bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dorsal Fusion as Correction of Craniocervical and Atlantoaxial Instability in Patients with Benign and Malignant Lesions using O-Arm System
Authors: Mirchev Nikolay , Behr Robert 
Published: April 2016

Introduction A retrospective and prospective analysis of the surgical treatment and results of 99 patients with benign and malignant craniocervical, atlantoaxial and high cervical lesions operated during 36 – month period (2011–2014) at the Department of Neurosurgery, Klinikum Fulda gAG, Germany was performed. The aim of the analysis was to assess the factors affecting dorsal fusion as correction of craniocervical and high cervical instability. Material and Methods The mean age of the patients was 57 years. The female to male ratio was 1:1,3. The most frequent neurological symptoms were quadriparesis, discoordination, cranial and spinal nerves palsy and local pain. We analyzed 67 patients with traumatic lesions, 10 patients with inflammatory lesions, 8 patients with degenerative instability, and 14 patients with high cervical tumors. In the subgroup of patients with traumatic lesions we found 39 odontoid fracture II Type, 11 Hangemann fracture and 17 combined cervical fracture; in the subgroup of patients with tumors we observed 3 cases with plasmocytoma, 3 case with chordoma, 1 case with C2–3 schwanoma, and 7 cases with metastatic lesions; in the inflammatory subgroup we analyzed 6 cases with RA and 4 cases ankylose spondylitis. Results In 99 patients we performed 129 operations. We used posterior cervical, and craniocervical median approach. Because of craniocervical/cervical instability we made posterior screw fixation in all of 99 patients. In 47 patients we performed additionally decompressive laminectomy. To improve screw placement accuracy we performed intraoperative O-Arm in 82 cases. The operative duration was 2.25 hour. in O-Arm operations and 4.35 hour in C-arm operation. The most common operative complications were: CSF leak – in 2 cases, postoperative infection – in 4 cases, and without early operative mortality. The 12-monts follow-up showed good recovery in 65 patients, moderate disabling – 25 patients, severe disabling – 5 patients, vegetative state – 4 patients, death 3 patients with malignant lesions. Conclusion Early correction of craniocervical and high cervical instability facilitated neurological recovery by preserving the existent neurological function. Using of O-Arm increase operative screw placement accuracy, and preserve intraoperative nerve and vertebral artery injury. Recently because of the improvement of neuroimaging techniques, operative approaches, surgical techniques and neurointensive care the results of treatment of these lesions are optimal.
Safety and Efficacy of Harms' Technique in the Management of Atlantoaxial Instability. A Single Institution Experience and Review of the Literatures
Authors: Abou-Madawi Ali 
Published: April 2016

Introduction various procedures for the management of atlantoxial instability have reviewed in the literatures. Advantages and disadvantages of these procedures have been stressed. Harms' procedure is one of the recently introduced techniques. This is a retrospective descriptive clinical case study to evaluate the safety and efficacy of Harms' technique. Patients and Methods we reviewed our hospital medical records between 2009 and 2014. We were able to track 19 patients treated for atlantoaxial instability using Harms' technique with complete records. Patients' mean age was 19.6 years. Twelve were males and 7 were females. Surgical indications included: atlantoaxial ligamentous instability in 2, Os Odentadium in 2, Downs' syndrome in 3, type-II dens fracture in 5, atlantoaxia rotatory fixation in 7. All patients had plain radiography, CT scan, and MRI. According to the JOA-score 15 were normal, 3 were grade-1 and one was grade-2. All patients were operated with Hams' technique with iliac Bone graft. The following factors were evaluated; age, sex, pathology, neurological status, operative time, blood loss, hospital stay, morbidity, screw purchases, stability, fusion, and clinical outcome. Results mean operative time was 125 minute. Mean blood loss was 350 ml. Hospital stay was 4 days. Screw purchase was adequate in all cases but one. Stability was adequate in all. Fusion was sound in all but two. All intact patients remained intact. Other patients improved at least one grade on JOA-Score. One patient had vertebral artery perforation by a low seated screw. There were no added neurological deficits in any of our patients. Conclusion our experience demonstrates the safety and efficacy of the Harms' technique in the management of atlantoaxial instability. Meticulous technique and anatomical knowledge are mandatory for optimizing outcome.
Outcome of Patients with Occipitocervical Fusion for Acute Craniocervical Instability
Authors: Hoffmann Martin F. , Freund Kai , Schildhauer Thomas A. 
Published: April 2016

Introduction Occipitocervical fusion (OCF) is a safe and reliable method for stabilization of craniocervical instabilities caused by different mechanisms. Especially patients with acute instabilities and unaffected previous range of motion of the cervical spine, may be affected by the fusion procedure. The purpose of this study was to evaluate retrospectively surgical outcome and patient disability after OCF procedure for acute instabilities. Methods Over a 5-year period, 2009–2014, 33 consecutive patients from one academic trauma center were retrospectively identified as having been treated with OCF. Of these, 29 patients were diagnosed with traumatic or pathologic fractures or nonunion after previously failed surgical intervention. Average follow up was 25 months (range 4–55 months). Demographics were assessed. Fixation constructs were delineated. Nonunion, infection, implant failure, neurologic disabilities, and deaths were used as complication variables. Patient disability was addressed by the Neck Disability Index (NDI) and persistent pain (VAS). Results Traumatic and pathologic fractures were the main reason (90%) for an OCF procedure in our study population. Three patients (10%) suffered from a persistent instability after previously failed surgical stabilization. Fracture location was the odontoid process of C2 in 69% of the patients and 31% had a combined injury to C1 and C2. Fusion was performed between the occiput and C4 in 55%, C5 in 28%, and C3 in 17%. Fusion was enhanced by autologous bone in 14 patients (48%). 3 patients (10%) underwent a surgical revision due to screw misplacement (1) and infection (2). Related to the advanced patient age, 15 patients died before the evaluation. One patient died during hospital stay related to his preoperatively existing comorbidities. Fourteen patients were evaluated. Average age was 74.2 years (range 18–95 years). Regarding the clinical outcome, pain averaged 2.5 on the VAS (median 2). 64% of the patients reported no or minimal pain (VAS 0–2), 23% complained of mild pain (VAS 2–4). The NDI averaged 42% (range 16 – 80%). Conclusion OCF is a reliable and safe procedure for the treatment of craniocervical instabilities caused by different injuries and diseases. Overall, pain reduction was effective. Patients reported no or only mild pain (VAS 0–4) in 86% during our evaluation. Functional disability averaged 42% utilizing the NDI, which is rated as “medium disability.” The rate of 52% deceased patients reflects the fact that OCF is performed in our institution especially in elderly and patients with increased rates of comorbidities.
Predictors of Discharge Destination after Lumbar Spine Fusion Surgery
Authors: Aldebeyan Sultan , Aoude Ahmed , Fortin Maryse , Nooh Anas , Jarzem Peter , Ouellet Jean , Weber Michael 
Published: April 2016

Introduction Lumbar spine fusion surgery is a common surgical procedure used to treat a variety of lumbar spine conditions. A great number of patients fail to go home after surgery and require transfer to a rehabilitation center. Many Patients requiring transfer to rehabilitation centers often have an extended hospital length of stay due to lack of beds at rehabilitation centers. Each extra day spent at the hospital costs the health system approximately $1000 USD. The aim of this study was to identify predictive factors for discharging patients to an inpatient rehabilitation center after undergoing lumbar spine fusion surgery. Methods We retrospectively identified a total of 15,092 patients undergoing lumbar spine fusion from 2011 to 2013 using the ACS-NSQIP database. Patients were dichotomized based on discharge destination to patients who were discharged home ( N = 12,339) and others who were discharged to a rehabilitation center ( N = 2753). Outcomes included patient demographics, comorbidities, and clinical characteristics. A multivariate logistic regression was used to identify whether outcomes studied were predictive factors for discharging patients to a rehabilitation center after lumbar fusion surgery. Results Majority of patients were discharged home after lumbar fusion surgery (81.76%) with only some discharged to a rehabilitation center (18.24%). Multivariate analysis identified age ≥40, female gender, comorbidities (diabetes, COPD, CHF, and obesity), minor and major complications, hospital length of stay (LOS), operative time ≥ 259 minutes, multilevel surgery, and return to the operation room as significant predictive factors of discharging patients to a rehabilitation center after lumbar fusion surgery. Conclusion The identified predictive factors can help the health system in developing an algorithm for early recognition of patients requiring postoperative admission to a rehabilitation center and possibly decreasing their hospital LOS. This can significantly decrease the hospital costs for such patients.
Surgical Outcomes after Traumatic Spinal Injury in Patients with Ankylosing Spondylitis - A Review of Ireland's National Spinal Unit
Authors: Berney Mark , Morris Seamus , Nugent Mary 
Published: April 2016

Introduction Patients with ankylosing spondylitis have a significantly increased risk of spinal injury when compared with the general population. Due to the pathogenesis of this condition, they are prone to spinal fractures even with low-energy mechanisms of injury. Since being established, the National Spinal Unit has admitted a significant number of these patients with a wide range of spinal injuries for surgical management. In this study, we reviewed fractures in patients with ankylosing spondylitis to better define the mechanism of injury, associated neurological deficit, predisposing factors, management strategies, and clinical outcomes. Material and Methods Between January 2005 and September 2015, 28 patients with fractures were treated in the Unit. Imaging evaluation was obtained in all patients by using plain radiography, CT scan, and MRI. The ASIA Impairment Scale was used to evaluate the neurologic status of the patients. Management was based on the presence or absence of spinal instability. A retrospective chart review was performed to determine patient factors, mechanism of injury, pre-operative status, management, and post-operative course. Results Of 28 patients reviewed, 21 cervical fractures and 8 thoracic fractures were identified. 14 cases were caused by minor trauma. Post-traumatic neurological deficits demonstrated by ASIA assessment in 15 patients with neurological improvement seen in 8 of these cases. Conclusion Patients with ankylosing spondylitis are highly susceptible to spinal fracture and spinal cord injury even after only mild trauma. Initial CT or MR imaging of the whole spine is recommended even if the patient's symptoms are mild. The patient should also have early surgical stabilization to correct spinal deformity and avoid worsening of the patient's neurological status.
The Pathoanatomy of Congenital Cervical Stenosis: The Triangle Model
Authors: Mai Harry , Jenkins Tyler , Hsu Wellington 
Published: April 2016

Introduction Congenital cervical stenosis (CCS) describes a patient with a decreased spinal canal diameter at multiple levels of the cervical spine in the absence of degenerative changes. Despite recognition of CCS throughout the literature, the anatomical features that lead to this condition have not been established. Knowledge of the pathoanatomy behind CCS may lead to alterations in surgical technique for this patient population that may improve outcomes. Methods From 1,000 cervical MRIs between January 2000 to Dec 2014, CCS was identified in 68 patients using a strict definition of age less than 50 years with mid-sagittal canal diameters (<10 mm) at multiple sub-axial cervical levels (C3-C7). A total of 68 patients met the inclusion criteria for this group. Fourteen controls with normal SCDs (>14 mm) at all cervical levels were used for comparison. Anatomic measurements obtained at each level (C3-C7) included: coronal vertebral body, AP vertebral body, pedicle width, pedicle length, laminar length, AP lateral mass, posterior canal distance, lamina-pedicle angle and lamina-disc angle. Statistical significance was defined as p < 0.01. Results CCS patients demonstrated significantly different anatomical measurements when compared with controls. Significantly smaller lateral masses, lamina lengths, lamina-pedicle angles and larger lamina-disc angles were identified at levels C3-C7 in the CCS group ( p < 0.01). These anatomic components form a right triangle that illustrates the cumulative narrowing effect on space for the spinal cord. Conclusions The pathoanatomy of CCS is associated with a decrease in the lamina-pedicle angle and an increase in the lamina-disc angle. These changes in the alignment of the bony posterior elements lead to decrease in lamina length and ultimately to a smaller cross sectional area for the spinal cord. The global changes in CCS are best illustrated by this triangle model and driven by the posterior elements of the cervical spine.
Measuring Cobb's Angle in Scoliosis: Can Smartphones Match Manual Methods and Software Based Analysis? A Three Way Crossover Study
Authors: Sudarshan Pramod , Panda Aditya , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan 
Published: April 2016

Introduction Cobb's angle in scoliosis has been widely accepted to analyze the extent of deformities and can be used as an indicator of the degree of correction obtained following a corrective surgery. Measurement has traditionally been manual using a pencil and protractor on radiographs. Smartphones have changed the way we live in every field of life. Use of apps in smartphones with accelerometers aids to measure the angle quickly. This study analyzes the accuracy and efficiency of the inclinometer app in smartphones to measure cobb's angle in scoliosis. Material and Methods We analyzed cobb's angle in scoliotic patients who underwent robotic guided corrective surgery at our center over the past 2 years. The Cobb angle measure tool in the software used in robotic surgery (Renaissance, Mazor robotics) was used as the gold standard (GS) as it was software based analysis. Clinometer app was used in the smartphone by the primary observer over the computer screen to measure the cobb angle and then manual method was used. Time taken to measure using both the techniques was noted by other observers. Another two observers then independently measured the angle using their smartphones to assess the interobserver variability. Data was tabulated and analyzed by a biostatistician. Results Cobb angle of 25 patients with mean age of 14.1 years were analyzed for primary and secondary curves separately. The mean Cobb angle of all measured X-rays was 48.9 degrees in the manual set and 47.9 degrees in the smartphone set as compared with 48.2 degrees as per GS. The mean time consumed was 13.5 seconds for the smartphone set, significantly shorter than that of the manual set which was 36.2 seconds (statistically significant – p < 0.05). 95% confidence intervals for inter-observer variability using smartphones were ±1.5degrees. Conclusion Cobb angle measurement using the smartphones was more accurate than the manual methods in our study. With significant time difference between the methods indicating the simplicity of the use of apps in our daily use and the minimal interobserver variability, smartphones indeed can replace the manual methods and can be a reliable tool in the hands of spinal deformity surgeons.
Treatment of Osteoporotic Vertebral Fractures with Elastoplasty: 1-year Results
Authors: Eichler Michael 
Published: April 2016

Introduction Vertebral compression fractures (VCF) are an increasing problem. Common surgical treatments are vertebroplasty and kyphoplasty. Both are mainly performed with PMMA bone cement. Recently a new elastomer (VK100) was developed as optional material for kyphoplasty instead of PMMA. This study investigated the outcome and safety of balloon kyphoplasty performed with the VK100 Vertebral Augmentation System over a follow-up period of 12 months. Material and Methods The study includes patients with osteoporotic fractures of one or two vertebrae. All patients were treated with balloon kyphoplasty using VK100 (Bonwrx, Lansing, Michigan, USA) instead of PMMA. VK100 is a radio opaque, bone adherent, non-exotermic elastomer, which is less stiff as PMMA and therefore more comparable to the natural bone. VAS and ODI of all patients was measured preoperative, postoperative, at 12 months. Additional cement leakage and additional fractures were documented. Results 82 patients were included in the study (age: 63.69 ± 7.54). VAS improved significantly from preoperative 82.9 ± 10 mm to postoperative 18.3 ± 10.2 mm ( p = 0.0015) and improved significantly from postoperative to 8.92 ± 11.5 mm at the 12 months follow up ( p = 0.0163). ODI improved significantly from preoperative 72.92 ± 14.6% to postoperative 47.08 ± 16.35% ( p = 0.0015) and from postoperative to 20.15 ± 7.56 at 12 months ( p = 0.0022). There were no complications due to leakage. Patients showed no additional fractures within the follow up period. Conclusion VK100 showed good results in terms of VAS and ODI improvement and occurrence of adverse events. VK100 is an alternative to PMMA bone cement augmentation. Further studies are needed for longer implantation years.
Magnetically Controlled Growing Rods for the Management of Early-onset Scoliosis: Results and Complications at 3-year Follow-up
Authors: La Rosa Guido , Ruzzini Laura , Oggiano Leonardo 
Published: April 2016

Introduction A new method for the management of early-onset scoliosis (EOS) has been recently introduced: it consists of a magnetically controlled growing rod (MCGR) that allows gradual outpatient distractions under control of an external remote device. We present a series of 14 patients with EOS managed with MCGR (Ellipse TM MAGEC System, Irvine, CA). Material and Methods We implanted MCGR in 14 patients affected by EOS with various etiology. Scoliosis and kyphosis angles, T1-T12 and T1-S1 length were evaluated preoperatively, postoperatively, and at the last follow-up. A visual analogue scale score was used to evaluate pain during outpatient rod distraction procedures. The mean follow-up is 34 months. All patients attended distractions of the magnetic rod through an external remote control every 3 months. The mean predicted distraction was 3 mm at each lengthening session. Results The mean Cobb angle value was 64.7 ± 17.4 degrees (range, 45 to 100 degrees) preoperatively and 28.5 ± 13.9 degrees (range, 15 to 59 degrees) at the latest follow-up. The mean T1-S1 length value was 27.1 ± 5.4 cm (range, 16 to 34.8 cm) preoperatively and 32.8 ± 4 cm (range, 26.5 to 39 cm) at the latest follow-up. The mean T1-T12 length value was 16.2 ± 2.7 cm (range, 10 to 19 cm) preoperatively and 20.6 ± 2.9 cm (range, 15.5 to 23.5 cm) at the latest follow-up. The average monthly T1-T12 height increase was 0.8 mm, whereas the average monthly T1-S1 increase was 0.9 mm. Two patients experienced a rod breakage and 1 patient had a pull-out of the apical hooks. In cases of rod breakage, the magnetic rod was removed and replaced. In case of pull-out, apical pedicle screws have been positioned in substitution of hooks. Conclusion Although implant-related complications could occur, as in all EOS growing rods procedures, MCGR can be effectively used in patients with EOS. This spinal instrumentation can overcome many of the complications related with the traditional growing rods implants. In our experience, rod breakage occurred only in patients with a single magnetic rod instrumentation. First case was a patient with a severe thoracic kyphosis. In effect, the management of kyphosis with the MCRG is quite challenging. Moreover, a marked kyphosis was also the cause of pull-out of the apical hooks. Instead, in the second case of rod breakage, we reported a failure of the internal magnet of the rod. In conclusion, this procedure can be effectively used in outpatient settings, minimizing surgical scarring, surgical site infection, and psychological distress due to multiple surgeries needed in the traditional growing rods system, improving quality of life, and saving health care costs.
Validity of CT Scan Measurements of Thoracic and Lumbar Pedicle Dimensions
Authors: Apostolou Thomas , Chatziprodromidou Ioanna , Magras Ioannis , Foroglou Nikos 
Published: April 2016

Introduction The transverse and sagittal inner and outer pedicle diameter of thoracic and lumbar vertebrae were measured with an electronic caliper and with CT scan. To determine the validity of CT scan measurements, comparing with those taken by an electronic caliper. Material and Methods A total of 12 anatomic skeletal specimens were acquired from T1 to L5 in the mean age of 69.6 years. Each vertebral pedicle was measured with an electronic caliper and CT scan. A total of 1632 measurements of 408 pedicles were taken. The data were collected and analyzed using the t-test. The comparison of the measurements between left and right pedicle, males and females, as well as between electronic caliper and CT scan was evaluated. Results The sagittal diameter of the pedicle was always bigger than 7mm. In the mid-thoracic area (T3-T8), the transverse outer diameter could be less than 4mm, so there is need of use of pediatric screws (<4mm). In the opposite, caudally of T11, the transverse outer diameter was at least 7mm. Conclusion Significant statistically difference was found between the two genders, while pedicles from male spines were bigger. Additionally, the CT scan was proved to be precise and valid for the measurement of the transverse outer diameter of the pedicle. For this reason, this method becomes valuable for the preoperative evaluation of the pedicle dimension, especially in scoliosis surgery, helping the surgeon to choose the appropriate size of the screws.