bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronal and Sagittal Plane Correction in Adolescent Idiopathic Scoliosis (AIS) using All Pedicle Screw versus Hybrid Instrumentation. A Systematic Review
Authors: Mostafa Wael , El-Sharkawi Mohammad , Koptan Wael , Darwish Manal , Quraishi Nasir A. 
Published: April 2016

Introduction Using all pedicle screw (APS) technique for the treatment of AIS is said to be more effective than hybrid instrumentation (HI). However this has not been proven yet. This systematic review on studies comparing all pedicle screw and hybrid instrumentation in the treatment of AIS tries to answer this question. Material and Methods Pubmed and Medline Databases have been searched for articles from 1990 to June 2015 using the keywords “adolescent idiopathic scoliosis,” “hybrid” and “screw.” Only papers with full text in English were reviewed. Eleven articles met the inclusion criteria (only adolescent idiopathic scoliosis, main thoracic and thoracolumbar curves, posterior instrumentation and fusion only i.e., no anterior release, at least 2 of the parameters evaluated is mentioned preoperative and at final follow up “one coronal plane parameter and one sagittal plane parameter”). Ten of the articles were retrospective cohort studies and one was a prospective cohort study. Level of evidence for all of them was 3. The following parameters were evaluated preoperative and at final follow up: thoracic kyphosis, main thoracic Cobb's angle, coronal correction ratio, global sagittal balance and global coronal balance. The follow up duration ranged from 2 – 5 years. Meta-analysis could not been performed because of the heterogeneity of the data. Results The total number of patients was 614 (306 APS, 308 HI). The only significant difference found was the coronal correction ratio (67.71% in APS vs 58.34% in HI, p = 0.001). Thoracic kyphosis changed from 24.5° to 21.3° in the APS group and from 25.4° to 23.6° in the HI group ( p = 0.419). Global coronal balance changed from 15mm to 8.8mm in the APS group and from 14.6mm to 8.9mm in the HI Group ( p = 0.811). Global Sagittal Balance changed from (−7)mm to (−4.6)mm in the APS and from (−1)mm to (−3.6)mm in the HI group ( p = 0.344). Conclusion Using all pedicle screw technique for the treatment of AIS may achieve better coronal plane correction. Contrary to the common belief, the use of Hybrid instrumentation does not lead to a better sagittal correction than all pedicle screw technique.
Vertical Expandable Prosthetic Titanium Rib (VEPTR) Complications
Authors: Abouyoussef Islam , Ventura Norberto 
Published: April 2016

Introduction This retrospective study evaluates the complications and radiographic results of 30 patients treated with VEPTR for correction of complex spine deformities in children. Material and Methods 30 cases of spine deformities followed up for a minimum of 2 year and maximum of 7 years, were retrospectively reviewed. 8 congenital malformation of spine, 3 infantile scoliosis and the others were spinal deformities associated with; spinal cord tumors, osteogenesis imperfecta, Jarcho Levin syndrome, spinal muscular atrophy, arthrogriphosis, myelomeningocele and congenital myopathy. The age at surgery varied between 2 and 12 years (6.65). We studied the postoperative change in cobb's angels (in antero-posterior and lateral views), space available for lung (SAL) and complication patterns in relation to number of lengthening operations. Results Complications: the complications rate was (36.6%). Complications varied from mortality “one case (3.3%)” to skin sloughing, surgical site infection, junctional kyphosis, metal failure, and pelvic hook migration. The average Cobb's angles preoperatively in the antero-posterior view were 86.8°, while the postoperative average was 55° (average correction 31.8°). The average (SAL %) was 82.3% preoperatively, and has been improved to become 93.5% postoperatively. Conclusion VEPTR represents a good alternative to “spine to spine growing rod techniques” and vertebral column resections “VCR” in spite of its complications rate with regard to the nature of deformity and number of “lengthening reoperations,” however it should be used in well selected cases.
Why Does C5 Palsy Occur after Prophylactic Bilateral C4-5 Foraminotomy in Open-Door Cervical Laminoplasty? A Risk Factor Analysis
Authors: Liu Gabriel , Reyes Ma. Ramona , Riew K. Daniel 
Published: April 2016

Introduction Prophylactic bilateral foraminotomy has been shown to reduce the risk of C5 palsy after open-door laminoplasty surgery. However, it does not totally eliminate it. Other factors such as inherent cord pathology may play a role in its development. Material and Methods A retrospective review to evaluate the efficacy of bilateral C4–5 foraminotomy in preventing occurrence of postoperative C5 palsy and to identify possible risk factors for its development was performed. A total of 70 consecutive patients who underwent open-door laminoplasty with bilateral C4–5 foraminotomy were included. Clinical, radiographic, and operative data were reviewed. Development of postoperative C5 palsy was analyzed. Results Fifty-four males and 16 females were reviewed. Mean age was 56 years (range, 30–86 years). The primary pathology was spondylosis in 76% of cases and ossified posterior longitudinal ligament in 21%. Radiographic evidence of C4–5 foraminal stenosis was seen in 81% of the patients. The mean duration of preoperative symptoms was 7 ± 19 months. Four (5.7%) out of 70 patients developed C5 palsy after open-door laminoplasty with bilateral C4–5 foraminotomy. Multivariate analysis showed that a long duration of preoperative symptoms (> 12 months) and the presence of preoperative C4–5 T2-MRI cord signal change were statistically significant risk factors for the development of C5 palsy even after bilateral C4–5 foraminotomy in open-door laminoplasty ( p < 0.0001 and P 0.036 respectively). Conclusion While bilateral C4–5 foraminotomy may reduce post-laminoplasty C5 palsy when compared with the historical cohort, foraminotomies do not eliminate C5 palsy occurrence. Prolonged duration of symptoms and presence of preoperative T2-MRI cord signal change increased the risk for developing postoperative C5 palsy in laminoplasty patients who underwent bilateral C4–5 foraminotomy.
Efficacy of a Postoperative Infection Prevention Protocol in Spine Surgery
Authors: Pantoja Samuel , Luna Felipe , Hervé Beatrice , Gutierrez Cecilia , Postigo Roberto 
Published: April 2016

Introduction post operatory wound infection is an unwanted complication of spine surgery. Infection rate ranges from 2.1 to 5.5%, and the consequences in some cases can be devastating for the patient and for the medical team. Material and Method: we compare post-operative wound infection incidence before and after the implementation of a wound infection prevention protocol specific for major spine surgery established in our Center in collaboration with the HealthCare Associated Infection Committee (HCAIC). Post operatory wound infection incidence was reviewed for 4 years after implementation. The protocol consisted on a 28 point check list, that included: skin preparation with chlorhexidine one day before surgery at home, and at entrance the morning of the surgery; strict control of blood glucose under 200mg/dL before surgery; programming instrumented surgeries preferably as the first surgery of the Operating Room (OR); OR with laminar air flow; OR temperature between 18°-22°C during surgery (64.4°-71.6°F); skin preparation with alcohol-based chlorhexidine and covering with adherent antimicrobial incise drapes at surgery; Cefazolin prophylaxis (or Clindamycin in case of β-lactam antibiotics allergy) no more than 60 minutes before skin incision and a new dose every 3 hours during surgery; strict control of patient temperature at 36°C(96.8F) with the aid of warming blankets (Bair Hugger®); maintaining a target Hemoglobin of 7–9 g/dL with restriction of blood transfusion indication; hematocrit and glycemia control after surgery and the morning after. Results After the introduction of the protocol we found a progressive reduction in the post operatory wound infection rate in spinal surgery from 2.89% in 2009 (before the protocol), to 2,5% in 2010, 1,71% in 2011 and 1.56% in 2012. During the surveillance made by the HCAIC, we observed a rise in the infection rate during 2013 (2.02%) which was associated with breaches in protocol adhesion. The relevance of the check list control by the OR nurse was reinforced and the strict control of patient temperature at 36°C(96.8F) with warming blankets used before, during surgery and in recovery room was added. With this new update and more strict control of protocol adhesion, we reduced the infections rate to 0.95% in 2014. Conclusion We consider that a wound infection prevention protocol specific for spine surgery, with proper surveillance and strict follow-up, is an effective way for reducing the infection rate in spine surgery. Although, the microbiological environment for every center is different, we think that this protocol can be used as a guide for centers were this complication becomes an issue.
Factors Leading to a Poor Functional Outcome in Spinal Meningioma Surgery: Clinical and Surgical Remarks on 173 Cases
Authors: Raco Antonino , Pesce Alessandro , Toccaceli Giada , Dominicucci Maurizio , Delfini Roberto 
Published: April 2016

Introduction Spinal meningiomas are common spinal tumors in most cases benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement or spinal root involvement can bring to a less favorable prognosis. Aim of this work is to systematically the influence of this factors in the neurological outcomes of our patients. Matherial and Methods 224 consecutive patients with spinal meningiomas treated from 1976 to 2013 in our institution were analyzed; among these 51 were excluded for incomplete clinical data or follow up. The remaining 173 cases were classified regarding to: sex, age, symptoms, axial location, Simpson Grade resection, Functional pre/postoperative status. Results Most recurring onset symptoms were pain (32,9%) and motor deficit (31,8%); Thoracic spine was the most severely affected (69,8%). The functional improvement on the follow up was observed in 86,7% of cases, 6,4% of patients resulted stable and 6,9% worsened; a low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42,2%); a gross total resection (Simpson Grade I and II) was conducted in 98,8% and a macroscopically complete removal without dural resection or coagulation (Simpson III) was performed in 1,2%. 98,3% of meningiomas were classified as Grade I WHO. Recurrence rate was of 2,3% and 7 cases presented complications (4 of 7 required surgical procedure). Conclusions We can adfirm that negative prognostic factors in our study were: anterior or antero-lateral axial topography, long-lasting symptoms before diagnosis, WHO Grade > I, Simpson Grade resection II and III, sphincter involvement and worse functional grade at onset.
Right versus Left Sided Exposures of the Recurrent Laryngeal Nerve (RLN) and its' Branches- A Fresh Cadaveric Study Relevant to the Cervical Spine
Authors: Rajabian Ali , Quraishi Nasir A. 
Published: April 2016

Introduction The higher vulnerability of RLN in anterior approach to the cervical spine on the right versus left sides is the subject of ongoing debate. While most cadaveric studies have focused on in situ variations in course and local structural relations of the RLN as a suitable guide, they have mostly been done in preserved (fixed) cadavers or without relevance to the needs of spinal exposure. Our aim was to perform surgically relevant exposures of the anterior cervical spine with particular attention to observing the potential vulnerabilities of the RLN on right and left side in fresh cadaveric specimens. In addition, we aimed to explore its branches. Materials and Methods 12 cadavers had extensive layer by layer dissections by 2 surgeons (one with extensive experience as anatomy dissector). The RLNs and its branches were exposed in their entire length and explored for vulnerability. (Each stage was photographed) Results In all specimens, we demonstrated that right sided approach clearly causes undue stretch of the nerve and its branches particularly below C5 (photographed). The left side provided a good exposure without undue traction on the nerve. However, the terminal oesophageal branches of the nerve were especially vulnerable to this stretch or direct pressure on the left side. Conclusion Traction neuropraxia of the upper oesophageal branches of the RLN nerve may provide an alternative explanation for the transient post-op dysphagia (upto 60%). The laryngeal supply of the RLN benefits from Galen's anastomotic nerve supply of SLN (Ansa of Galen) and hence the neuropraxia of the nerve is less frequently symptomatic. Below C5, the left sided anterior cervical approach permits a wider access to the entire anterior cervical spine with less risk to the RLN. Neuropraxia induced on the oesophageal branches (directly by retractors or indirectly by traction) could provide a possible explanation for transient post-op dysphagia. We believe that this will help spinal surgeons to refine their surgical technique and thus reduce the incidence of iatrogenic injury. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Long-term Clinical and Radiological Outcome Evaluation of 3- and 4 Level ACDF with a Zero-profile Implant. Impact of Cervical Sagittal Alignment on Clinical Outcome
Authors: Barbagallo Giuseppe , Certo Francesco , Palmucci Stefano , Albanese Vincenzo 
Published: April 2016

Introduction Concerns remains on the role of ACDF in multilevel cervical disease as opposite to posterior approaches, and on the importance of cervical sagittal alignment in influencing long-term clinical outcome. We aim to analyze the efficacy of 3- and 4-level ACDF with a zero-profile implant in restoring cervical sagittal alignemnt as well as the impact of alignment on clinical outcome, both at early and long-term follow-up. And also to evaluate type and rate of complications. Material and Methods 24 patients (14 male), ranging in age from 41 to 77 years (mean 58.4) and suffering from multilevel spondylosis, were enrolled. Neurological improvement was graded according to the Nurick scale. NDI, VAS and SF-36 were used for pre- and postoperative functional evaluation. Imaging included X-rays, CT and MRI before surgery; X-rays were obtained at every follow-up visit and CT scan at last follow-up. Sagittal alignment was assessed before and after surgery using the Cobb method. Fusion rate was studied on both X-rays and CT scan. Complications were analyzed and dysphagia evaluated using the Bazaz scale. Results Mean follow-up ranges from 24 to 72 months (mean 39). No intra- or postoperative complications, either related to surgical technique or to devices implanted, were encountered. Mean neck pain VAS score decreased from a 6.7 ± 2.9 to 1.6 ± 2.3 ( p < 0.01). Mean arm pain VAS score decreased from 5.9 ± 2.9 to 0.9 ± 1.4 ( p < 0.01). There were significant improvements ( p < 0.01) in SF36 and NDI following surgery. Five patients complained of mild dysphagia (20.8%). Three of them (12.5%) showed complete resolution within two months (short-term dysphagia); the other two (8.3%) within six months (medium-term dysphagia). No case of long-term dysphagia (more than 6 months) was observed. According to Pitzen criteria, radiographic fusion was achieved in 90% of patients. Cobb angle had a significant improvement both after surgery and at long-term follow-up. Conclusion 3- and 4-level ACDF with a zero-profile device is safe and effective. It allows satisfactory neurological and functional outcome as well as interbody fusion. Multilevel anterior approach provides satisfactory sagittal alignment restoration, and this is associated with persistent clinical improvement at long-term follow-up.
Adult Spinal Deformity in the Elderly. Preliminary Clinical and Radiological Results in 22 Patients Treated by a Two Times Minimally Invasive Spine Surgery
Authors: Cimatti Marco , Forcato Stefano , Miscusi Massimo , Frati Alessandro , Polli Filippo Maria , Raco Antonino 
Published: April 2016

Introduction The adult spinal deformity (ASD) seems, in the last years, in a progressive increment. It should be in relation to the aging of the population. This trend leads to a progression of the disability and the reduction of the quality of life of these patients. The surgical correction of the ASD obtained by a traditional “open” surgery can often be incompatible with the co-morbidities of these patients. The minimally invasive surgery for correction of the deformities (MISDEF) can offer technical nuances, such as reduce of intraoperative blood loss and quickly recovery, which can lead the opportunities for these patients to approach the surgery. We present the preliminary results of our observational study on the radiological correction and clinical results of old patients affected by ASD treated by MISDEF. Methods Observational study with 20 months of follow-up. Twelve patients affected by low-back pain, sciatalgia and/cruralgia, neurological claudication were enrolled in this study. All the patients underwent to a MISDEF based on a percutaneous transpedicular stabilization plus a lateral or transforaminal interbody fusion. We collected all the radiological datas, such as sagittal vertical axis (SVA), sacral slope (SS), pervic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL) and coronal cob (CC) and the clinical status, oswestry disability index (ODI) and SF-36. Results The mean age was 70 years (65 – 78 years), 3 men and 9 women. 7 patients presented a lumbar left side convex scoliosis, while 5 patients presented a right side one. All the patients underwent to a 2 times surgery: the first time was a lateral access, the second time was the posterior access. The side for the lateral interbody fusion was the concave side of the scoliosis. L4L5 segment was always been approached for a transforaminal interbody fusion. The proximal strumental vertebra was T10. The mean intraoperative blood loss was 500 cc. All the patients were mobilized within 2 days. The ODI and SF36 evidenced a statistically improvement ( p < 0,05). No evidence of infections, neurological deficit, failure of the implant and/or loosening of correction were documented in the follow up. Conclusions The MISDEF offers, even for elderly patients with co-morbidities, a valid and secure surgical solution for the correction of the ASD. From the results of our study appeared a good compliance of these techniques for all the patients, with a good result even at 20 months of follow-up. We considered that the opportunity to separate the surgical correction of the deformity in 2 times surgery seems to be a better and secure solution especially for elderly patients.
Pelvic Incidence is Not Constant
Authors: Tammam Hamdy , Mostafa Amer , Gad Wael , Koptan Wael , El-Sharkawi Mohammad 
Published: April 2016

Introduction The pelvis is a very important component in the overall balance. It changes its orientation in space aiming at compensation for any sagittal imbalance. Three pelvic parameters were recognized as descriptive tools for pelvic status. Pelvic incidence (PI) is considered as a constant value after maturity which changes only in pelvic trauma. This work aims to evaluate if the surgical correction of the fixed sagittal imbalance has any effect on the pelvic incidence. Patients and Methods Twenty seven cases with fixed sagittal imbalance were corrected surgically by posterior spinal osteotomies and prospectively followed for at least one year. Pelvic Incidence (PI), Sacral Slope (SS), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK) and Sagittal Vertical Axis (SVA) were compared between preoperative, postoperative and last follow up long standing lateral whole spine radiographs. Measurements were taken by three experienced spine surgeons independently. Results Twenty four cases were included, half of them were males, and the mean age was 16.3 (5–46) years. PI was fixed or changed by five degrees or less in seventeen cases (70%). PI increased in four patients (16%) by more than five degrees and decreased by more than five degrees in three cases (12,5%). The mean increase in the PI was 11.75° (6–20°) and 11.2° (7–23°) postoperatively and at last follow up respectively. Conclusions Despite that the PI is fixed or minimally changes (five degrees or less) in most of the cases of surgically corrected fixed sagittal imbalance, it is increased in some patients and decreased in others. The long term effect of this observation and its implication on surgical planning is yet to be determined.
A Radiological Evaluation of Effect of a Single Level Trans-Foraminal Lumbar Interbody Fusion (TLIF) on Lumbar Sagittal Parameters
Authors: Salem Khalid , Fisher Charles , Dvorak Marcel 
Published: April 2016

Aim To investigate the effect of a primary single level TLIF on the lumbar sagittal profile (segmental lordosis and total lumbar lordosis) comparing pre-operative, intra-operative and post-operative radiographs in patients with lumbar spine degenerative disease. Methods Patients over the age of 16 who underwent a single-level interbody fusion for degenerative stenosis and/or spondylolisthesis without scoliosis between March 2008 and March 2014 were reviewed. Age, gender, surgical level, surgical approach, facetectomy (unilateral vs bilateral) were recorded. Standardized pre and early and 6 month postoperative upright radiographs as well as an intra-operative lateral radiographs were analyzed for the pelvic incidence (PI), segmental lordosis (SL) at the TILF level and total lumbar lordosis (TL). Data analysis was performed after confirming normality using a paired t-test and is presented as mean (SD). p-value < 0.05 was considered significant. Results 69 patients were reviewed. The mean age was 58.6 (13.6) years, 39 males (56.5%), a Wiltse approach was used in 30 (43.5%) while 39 had a midline posterior approach. Segments operated were L2/L3 (1 case), L3/L4 (6), L4/L5 (43), L5/S1 (19) and bilateral facetectomy was performed in 13 (18.8%). SL changed from 15.2° (7.3) preoperatively to 20.4° (7.7) intraoperatively ( p-value < 0.0001) but measured 17.9° (7.2) ( p-value < 0.0001) on early postoperative images and 17.2° (7.3) at 6 months follow up ( p-value= 024). The total improvement in SL at 6 months was 2° (6.7), ( p-value= 0.001). TL change was insignificant on the early postoperative X-rays (48.5° (12.4) to 47.2° (11.3), p-value= 0.37) but significantly increased to 53.1° (11.5) at six months ( p-value < 0.0001) with a total improvement of 4.6° (10) ( p-value= 0.001). The mean pelvic incidence was 59.7° (11.2). The cage subsided in 11 (15.9%) cases and we had no metal work loosening. Conclusion At the level of the TLIF, much of the lordosis achieved intra-operatively is lost once the patient mobilizes. An improvement in the total lumbar lordosis at 6 months following surgery is likely to be due to the decompression component of the surgical intervention.