clinical outcome, completed bony fusion, subsidence or loosening. When performing TLIF there are different arguments to position the intervertebral spacer in different position (anterior or posterior) In this prospective, randomized study we would like to compare the segmental anatomical changes following the position of a custom made PMMA spacer in monosegmental TLIF. Material and Methods In our study we planned to collect 60 consecutive patients to whom we perform one level TLIF in the lumbar spine. The patients are randomized in two groups by the GraphPad QuickCalcs software. Group A is standard TLIF with PMMA spacer placed in the anterior part of the intervertebral space. Group B is standard TLIF with PMMA spacer positioned in the posterior part of the intervertebral space. Patients between 18–65 years/o were inclouded. Patients with a high grade spondylolisthesis, metabolic bone desease, spinal infection, cancer, severe scoliosis (Cobb over 30°) were excluded. We evaluate changes in segmental, and overall lordosis and in the height of the neuroforamen according to the position of the spacer. Results 58 patients, 31 in group A and 27 in group B, has a minimum of one year follow up. In both groups the segmental lordosis increased. The mean change was 6° in group A and 4° in group B, the difference was not significant. The foraminal height also increased in both groups, the mean change was 18% in group A and 27% in group B but this difference was not significant eather. Conclusion Anterior position of the intervertebral spacer seems to provide more possibility to correct lumbar lordosis, but the advantage on posterior position hasn't been shown significant in this study. Better foraminal height restoration was found in the posterior position of the spacer, but there was no correlation of this parameter to the clinical outcome. We can conclude that both positions provide good radiological and clinical result.
Verification of Nerve Decompression Using Mechanomyography
Authors: Wessell Nolan , Ghacham Wael , Khalil Jad , Zavatsky Joseph , Bartol Stephen 
Published: April 2016

Introduction Assessment of nerve root decompression in surgery is largely based on visualization and tactile feedback. Often times, visualization can be limited, such as in minimally invasive surgery, and tactile feedback is a subjective assessment that makes the evaluation of successful nerve decompression difficult. Electromyography (EMG) has been proposed as an assessment tool but EMG responses are often difficult to quantify. Alternatively, mechanomyography (MMG) provides a quantifiable response with minimal signal to noise ratio compared with EMG. MMG provides a sensitive tool to accurately quantify mechanical responses to motor action potentials generated by electrical stimulus, allowing more reliable assessment of nerve decompression. The objective of this study was to assess the ability of mechanomyography to quantitatively demonstrate successful nerve root decompression. Materials and Methods Seventy-two (72) nerves roots in 46 patients undergoing lumbar decompression procedures were examined using MMG. Nerves were stimulated upstream from the compression site and the lowest threshold current needed to generate a muscle response was determined. Signal response sizes were recorded before and after decompression. Visual-analog scale (VAS) scores were collected pre and post-operatively. Results Ninety percent (90%) of patients (65/72) had elevated stimulation thresholds (>1mA) prior to decompression. After decompression, 98% of patients (64/65) with elevated current thresholds exhibited a drop in threshold of ≥ 1mA ( p < 0.001). A post-decompression increase in response amplitude was recorded in all patients. VAS scores improved post-decompression (6.8 versus 1.1, p < 0.001) with a positive correlation between decreased stimulation thresholds and improved VAS scores ( p < 0.001). Conclusion MMG is an effective tool that can be used to differentiate normal and compressed nerves by quantifying the mechanomyographic response to a stimulating current. MMG allows one to measure the effect of decompression, judge its effectiveness in real time, and eliminate the subjectivity seen in tactile feedback methods. When the adequacy of decompression is uncertain, MMG can guide the surgeon toward additional or alternative procedures to ensure complete nerve root decompression.
Movement along the Spine Induced by Transcranial Electrical Stimulation (TES) Related to the Montage of Electrodes
Authors: Hoebink Eric 
Published: April 2016

Introduction Transcranial Electrical Stimulates Motor Evoked Potentials (TES-MEP) is a safe technique for neuromonitoring during spinal surgery. However induced movement can cause injuries and delay surgical procedures. When TES movements are evoked by other than monitored muscles, one may expect that adjustments in stimulation paradigms and electrode montages may minimize movement while preserving quality of monitoring. In this study, TES evoked seismic evoked responses (SER) are studied at different electrodes montage during spinal deformity surgery. Materials and Methods In 12 patients undergoing corrective spine surgery, intra-operative TES-MEP was performed. Accelero transducers recorded SER in two directions at 4 different locations of the spine for TES-electrode montages groups Cz-Fz and C3-C4. A resulting acceleration value, SERr, was computed. A paired t-test was used to compare the means of SER and the relationship between movement and TES electrode montages. Results SER's are the strongest in the upper body. All mean SER's values of the Cz-Fz group are up to 5 times larger when compared with the C3–4 group. However, there are no differences between the C3-C4 and Cz-Fz groups in the lower body locations. Both electrode montage groups show gradual decreasing steps of all mean SER values along the spine from cranial to caudal. For the upper body locations there were no significant correlations of SERr between both montages, whereas in contrast, a significant correlation of SERr exists at the lumbar region. Conclusions At supramaximum levels, movements resulting from multipulse TES is likely caused by relative strong contractions from muscles in the neck resulting from extracranial direct stimulation. When interchanging electrode montages in individual cases, the movement in the neck may become reduced. At lumbar levels transcranial evoked muscle contractions dominate movement in the surgical exposed areas likely dominated by local muscles.