bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Risk Factors for Early Adjacent Segment Disease Underwent Revision Surgery within 5 Years after Lumbar Spinal Fusion
Authors: Soh Jaewan , Hong Chang-Hwa 
Published: April 2016

Introduction There are many concerns about adjacent segment disease after lumbar spinal fusion using pedicle screws. Of them, we have a question which occurs early adjacent segment disease(EASD) within 5 years. We analyze the risk factors about EASD in patients who underwent revision surgery within 5 years from first operation. Materials and Methods From August 1988 to December 2007, 657 patients underwent lumbar spinal fusion of 3 and less segment to treat degenerative lumbar disease. Among them, 137 patients underwent revision surgery within 5 years due to adjacent segment disease or previously followed more than 5 years were included in this study. Gender, age, fusion method, preoperative diagnosis, number of fusion segments and radiological measurements were analyzed. In radiological measurement, pre-& post-operative lumbar lordotic angle(LLA), pre-& post-operative fusion segment lordotic angle(FSLA), pre-& post-operative FSLA per level, correction of LLA, correction of FSLA, and correction of FSLA per level were estimated. Statistical univariate analysis was performed with the Chi-square test and multivariate logistic regression analysis was done by using SPSS 14.0. Results There were 13 patients with revision surgery due to EASD. 6 patients were operated by decompression or discectomy and 7 patients needed additional fusion. In univatiate analysis, there was little relationship between EASD and gender, age, preoperative diagnosis, number of fusion segments, pre-& post-operative LLA, pre-& post-operative FSLA, pre-& post-operative FSLA per level, correction of FSLA and correction of FSLA per level. However, the frequency of EASD was significantly high in cases where PLIF was more than PLF( p = 0.023), correction of LLA was > 15°( p = 0.021) and correction of FSLA per level was > 5°( p = 0.049). In multivariate logistic regression analysis, the frequency of ESAD was significantly high in case where PLIF was more than PLF(odd ratio = 17.866) and correction of LLA was > 15°(odd ratio = 19.282). Conclusions There was no statistical significance between EASD and gender, age, preoperative diagnosis, number of fusion segments, pre-& post-operative LLA, pre-& post-operative FSLA, pre-& post-operative FSLA per level, correction of FSLA and correction of FSLA per level. However, PLIF and correction of LLA more than 15 degree increased risk of EASD.
Comparison of Three Doses of Epidural Steroid Injection with Single Dose of Epidural Steroid Injection for Lumbar Radicular pain in Spinal Stenosis Patients
Authors: Ahmad Saeed , Aziz Amer , Ahmed Ijaz , Javed Shahzad , Ahmed Naeem , Uz-Zaman Atiq , Akram Rizwan 
Published: April 2016

Introduction Low Back pain and lumbar radicular pain due to Lumbar spine stenosis is one of the most common complaint in the Spine outpatient department or hospital admissions. Epidural steroid injection have well established role in the treatment of lumbar radicular pain, but the exact dose of Epidural Steroid injection has yet to be decided. The aim of this study is “To Compare three doses of epidural steroid injection with single dose of epidural steroid injection for Lumbar Radicular pain in spinal stenosis patients.” Materials and Methods 95 patients with lumbar radicular pain due to spinal stenosis were randomly allocated into 2 groups. In group A 42 patients were given 120 mg of Depo-medrol (40 mg per day for 3 days) and in group B, 43 patients were given 40 mg of Depo-medrol as a single dose. Both group A and Group B were matched in terms of age and gender. On visual analogue score pain was assessed after 2 weeks, 3 months and 6 months. Results In group A (3 doses of depomedrol) VAS improvement at 2 weeks, 3 months and 6 months were more than group B(single dose of depomedrol) which was statistically significant ( p < 0.05). There were no major complications like epidural hematoma or abscess formation in both groups. The overall minor complications like flushing, transient hyperglycemia and headache due to CSF hypotension were more in Group A than Group B but statistics shows no significant difference. All the complications resolved without any morbidity and no patient required further hospitalization. Conclusion In the case of lumbar radicular pain, Epidural Steriod Injection with 3 doses of Depo-medrol is more effective than a single dose of epidural steroid without significant increase risk of complications.
Thoracic Disc Herniation: 20 Years Experience in 82 Cases
Authors: Rahimizadeh Abolfazl 
Published: April 2016

Objective Thoracic disc herniation in uncommon though its surgical management remains challenging topic. Surgery of such disc herniation represents less than 1%to 2% of operation for all disc disease. However, there is no consensus on the best approach and reports are based on small series. Method:This study includes 82 patients with thoracic disc herniation operated in the past 20 years. 71 cases were operated via transthoracic or retopeitonral subdiphargmatic approach and nine through transfacet pedicle sparing route and Two with T1-T2 through low suprasternal notch corridor. In 12 instances two level discs were approached and in one three level, corpectomy was done in 3 cases. Autogenous graft was used in 18 cases, simple cages in 36, expandable cage in three and allograft in the remaining cases. Result Clinical outcome according to the thoracic JOA Score showed significant postoperative improvement. All transfacet pedicle sparing cases and two cases with isolated T1-T2 showed excellent result. six of the anterior group cases were complicated with unilateral paralysis of abdominal wall muscles. Intraoperative dural tear occurred in 4 cases which were sutured. All the patients in this group showed marked recovery except one who was temporarily deteriorated but gradually became better but not fully yet. In two other patients who were wrongly operated with laminectomy and screw fixation no recovery was seen in one but the other one has shown some recovery. In one case where the dura was covered with a thin layer of free fat graft for control of bleeding, overgrowth of fat was observed without any neurology till now. Conclusion Surgery of thoracic disc pose a challenge to the surgeon. The type of the surgery depends on the location of the disc. Centrally located ones and calcified hard ones are best achieved anteriorly But does located laterally via transfacet pedicle spring. Clinical outcome after surgery of a herniated thoracic disc proved successful, especially when the disc consistency, is evaluated before surgery and the affected level intraoperatively. Microscope, patience and the learning curve are important in achieving good result.
How Lumbar Disc Geometrics Affect the Risk for Rod Fracture in Patients Undergoing Adult Spinal Deformity Surgery: An Initial Report
Authors: Briski David , Zavatsky Joseph , Cook Brandon 
Published: April 2016

Introduction Rod fracture (RF) may have significant consequences for patients, including pain, loss of deformity correction, and the need for revision surgery. Risk factors associated with RF includes age, previous spine surgery, insufficient sagittal plane correction, rod material and bending, and pedicle subtraction osteotomy (PSO). Lumbar disc geometrics, regardless of PSO, may be a risk factor affecting RF rates. Out Objective is to evaluate disc geometrics as a risk factor for RF in patients undergoing surgical correction for adult spinal deformity (ASD). Materials/Methods: A retrospective review of a single surgeon's practice from 2010 to 2014 was performed. All patients who underwent long fusion constructs for adult deformity with a minimum of 2-year follow-up with radiographs were included. Patients were divided into 2 Groups: Group 1 (RF) - patients who sustained a rod fracture, Group 2 - patients without RF. Results Thirty-seven of 41 patients met inclusion criteria. Group 1 - included 11 patients (30%) with RF, all requiring revision surgery. Group 2 - included 26 patients (70%) who did not have evidence of RF at 2-year follow-up. There was no significant difference between the 2 Groups regarding age, weight, construct length (12 versus 11 levels), apical lordosis level (L3), pre or post-operative lumbar lordosis, or mean number of non-fused lumbar discs (3). Twenty-one of the 37 patients (54%) had a PSO performed. There was no difference in the prevalence of PSO between the 2 Groups: 5/11 patients (45%) in Group 1 (RF) versus 17/26 patients (65%) in Group 2. Nineteen of the 37 patients (51%) had previous lumbar spinal surgery. Measurements comparing intervertebral disc geometry 2 levels immediately cranial and caudal to the PSO or the apical lumbar vertebra were noted to have a significant difference in the mean cranial disc height (9.5mm versus 6.5mm, p < 0.01), mean cranial diameter (40mm versus 34mm, p < 0.01), mean cranial volume (13284mm3 versus 8145mm3, p < 0.01), and mean caudal volume (10635mm3 versus 7771mm3, p = 0.02). Caudal disc heights and diameters were larger in the RF group, but did not reach statistical significance. Conclusions The overall prevalence of RF was 27% with no difference in PSO rate between the 2 Groups. Patients with RF had significantly larger non-fused disc heights, diameters and volumes. The increased disc geometrics may allow for increased micro-motion in the anterior column resulting in increased failure rates. Lumbar interbody support in those discs at risk may improve stability and decrease RF rates. Further data analysis and clinical correlation is required.
Preoperative Prone Position Exercises: A Simple and Novel Method to Improve Tolerance in Kyphoplasty for Treatment of Single Level Osteoporotic Vertebral Compression Fractures
Authors: Lee Guangzhou , Wang Qing 
Published: April 2016

Introduction To evaluate the effect of preoperative prone position exercises(PPPE) on patient tolerance to percutaneous kyphoplasty(KP) and to determine if such exercises will improve postoperative clinical outcome. Material and Methods Eighty-three patients with single level osteoporotic vertebral compression fractures (OVCFs) were nonrandomly assigned to undergo KP under local anesthesia with PPPE or without. The number of procedure with or without a pause, need for intravenous sedation, and patient satisfactory were recorded and analyzed. Clinical outcomes were assessed using the visual analog scale and the Oswestry Disability Index. The follow-up time was 6 months. Results The baseline characteristics of both groups were comparable. The number of procedure without a pause in the exercises group was more than the control group (30/42 patients vs 10/41 patients, respectively, P < 0.001),and fewer patients required intravenous sedation in the exercises group (7/42 vs 28/41, respectively, P < 0.001). Patients in the exercises group were more satisfied compared with the control group (41/42 vs 32/41, respectively, P < 0.01). There were no significant differences between the two groups with regard to improvement in pain and functional scores at all postoperative intervals. Conclusion PPPE improves patient tolerance and satisfaction and decreases the need for intravenous sedation for patients with single level OVCFs undergoing KP under local anesthesia. To confirm and validate the results of our study,a large multi-center randomized controlled trial (RCT) study should be conducted.
Facet Joint Manipulation for Craniovertebral Junction Arthrodesis. Worth the Extra Effort?
Authors: Duff John , Henchoz Yves , Bobinski Lukas 
Published: April 2016

Introduction The goal of arthrodesis is bone fusion, effected at the craniovertebral junction through onlay of either morselized iliac crest autograft (ICAG), or posterior structural unicortical ICAGbetween posterior elements. As an alternative, facet manipulation (FM) with C1-C2 or C0-C1 facet decortication and “jamming” of bone spacers into the articular space (C1-C2) has been described. We describe a series of 79 cases of surgical fusion of at least 1 component of the CVJ. FM was used in 65 cases requiring arthrodesis. Among these, we describe 14 cases using cages placed in the atlanto-axial joints (Cage assisted facet arthrodesis CAFA). To examine the efficacy of FM, we look specifically at CT documented fusion, and time to fusion using this technique. Material and Methods Retrospective review of medical records of 88 patients undergoing posterior arthrodesis of the craniovertebral junction (CVJ) at our unit from May 2004 to December 2013 was performed. 4 patients were excluded in case of early postoperative death (up to 30 days after the surgery). 5 patients had insufficient radiological follow-up data (follow-up < 6 months). Construct length is detailed in Table 1 . Fusion – pseudarthrosis. Fusion was considered successful on CT if there was visible bridging trabeculations with or without bony remodeling and callus formation, across at least one of C1/C2 facets, and absence of pseudoarthrosis. Criteria for pseudoarthrosis were construct failure, or bone lucency around the screws. Time to fusion was defined as months between surgery and the earliest radiological assessment confirming solid fusion. Results Fusion rate and time to fusion. Sixteen patients were not considered for fusion analysis ( N = 6 not grafted), or insufficient follow-up ( N = 10). A solid fusion was achieved in 55 (87.3%) patients. Fusion rate was strongly associated with age. [Table: see text][Figure: see text] Conclusion Many techniques are used to achieve solid bony fusion in the upper cervical spine. Facet manipulation, first described by Goel should be the ideal fusion bed but has not been widely used. We report our experience using FM as a fusion technique to highlight its usefulness as a primary means of achieving fusion. It exploits the weight bearing part of the spine, the volume of bone graft materiel is very small compared with other techniques, it can be used when there are no posterior elements. Cage assisted facet arthrodesis (CAFA) may accelerate time to fusion, and may enhance fusion rates.
Two Level Anterior Cervical Arthrodesis with Integrated Spacer and Plate versus Traditional Anterior Spacer and Plate System
Authors: Panchal Ripul , Beliveau Angela , Lee Paul , Shen Peter , Li Chin-Shang , Klineberg Eric , Kim Kee 
Published: April 2016

Introduction Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed by spine surgeons to treat cervical degenerative disc disease. Use of anterior spacer and plate system (ASPS) results in increased disc height, a higher fusion rate, a lower subsidence rate, and a lower complication rates than a spacer alone.1,2 However, anterior cervical plating (ACP) is associated with significant complications, such as dysphagia, plate screw dislodgement, soft tissue injury, esophagus perforation, and neural injury.3–9 Integrated spacer and plate (ISP) or zero-profile cage systems have recently gained popularity among spine surgeon to reduce the drawbacks of the ASPS technique. The objective of this study is to retrospectively evaluate and compare clinical and radiographical outcome of patients after two-level ACDF with IPS and traditional two-level ASPS. Materials and Methods From January 2007 to October 2014, a total of 84 consecutive patients with cervical degenerative disc disease who underwent two-level ACDF using the ISP or the ASPS were reviewed for clinical and radiographical outcomes. Patient reported VAS and NDI scores, fusion rates, hardware failure were recorded at 1, 3, 6, 12, and 24 months after surgery. Results Forty-three patients received ISP and forty-one patients received ASPS. There were no statistical differences in patient demographics between the two groups. In regards to operative details, there was no statistical differences except ISP were done almost exclusively with autograft and ASPS with allograft. Overall, there were no statistical differences in VAS scores, NDI scores and fusion status between the two groups (p > 0.05). At the proximal surgical level, there was a trend toward an earlier observed radiographic fusion rate in the ASPS group, 6.8 ± 5.4 months compared with ISP group, 8.3 ± 5.5 months ( p = 0.09). Similarly, the observed radiographic fusion rate at the distal surgical level in the ASPS group was 7.0 ± 6.2 months and in the ISP group was 8.1 ± 5.5 months ( p = 0.12). One case of long-term dysphagia (> 3 months) was reported in each group. Both groups had no reports of implant failures. Conclusion The integrated spacers and plate for two-level ACDF compared with traditional anterior spacer and plate system may provide comparable clinical and radiographical outcome at two years. However, there may be an earlier observed radiographical fusion in the ASPS group and no difference in long-term reported dysphagia rate.
Is it Necessary to Fuse to S1 for the Tilted L5 in the Treatment of Adult Degenerative Scoliosis?
Authors: Wang Dechun 
Published: April 2016

Introduction The extension of fusion to S1 compared with L5 and lower thoracic levels compared with L1 remains a highly controversial topic in the surgical treatment for adult degenerative scoliosis (ADS). As one of the criterion, if the tilted L5 were over 15°, the distal fusion level should extend to the sacrum. Could the tilted L5 be neutralized and the L5S1 be saved in the ADS correction? Material and Methods Posterior one stage of facetectomy and interbody release combined with key segment anterior structural column support were used to treat 32 ADS cases. The thoroughly interbody release and fusion were done with both side in all involved segment, a little bigger inserter were inserted into L3,4 and L4,5 cave side to neutralize the tilted L5 maximally. The operating time and the blood loss were recorded. Mean follow-up was at least two years. All the subjects were analyzed by visual analog scale, Oswestry Disability Index (ODI), and SF-36 scores, SRS 22 before and after surgery and at follow-up. The scoliotic curve, thoracic kyphosis, lumbar lordosis, pelvic incidence (PI), pelvic tilt (PT), sacral slope, and C7 plumb line were measured. For the statistical analysis, multivariate multiple regression models were formulated, considering as significant ( p < 0.05). Results The average operating time were 150min and the mean blood loss were 520ml. A statistically significant clinical and radiological amelioration was noted after surgery and at final follow-up. The ODI, and SF-36 scores, SRS 22 improved. The Cobb angle of lumbar lordosis (7 plumb line) and spino-pelvic parameters (PI, PT, sacral slope) returned to the normal range after surgery. L5S1 radiological adjacent segment pathology (RASP) happened in two cases at the follow-up, one was extended to the S1,there is no symptom in another case. Conclusion The tilted L5 can be neutralized and the L5S1 can be saved in the ADS correction. Even with a little movement, the saved L5S1 is important for a whole body to balance.
Lateral Approach for Anterior and Anterolateral Placed Cervical Meningioma or Schwannoma
Authors: Abou-Madawi Ali 
Published: April 2016

Introduction Cervical meningioma and schwannoma are benign tumors that may present with a wide variety of clinical features. Surgical treatment of those tumors carries a risk of neurological complications and spinal deformities. Surgical approaches include posterior, anterior, or anterolateral options. This is a Descriptive retrospective clinical case series to evaluate the lateral surgical approach in these tumors. Patients and Methods We reviewed patients who underwent lateral surgery for anterior and anterolateral placed cervical meningioma or schwannoma through the past 7 years. A total of 23 patients including 15 females and 8 males were reported. Mean age was 46 years. The average duration of history was 14.9 months. Fourteen patients had meningioma and 9 had schwannoma. According to the JOA-score 15 were normal, 5 were grade-1 and 3 was grade-2. The following factors were evaluated; age, sex, duration, pathology, levels, topographical locations, neurological status, operative time, blood loss, hospital stay, morbidity, and clinical outcome. Results All patients were operated through the lateral cervical approach. All patients but three had total tumor removal where small fragment were lift due to technical reasons. According to the JOA-score the 15 normal patients remain the same, the 5 grade-1 improved to normal, and the 3 grade-2 patients improved to normal in one and to grade-1 in another. There was no reported major morbidity or mortality. CSF leak into the closed drainage system was reported in 5 patients without serious effects. Conclusions The lateral approach allows for safe and effective removal of anterior and anterolateral placed cervical meningioma or schwannoma. It gives a direct access to tumor without risk of cord manipulation or destabilizing the spine. In addition it gives the same clinical results.as the standard posterior approach.
Trends in Hospital Admissions and Surgical Procedures for Degenerative Lumbar Spine Disease in England: a 15 Year Time-series
Authors: Siva Vino , Papadopoulos Marios , Ozedemir Baris , Patel Hitesh 
Published: April 2016

Introduction Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources. Material and Methods Retrospective cohort study using Hospital Episode Statistics (HES) data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyze trends. Outcome measures include trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay. Results Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100,000, respectively( p < 0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33 fold increase in admissions for patients aged 60–74 and ≥75 years respectively, and a 2.8 fold increase in procedures for those aged ≥60 years. Trends in hospital admissions were characterized by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay ( p < 0.001). Trends in procedures were characterized by a narrowing gender gap, increasing mean patient age ( p = 0.014) and decreasing mean hospital stay ( p < 0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100,000 (95%CI 0.25–0.30, r 0.99,p < 0.001). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient: 7.63 versus 2.18 per 100,000/year). Conclusions LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non-surgical management of this disease, and highlight the need for services capable of dealing with the increased co-morbidity burden associated with an aging patient group.