bluuebunny/crossref_metadata_2025_split huggingface dataset:
2-Year Outcome of a New Modified Luque Trolley Technque versus Traditional Growing Rods in the Management of Progressive Juvenile Onset Scoliosis
Authors: Cottam Andrew , Van Herwijnen Bart , Davies Evan 
Published: April 2016

Introduction Our objective was the long term evaluation of a new growth guidance technique compared with growing rods for posterior instrumentation of scoliosis. We performed a retrospective review of patient records and radiological imaging. A traditional Luque Trolley construct uses wires to hold growth guidance rods together. We describe a new technique which uses Domino end to side connectors in place of the wires with the aim of providing a stronger construct to limit curve progression. From a group of 28 patients treated with this technique we review 23 patients with a minimum of 2 year follow up. The mean age at surgery was 7.3 years (10 Male and 18 Female). The mean pre-operative Cobb angle was 69.1 degrees. All patients had posterior correction and modified Luque trolley construct with domino. We compared this to a group of 6 patients with a minimum 2 year follow up who were treated with growing rods. The mean age of this group was 7 years (2 Male 4 Female). The mean pre-operative Cobb angle was 56.5 degrees. All of these patients had posterior correction with growing rods. Materials and Methods Sequential measurement of Cobb angle and length of rods was performed, with recording of further surgical procedures and associated complications. This enabled us to demonstrate curve progression and growth of the construct in both patient groups. Results In the domino group the mean pre-operative curve was 69.1 degrees corrected to a mean post-operative angle of 36 degrees showing a mean percentage correction of 48.9%. This compared with a mean pre-operative curve of 56.5 degrees in the growing rods group, which was corrected to a mean post-operative angle of 36.1 degrees showing a mean percentage correction of 41.3%. In both groups the curves progressed despite surgery with a mean progression of 10.9 degrees after 1 year and 15.7 degrees at year 2 in the domino group and a mean progression of 3.3 degrees after year 1 and 14.9 degrees at year 2 in the growing rod group. In both groups the constructs had limited growth. The mean amount of growth at 2 years was 3.7mm (~0. 19cm per year) in the domino group and 10.8mm (~0.54cm per year) in the growing rod group. Conclusion Both techniques do not completely prevent progression of scoliosis. Our new domino technique demonstrates as good a capacity for initial curve correction and limiting further curve progression as a growing rod technique but has a more limited capacity for further longitudinal growth. However the new domino technique is vastly cheaper and avoided a mean of 3.4 surgeries in the 2 year period compared with the growing rods.
Low Body Weight in Patients with Adolescent Idiopathic Scoliosis
Authors: Junior Charbel Jacob , Cardoso Igor Machado , Junior José Lucas Batista , Maia Thiago Cardoso , Brazolino Marcus Alexandre Novo , Debom Tadeu Gervazoni , Roncaglio Bruno 
Published: April 2016

Introduction Scoliosis is a three-dimensional deformity of the spine that leads to more than 10° in the frontal plane. In adolescent idiopathic scoliosis (AIS) does not know the cause of the condition, and the search of the pathology source settings may involve the analysis of the nutritional status of patients. This study aims to investigate the nutritional status of patients (AIS) compared with asymptomatic population in the same age group. Methods A prospective, descriptive and comparative study with a sample of 60 subjects divided equally into two groups. The AIS group ( n = 30) represented by holders of AIS and control group ( n = 30) comprised healthy subjects both sexes and groups with equivalent age. We analyzed age, gender, menarche, weight, height and BMI. Results In terms of age: AIS Group: 14.3 ± 1.97 years; Control group: 14.23 ± 1.79 years. Regarding weight: Group AIS: 47.4 ± 13.8 kg; Control group: 55.6 ± 11.63 kg As for height: AIS Group:. 1.6 ± 0.1 m; Control group: 1.64 ± 0.08 m. As for BMI: AIS Group: 18.5 ± 3.7 kg / m2; Control group: 20.79 ± 2.92 kg / m2. Age and height did not achieve statistical difference when compared with the different AIS and control groups (p > 0.05). While statistically significant difference of body weight ( p = 0.01) and BMI ( p = 0.01) when comparing the AIS and control groups. Conclusion Patients with AIS have a low body weight.
Proximal Junctional Kyphosis in Pediatric Deformity: Analysis of Management with a Surgical Technique Limiting Cervical Extension
Authors: Pantoja Samuel , Chahin Andrés , Arriagada Gonzalo , Luna Felipe 
Published: April 2016

Introduction Proximal junctional kyphosis (PJK) is a relatively frequent complication of spinal deformity surgery which can result in significant symptoms and potential neurological compromise. Reconstruction of PJK in the cervico-thoracic junction usually entails proximal extension of fixation to the cervical spine, with a compromise of function in this young population. Material and Methods We designed a retrospective review of clinical and radiological features in a consecutive series of patients treated for PJK of the upper thoracic spine. Objective: discuss the use of an anterior plus posterior reconstructive technique which aims to avoid proximal extension into the cervical spine for the management of PJK in the pediatric deformity population. Patients: Three patients with spinal deformity (neuromuscular scoliosis 2, Scheuermanns kyphosis 1) developing progressive PJK were operated with an anterior and posterior reconstruction. Clinical and radiographic follow-up is analyses with a minimum of 9 months. Results All patients were successfully managed with adequate control of the progressive deformity and proximal extension into the cervical spine was significantly limited with this anterior and posterior approach. Conclusions For this selected group of patients with upper thoracic PJK, an interior and posterior surgical reconstruction was successful in managing the condition with limited extension into the cervical spine, thus avoiding greater future functional compromise.
The Use of MAGEC Growing Rods as a Temporary Distraction Rod in Severe Kyphoscoliosis: A Case Report
Authors: Smith John , Morgan Jessica 
Published: April 2016

Background The acute correction of severe spinal deformity can be associated with significant neurologic risk. Halo traction can be used as a method to slowly correct deformity while allowing for close neurologic monitoring during correction. However, this typically requires a prolonged hospital stay and significant costs. Methods This case reports using a magnetically controlled growing rod (MCGR) to continue correction of a severe spinal deformity after an initial period of halo traction to allow for safe correction a severe kyphoscoliosis. Results The patient is a female child, adopted from Ethiopia, with an estimated age between 10–13 years. She presented with a severe kyphoscoliosis measuring greater than 135 degrees. She is otherwise healthy. An MRI showed no abnormalities of the spinal cord. Due to the severity of her curve, we elected to use halo-gravity traction for 4 weeks. During that time, she gained 7 inches in height and her curve improved to 100 degrees. To continue her correction, we then placed a Magnetic Growing rod from T1-L3/4, and distracted on a monthly basis for 6 months; resulting in correction of her curve to 80 degrees. The patient then underwent removal of the MCGR, and had definitive posterior spinal instrumentation and fusion from T2-L4 with apical Ponte osteotomies. Her scoliosis corrected to 47 degrees and her kyphosis to 42 degrees. She was left with a visible cervical deformity that is currently asymptomatic. Conclusion Multiple authors have reported the use of traction as part of the treatment of severe scoliosis as a means to reduce neurologic risk during deformity correction.1,2 Surgical placement of temporary distraction rods have also been reported as part of a staged correction of severe scoliosis but is associated with loss of neuromonitoring signals in 41% of patients. These changes were reversible if the temporary traction was reversed. Cheung et al reported the use of a MCGR in a girl with severe spinal deformity where distractions were made daily for 2.5 months prior to definitive correction.3 The MCGR offers a safe option as a temporary distraction rod that can be lengthened gradually on an outpatient basis. This allows for neurological monitoring during gradual correction of the curve in anticipation of definitive correction. References Sponseller PD, Takenaga RK, Netown P, et al. The use of traction in the treatment of severe spinal deformity. Spine 2008;33:2305–2309 Buchowski JM, Bhatnagar R, Skaggs DL, Sponseller PD. Temporary internal distraction as an aid to correction of severe scoliosis. J Bone Joint Surg Am 2006;88:2035–2041 Cheung JP, Samartzis D, Cheung KM. A novel approach to gradual correction of severe spinal deformity in a pediatric patient using the magnetically-controlled growing rod. Spine J 2014;14:e7–e13
Surgical Management of Recurrent Compressive Myelopathy after Anterior Cervical Discectomy and Fusion
Authors: Negm Mohammad 
Published: April 2016

Introduction Recurrent myelopathy after anterior cervical discectomy and fusion is a rare condition, the literature in this entity were limited. This recurrence may occur at the same level or in adjacent level/s, usually the proximal level, the compressing element either anteriorly by a newly prolapsed disc or posteriorly by enfolding of the ligamentum flavum Material and Methods From 2008 to 2012, 9 cases of recurrent cervical myelopathy were treated surgically at Bab El-Sheria university hospital, all of them had an anterior cervical discectomy before with a good improvement after surgery. All patients were evaluated clinically by both JAO score and Nurick's grades and radiologically by plain X-ray and MRI, In MRI the pattern of compression were evaluated in T2 waited image and the cord was evaluated according Yasutsugu classification.. 6 out of the 9 cases were operated through anterior approach and 3 via posterior approach. The mean follow up period was 30.7 months. Results All cases in this study were improved clinically and radiologically, the average time of surgery were 65 minutes (45–80), the average blood loss 140cc (100–170cc), non of patient develop any major complication, only 4 cases suffering mild dysphagia which improved spontaneously, Improvement of JAO score was evaluated by the Recovery rate (RR), according to Hirabayashi's method. All patients were satisfied as they regain all or most of their previous activity and work. 7 out of 9 cases (77.8) classified as excellent result according to improvement of JAO, RR ˃ 70%. Other 2 cases classified as good result Conclusion Excellent results could be obtained through this procedure, improvement in clinical outcome and cord condition was evident.
Reliable Measure of Safe Zone for Cervical Spinal Surgery in Keeping of the Embryologic Origins of the Course of the Recurrent Laryngeal Nerve (RLN) on Right and Left
Authors: Rajabian Ali , Quraishi Nasir A. 
Published: April 2016

Introduction Considerable variations are observed of a “safe zone” for avoiding RLN injury during anterior cervical exposures. Most studies have attempted to accurately measure RLN versus the background of cervical vertebrae level. However all studies so far have not factored-in the unique embryology of RLN following the descent of the aortic arches. Thus, making it a floating structure separate from the bony spine. We aimed to measure the positional variation of this floating complex (RLN, Larynx, Esophagus) in fresh cadavers that are not yet fixed. Methods 8 fresh cadavers were dissected to measure the point at which RLN on the right and left sides joined the tracheoesophageal groove TEG medially (considered safely protected) thence ascending to enter larynx. This was also measured against backdrop of the cervical level with neck in neutral and extension. Results The RLN joins the TEG 4.45 cm vertically inferior to laryngeal prominence on the right and 7.7 cm on the left (Range of +/− 0.5 cm). There were significant variations of this point (RLN joining TEG) measured with neck in neutral and extension by ~1.8 cm (+/− 0.3 cm) (the length of one vertebral level (Photographed). Conclusion While the use of vertebral level landmarks may work well for nerve structures exiting or attached to the “fixed” spine, landmarking of a totally free floating nerve, such as the RLN is not practical. This nerve is closely related embryologically to that of the pharyngeal pouches and aortic arches and can undergo positional variation as described. Neck positioning during anterior cervical procedures can produce variations in the location of the recurrent laryngeal nerve. This is due to this structure as a “free floating nerve” and its different embryological origins (to the spine). The RLN joins the TEG ~4.5cm and 8 cm below the laryngeal prominence on the right and left sides respectively. [Figure: see text]
Surgical Outcome of the Selective Posterior Spinal Fusions for Ossification of Posterior Longitudinal Ligament in the Cervical Spine
Authors: Mishiro Takuya , Manabe Hiroaki 
Published: April 2016

Introduction It is widely known that laminoplasty (LP) and anterior cervical fusions have been performed for ossification of posterior longitudinal ligament (OPLL). But progression of kyphosis and development of the ossification after surgery sometimes cause aggravation and revival of the symptoms. Recently, several authors reported that posterior cervical spinal fusion (PSF) for patients with OPLL. The purpose of this study is to assess surgical outcome of the selective spinal fusions for OPLL in the cervical spine. Method From 2010 to 2014, twenty seven patients with OPLL (mean age 68 years) who underwent surgical treatment with LP (14 patients) or PSF (13patients) were included in this study. Surgical outcomes were assessed by operative time, amount of bleeding and complications. Radiographic measurement included change of the alignment in C2/C7 (cervical lodosis), range of motion of cervical spine. Neurological function was assessed using a Japanese Orthopaedic Association Scale (JOA). Result Mean follow-up period is one year. The operative time was slightly longer in PSF group, but amount of bleeding was not significance. One patient had C5 paralysis in PSF group. In fixed range at PSF group, one interbody fixation was three cases, two fixations were seven cases and three fixations were three cases. On radiographic analysis, the mean change of alignment at last follow-up period were 2.8° ± 6.5° (LP) and 1.6° ± 6.9° (PSF). Range of motion of cervical spine were 8.6° ± 9.6° (LP) and 9.9°±7.6°(PSF). There was not significant difference between two groups at pre-operative JOA score. Improvement rate of JOA score were 55.7% ± 32.2% (LP) and 42.3% ± 25.4% (PSF). There was no significant difference between both groups in all categories. Conclusion It is natural to preserve as much as possible mobility in cervical spine. On the other hand, there is another opinion that instability of the cervical spine at boundary of ossification zone is related to development of ossification. It may prevent ossification to obtain stability of the cervical spine. In comparison with the LP, PSF did not adversely affect the clinical and radiographic outcomes in this study. This result suggested the possibility that PSF maintains a function of the cervical spine and prevents ossification. Limitation of our study include the short follow-up period and various fixed range. It is necessary to observe long-term progress.
Degenerative Scoliosis de Novo: Prospective Study of 50 Cases Operated with Stand-Alone ALIF with One Years Minimum Follow-Up
Authors: Norotte Gilles 
Published: April 2016

Introduction Posterior approach in degenerative scoliosis de novo is related to high rate of complications in elderly people. In a previous retrospective and comparative report in 2009 (French Spinal Society), Stand alone ALIF/OLIF proved a less iatrogenic procedure to relief the pain and meet patient's expectations. A prospective study including 50 patients has been performed to confirm this previous report, with at least one-year follow-up. Material and Methods The indications are based on a specific classification according to the biomechanism of the rotatory discogenic collapse. Therefore, two homogenic groups are compared. The details of the procedure are important with elderly people to avoid vascular complication or subsidence (preventive vertebral augmentation) due to osteoporosis. Stand alone ALIF/OLIF using a Peek cage. The cage and disk space are filled with nanoparticles of HAP. The outcomes are assessed with VAS, ODI, Kim&Kim score, standard radiography and spinogram at two, six and twelve-month follow-up periods. Results The two groups have specific physiopathology and epidemiology. But, outcomes are very similar after one-year follow-up. Surprisingly, it is not related to the number of disk's levels (1 to 4) operated on. According to Kim&Kim score: 30% have excellent outcome, 60% good result. VAS drops from 7/10 to 2/10 at one year. Complications (10% poor results) are mainly related to vertebral body fractures (upper endplate of L5). Posterior Vertebral augmentation was not efficient to improve the score. Symptomatic effect of sympathectomy is noted (8%) but with good acceptance. Revision rate is 6% mainly due to the persistence of a radiculopathy linked to posterior stenosis. A posterior decompression was performed after 4 months and relieved the symptoms. Radiologic fusion rate is 90% with HAP nanoparticles. It proves a low cost, less iatrogenic than BMP 2 and efficient solution in elderly people. Conclusion This prospective study confirms that Stand alone ALIF/OLIF is a better procedure to relieve the pain and meet patient's expectation compared with posterior instrumented surgery. Preserving posterior musculature and reshaping the anterior “lumbar arch,” Stand alone ALIF improves the sagittal balance in a physiological way. Osteoporosis required a “systematic” vertebral augmentation by anterior approach to lower subsidence or vertebral body fractures rate.
Use of a Sublaminar Decompression as an Alternative to Traditional Laminectomy in Degenerative Disorders of the Lumbar Spine
Authors: Peddada Kranti , Elder Benjamin , Ishida Wataru , Lo Sheng-Fu , Holmes Christina , Goodwin C. Rory , Witham Timothy 
Published: April 2016

Introduction The traditional treatment for lumbar stenosis with instability is laminectomy and posterolateral arthrodesis, ± interbody fusion. However, laminectomies remove the posterior elements and decrease available surface area for spinal fusion. A sublaminar decompression can achieve adequate decompression while preserving bone surface area to enhance spinal fusion. Material and Methods A retrospective review of 72 patients with degenerative pathology who underwent sublaminar decompression by a single surgeon at a single institution was performed. Data collected included baseline demographics, preoperative symptoms, operative data, symptoms at last follow-up (LFU), time to fusion, fusion rate, and radiographical measurements, consisting of thecal sac cross-sectional area, bilateral lateral recess height, and bilateral foraminal diameter on preoperative and postoperative scans. Paired t-tests were used to test significance of these changes. Results 31 males and 41 females with median age 60 (range: 19-78) years underwent sublaminar decompression with fusion. A mean of 1.9 levels were fused. The mean VAS pain score improved from 6.8 preoperatively to 3.0 at last follow-up. Fusion imaging was available for 44 patients, with a fusion rate of 91%, and median time to fusion of 10.7 (range: 3.2-17.4) months. Preoperative and postoperative mean thecal sac cross-sectional area, right lateral recess height, left lateral recess height, right foraminal diameter, and left foraminal diameter were 153 and 209 mm2 (p = 0.000012), 5.9 and 5.9 mm (p = 0.5), 5.7 and 6.3 mm (p = 0.014), 4.6 and 5.2 mm (p = 0.0084), and 4.2 and 5.2 mm (p = 0.00012), respectively. Conclusion This study demonstrates that patients had sufficient decompression, as evidenced by improvement in clinical symptoms and statistically significant increases in thecal sac cross-sectional area and bilateral foraminal diameter. Therefore, sublaminar decompression may be an effective alternative to laminectomy in treating central and foraminal stenosis. Fusion rates in this study also compare favorably to traditional posterolateral technique with radiographic pseudoarthrosis occurring in only four patients.
Challenges in Spine: Management of Spinal Infections. A Flow-Chart to Guide Decision Making
Authors: Gasbarrini Alessandro , Ghermandi Riccardo , Girolami Marco , Bandiera Stefano , Brodano Giovanni Barbanti , Terzi Silvia , Babbi Lisa , Boriani Stefano 
Published: April 2016

Introduction Spinal infections are rare diseases, whose management highlights the importance of a multidisciplinary approach. Although treatment is based on antibiotics, always selected on coltural and antibiogram tests, surgery is required in case of development of spinal instability or deformity, progressive neurological deficits, drainage of abscesses, or failure of medical treatment. The first step of the algorithm is diagnosis, which is established on MRI with contrast, PET/CT scan, blood tests (CRP and ESR) and CT-guided needle biopsy. Evaluation of response to the specific antibiotic therapy is based on variations in Maximum Standardized Uptake Value (SUVmax) after 2 to 4 weeks of treatment. In selected cases, early minimally invasive surgery was proposed to provide immediate stability and avoid bed-rest. Material and Methods From 1997 to 2014, 182 patients affected by spinal infections have been treated at the same institution (Istituto Ortopedico Rizzoli – Bologna, Italy) according to the proposed algorithm. Mean age was 56 years (range 1 - 88). Male to female ratio was 1,46. Results Minimum follow-up was 1 year. Infections were mostly located in the lumbar spine (57%) followed by thoracic (37%) and cervical spine (6%). Conservative treatment based on antibiotics needed surgery (open and/or percuteneous minimally invasive) as an adjuvant in 83 patients out of 182 (46%). Conclusion Management of spinal infections still remains a challenge in spinal surgery and multisciplinary approach is mandatory. This algorithm represents the shared decision making process from diagnosis to the most appropriate treatment, led to successful outcomes with a low-complication rate.