bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-reported Outcomes following Elective Surgery for Lumbar Degenerative Disease: Effect of Peri-operative Complications on Outcomes
Authors: Chotai Silky , Parker Scott , Sivaganesan Ahilan , McGirt Matthew , Cheng Joseph , Devin Clinton 
Published: April 2016

Introduction There is a paradigm shift toward rewarding providers for quality rather than volume. Complications appear to occur at a fairly consistent frequency when looking at large aggregate datasets. Understanding how complications affect long-term patient reported outcomes (PROs), following degenerative lumbar surgery, is vital. Our hypothesis was that 90-day complications would adversely affect long term PROs compared with a cohort that did not experience a complication. Methods 906 consecutive patients undergoing elective surgery for degenerative lumbar disease over a period of four-years were enrolled into a prospective longitudinal registry. PROs: ODI, NRS-Back and leg pain (BP, LP), Quality of life (EQ-5D), and NASS satisfaction questionnaire were recorded at baseline and 12-month follow-up. Complications were divided into major (surgical site infection, hardware failure, new neurological deficit, pulmonary embolism, hematoma and MI) and minor (urinary tract infection, pneumonia and deep venous thrombosis). Results Thirteen percent (118) of patients developed complications: (major-12% (108) and 8% (68)-minor) within 90-days after surgery. The patients with complications had significantly higher ODI scores at 12-months (29.43 ± 17.7 versus 25.2 ± 18.33, p = 0.02) after surgery. In a multivariable linear regression analysis, after controlling for array of preoperative variables, the occurrence of a major complication was not associated with worsening ODI scores 12-month after surgery. There was no difference in the percent of patients achieving minimal clinically important difference MCID for disability (66% vs 64%), back (55% vs 56%) and leg pain (62% vs 59%), quality of life (19% vs14%) and patient satisfaction rates (82% vs 80%) between those without and with major complications. Conclusion The occurrence of major complications did not significantly affect the PROs 12-month after surgery. These patients achieve clinically meaningful outcomes and patient satisfaction, as much as those without complication. This information allows a physician to council patients on the fact that a complication creates frustration, cost, and inconvenience, however it does not appear to adversely affect clinically meaningful long-term outcomes and satisfaction.
Transforaminal Lumber Interbody Fusion (TLIF) Clinical and Radiological Outcome
Authors: Alassiri Khaled 
Published: April 2016

Objective To evaluate the clinical and radiological outcome of TLIF in the treatment of Spondylolisthesis, degenerative disc disease and recurrent herniation of lumber disc. Methodology: A retrospective study, between Jan 2009 and December 2011.The patients with chronic back pain (more than 6 months of disability and refractory to conservative management) with or without leg pain / neurological deficit due to degenerative spondylolisthesis, degenerative disc disease and recurrent lumber disc herniation treated with Transforaminal Lumber Interbody Fusion (TLIF) were included. It was a retrospective review of the patient files to assess the pre and postoperative symptomatology, findings on clinical examination, radiological characteristics. The same procedure was performed in all cases by a single spine surgeon. The clinical outcome was assessed using Oswestry Disability Index (ODI) scoring system. Bony fusion was assessed based on a pre-set criteria on plain radiographs at 18 months postoperatively. Results Of 25 there were 16 male (64%) and 9 female (36%) patients with a mean age of 40 years (range: 20–60), who underwent TLIF (Transforaminal Lumber Interbody Fusion). 9 patients diagnosed as degenerative disc disease, 12 with spondylolisthesis and 4 having recurrent disc herniation. Of the 25 patients who underwent TLIF, in 14 (56%) cases fusion was performed at L5-S1, in 9 (36%) at segment L4-L5 and in 2 (8%) at L3-L4. We found subjective improvement in symptoms of back pain in 19 (76.0%) of 25 patients, leg pain in 15 (83.3%) of 18, and 04 (66.67%) & 02(40.0%) improvement in sensory and motor deficit respectively postoperatively. Based on the Oswestry Disability Index (ODI) and Visual Analog Pain Scale (VAS), showed significant improvement from preoperative 7.1 & 42.3 to 2.5 & 17.5 ODI and VAS scores at 18 months postoperatively respectively, with an overall improvement of 4.6 VAS and 24.8 ODI scores. A radiological fusion was observed at 18 months postoperatively on anterio-posterior (AP) and lateral X-rays following the pre set criteria in 23 of 25 patients (92.00%). Conclusion TLIF is a safe and effective method to treat chronic low back pain in patients with spondylolisthesis, degenerative disc disease and recurrent disc herniation. Our results confirm that TLIF is an option that is associated with good clinical and radiological outcome.
Preoperative Norepinephrine Levels in Cerebrospinal Fluid and Plasma of Pediatric Patients Predict Postoperative Pain Intensity after Spinal Fusion Surgery
Authors: Ferland Catherine , Parent Alexandre , Saran Neil , Ingelmo Pablo , Marchand Serge , Sarret Philippe , Ouellet Jean 
Published: April 2016

Introduction The purpose of the present study was to investigate if preoperative concentrations of monoamine neurotransmitters that are known to be involved in descending pain modulation are associated with perioperative pain intensity in a pediatric cohort of patients with idiopathic scoliosis scheduled for elective spinal fusion surgery. Material and Methods Patients scheduled to undergo spinal surgery for Adolescent Idiopathic Scoliosis (AIS) between the ages of 12 and 18 years were recruited from the outpatient clinic of the Shriners Hospital for Children ( n = 50). Plasmatic and cerebrospinal fluid concentrations of epinephrine (EPI), norepinephrine (NE), and their respective metabolite metanephrine (ME) and normetanephrine (NME), were assessed. Five mL of blood were collected for study analysis in an EDTA-coated collection tube after the anesthesia induction. Prior to the intratechal epimorphine injection, 2 mL of cerebrospinal fluid was collected in a low binding protein tube. Monoamine neurotransmitters were derivatized by reductive diethylation analyzed by liquid chromatography coupled with tandem mass spectrometry on TripleTOF 5600 mass spectrometer. At all time points throughout the study (preoperative, first postoperative 24 hours = postoperative day 1 (POD1), second 24 hours = postoperative day 2 (POD2) and postoperative 6 weeks follow-up visit), pain intensity was rated with the use of the Faces Pain Scale-Revised (FPS-R). Linear regressions were performed to assess the predictive role of catecholamine levels for postoperative pain. The Mann-Whitney-U test was used to assess differences in baseline characteristics between patients reporting presence of pain and pain-free patients as well as for all other comparisons other than correlations. Results Our results demonstrate that patients reporting persistent postsurgical pain 6 weeks after surgery have greater preoperative peripheral and/or central norepinephrine (NE) and normetanephrine levels when compared with patients reporting no pain at follow-up. Likewise, in the acute postoperative period, patients reporting moderate-to-severe pain intensity had higher preoperative central NE levels. Conclusion These results support the evidence for a potential role of catecholamine levels in predicting postoperative pain intensity and sympathetically maintained pain, which could place pediatric patients at risk for the development of chronic postsurgical pain. Incidence and severity of persistent postoperative pain may be reduced by specific NE preoperative interventions.
Treatment Options for Odontoid Fractures. A Comparasion between Anterior and Posterior Approaches
Authors: Neto Jamil Farhat , Veiga José Carlos Esteves , Daniel Jefferson Walter 
Published: April 2016

Introduction Odontoid fractures account for 9% to 15% of adult, cervical spine fractures, and are the most common fractures in the geriatric cervical spine. The mechanism of injury generally results from hyperflexion or hyperextension of the cervical spine during low-energy impacts in the elderly or high-energy impacts in the young and middle aged. No consensus exists on the optimal treatment (surgical or conservative) and the most relevant outcome parameter (osseous union, fracture stability or clinical outcome). Neurologic injuries associated with these fractures are rare. Material and Methods This study was a retrospective chart review of 13 patients who were treated for odontoid process fractures between November 2010 and May 2015. Inclusion criteria: Patients with odontoid fractures submitted to surgical treatment. Data were obtained from medical charts and spinal column imaging reports. Medical charts, imaging studies and the patient's outcomes were submitted to descriptive analysis in the pre-operative and post-operative period. The data submitted to descriptive analysis were: Fracture gaps; the direction and degree of odontoid process displacement; the odontoid fracture line anatomy; the degrees of the atlantoaxial instability; and the contact between the fractured odontoid and the axis vertebrae. We used conventional radiographs, three-dimensional computed tomographic (3D-CT) scans, and magnetic resonance images. We used the Grauer Algorithm for defining the surgical treatment modality. We identified the solid bone union through the presence of bony bridges and the definite continuity of cortical bone. Results A total of 13 patients who underwent surgical treatment for odontoid fracture were identified. The patients were 76.9% men, the mean age = 32.92 years. Traffic accidents (69,2%) were the most common cause of trauma. The main symptom was pain (84.6%) in the posterior cervical region. The elapsed median time from accident to surgery was 30 days. Mean follow-up was 20 months. Odontoid screw technics (38,4%) and Harms posterior technic (38,4%) were the most common surgical treatment adopted as primary surgical treatment. The most common Grauer's line fracture type was type B on 8 cases. 2 patients referred chronic cervical pain after surgery, 1(20%) were submitted to anterior technic and 1 (12,5%) posterior technic. We had 2 cases with complications, all submitted to posterior technic, 1 with CSF leak and 1 with vertebral artery lesion. No mortality was observed. Conclusion There was no difference between anterior or posterior approach when analyzing the cervical chronic pain and mortality. However, there were more complications in cases covered by the posterior approach. A well-designed prospective study with a larger number of cases is needed to better elucidate optimal treatment algorithms from both an outcomes and cost-effectiveness perspective.
Outcome Prediction in Elective Spine Surgery: A Prospective Cohort Study
Authors: Shiban Ehab , Meyer Bernhard , Shiban Youssef , Mühlberger Andreas 
Published: April 2016

Objectives To identify associations between demographic characteristics, anxiety, depression, social support, psychological and physical health in relation to self reported disability following elective spine surgery. Methods Study design: Prospective cohort study. Patients were asked preoperatively to complete a series of questionnaires, including the Oswestry Disability Index (ODI), the anxiety sensitivity index (ASI-3), the SF-36, the visual analogue scale for pain (VAS), the Berliner Social Support Scale, the PTSS-10 for PTSD symptoms and indicate demographic variables concerning education or partnership for example. The evaluation was based on the ODI filled out 3 months postoperatively. The univariate and multivariate analysis between risk factors and outcome parameter (ODI) was assessed with correlation coefficients and multivariate logistic regression. Results 144 patients met all inclusion criteria, 54% were male, 46% were female. Regardless of the operation dimension 75% had a lower ODI score at 3 months postoperatively compared with preoperatively and hence had a higher functionality after the operation. Preoperatively high values in age (r=0,153; p = 0,087), pain (VAS) (r=0,287; p = 0,01), trait anxiety(r=0,197; p = 0,027), PTSS (r=0,163; p = 0,069), ODI (r=0,459; p < 0,001) and low levels of social support (BSSS) (r = −0,148; p = 0,099) and education (r = −0,156; p = 0,098) correlated with high levels of ODI postoperatively which identifies all the mentioned variables as potential risk factors. A stepwise logistic regression model showed significant association with age, pain (VAS), state anxiety (STAI-S), and depression symptoms (ADS-K) ( p < 0,000). Conclusion Preoperative psychological status is associated with worse clinical outcome following elective spine surgery. A screening instrument allowing the identification of such patients is feasible.
Less False Negative in Neuromonitoring Lumbar Screws
Authors: Garcia Pedro Cortes , Lorensu Pedro Perez , Rodriguez Bernabe Deniz 
Published: April 2016

Introduction IOM is a standard care in cases of scoliosis.. there is more controversial their use in mubar pathology.. there are 5% lessions of nerve roots. There is a debate about the stimilation thresholds, to evaluate possibilities of medial positioning pedicular screws. The objetive of this paper is Evaluation of the effect of chronic compression of the lumbar roots in relation to thresholds direct stimulation. Material and Methods:Study Design:• prospective case series with measurement and threshold register direct stimulation of lumbar roots.• 80 patients (43 women and 199 nerve roots) consecutive undergoing spinal surgery in a period of six months (January to October 2014), 7 surgeons and one neurophysiologist.• Average age: 52.87 (SD = 14.9)• 199 were stimulated nerve roots formDirect recording their stimulation threshold. Results Stimulating a nerve roots 199 average 2.82 per patient (SD = 1• 52 (26.1%) were considered preoperatively chronically compressed. No differences were found in thresholds stimulation of different lumbar levels (e.g., L2, L3, L4, L5 and S1) or chronically compressed roots or non-compressed (ANOVA, p > 0.05; p = 0.190). Average maximum stimulation intensity 6.34 mA (SD = 7.2). Nerve roots uncompressed presented a average intensity threshold stimulation 4.33 mA (SD = 3.6) chronically compressed nerve roots. They had an average intensity thresholdstimulation of 11.93 mA (SD = 10.9). This difference was statistically significant (TStudent, p < 0.0001). No association was found between age and theaverage intensity of stimulus or between roots chronically compressed or non-compressed. Conclusion If you are using direct stimulation path of the pedicle and / or to confirm the screw indemnity pedicle, we bear in mind theexistence of symptoms of nerve root compression previously. As shown in this study, these variables determine a threshold stimulation intensity greater root to confirm the proper positioning screw. We could generate false negative results, and thus to detect a possible improper positioning intrapedicular screw.
Prospective Multicenter Assessment of Early Complication Rates Associated with Adult Cervical Deformity (ACD) Surgery in 78 Patients
Authors: Smith Justin , Lafage Virginie , Shaffrey Christopher , Protopsaltis Themistocles , Passias Peter , Schwab Frank , O'Brien Michael , Gupta Munish Chandra , Mundis Gregory , Hart Robert , Kim Han Jo , Klineberg Eric , Riew K. Daniel , Ames Christopher ,   International Spine Study Group
Published: April 2016

Introduction Although adult cervical deformity (ACD) can have profound impact, few reports have focused on the treatment of these patients. We present early complication rates associated with surgical treatment for ACD based on a prospective multicenter cohort. Material and Methods Prospective multicenter database of consecutive operative ACD patients was reviewed for early (<30 days from surgery) complications. Enrollment required at least one of the following: cervical kyphosis > 10°, cervical scoliosis > 10°, C2–7 SVA > 4cm or chin-brown vertical angle > 25°. Results 78 patients (59% women) underwent surgical treatment for ACD and had a mean age of 60.7 years and previous surgery in 52%. Surgical approaches included anterior-only (A, 14%), posterior-only (P, 49%), anterior-posterior (AP, 35%) and posterior-anterior-posterior (PAP, 3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications (Figure) were reported, including 26 minor and 26 major (Table) for an overall complication rate of 66.7%. 22 (28.2%) patients had at least one minor complication, and 19 (24.4%) had at least one major complication. Overall, 45 (57.7%) patients had at least one complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%) and respiratory failure (5.1%). One mortality (1.3%) was reported. Overall early complication rates were significantly different based on approach: A (27.3%), P (68.4%) and AP/PAP (79.3%) ( p = 0.007). Conclusion Among 78 patients treated for ACD and prospectively followed, a total of 52 early complications were reported (26 minor, 26 major). Overall, 45 (57.7%) patients had at least one complication and 24.4% of patients had at least one major complication. Significantly higher rates of complications were associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning and patient counseling.
Development and Implantation of an Individualized 3D Printed Titanium Cage for Cervical Fusion
Authors: Spetzger Uwe 
Published: April 2016

Introduction At present, all available cervical fusion cages have standardized sizes and mimic the anatomy of the intervertebral disc space more or less. Usually, the patient's anatomy is adapted during the surgery to the cage. Our idea was to respect the individual patient's anatomical situation and manufacture an individual cage with a perfect fitting accuracy. The production of individualized cages might be the next step for further improvement of spinal implants due to their perfect fit and improved load bearing surface. Material and Methods The computer-assisted planning, manufacturing, and implantation of the individualized cervical cage was performed in close co-operation with 3D-Systems Corporation, Rock Hill, SC 29730, USA and EIT Emerging Implant Technologies GmbH, Tuttlingen, Germany. A 3D model of the patient's cervical spine obtained from CT data was rendered. This model is the basis for the exact simulation of the operation. The newly developed 3D planning algorithms and special reconstruction software implemented in a high-end image-processing computer allow a virtual surgical procedure. The correction of degenerative deformities by repositioning of vertebrae and also the virtual resection of osteophytes is possible. The cage implantation can be simulated to check the accuracy of fit. These data are the basis for the production of the cage. This custom-made cage is manufactured of trabecular titanium by selective laser melting (3D printing procedure). Results The pilot project of the first implantation of an individualized cervical cage ever resulted in a high accuracy of fit of the implant. During surgery the cage ‘found’ its correct position after suspending disctraction due to its unique endplate design. Furthermore, it was impossible to move the cage in any direction. Thus, it can be assumed that the individualized cervical implant provides excellent primary fitting accuracy and stability. Conclusion Preconditions for the manufacturing of individualized cervical fusion cages using specific patient data are given. The implantation is uncomplicated. The improved load-bearing surface will lower the rate of implant dislocation and subsidence. The next essential steps will be to improve the workflow of the surgical simulation and shorten the time of the overall production process. The manufacturing of individualized cages at a reasonable price has to be figured out by spine surgeons and the industry.
Image of Slack Spinal Cord
Authors: Fujita Masaru 
Published: April 2016

Introduction In general, the spinal cord was constricted at the level of spinal canal stenosis. Rarely, spinal cord curved above the level of stenosis like the slack rope. There was no report about this image we called slack spinal cord. Material and Methods Slack spinal cord was shown in 7 patients. The average age was 70 years old. Multiple spinal canal stenosis were shown at the junction of thoracolumbar spine. The level of the most cranial stenosis was L1/2; 4 patients and Th12/L1; 3 patient. 5 patients of them presented a symptom of lumbar spinal canal stenosis. 2 patients presented myelopathy. Results Laminectomy was performed for them. Slack spinal cord was improved after operation. The reasons of slack spinal cord were considered as moving the spinal cord to the cranial side or compressed by redundant spinal nerve roots. The denticulate ligaments are fibrous spinal structures that are generally believed to stabilize the spinal cord within the vertebral canal. In anatomical study, the structures of these ligaments were different in the spinal level. At the lower thoracic level, the denticulate ligament is thin and long band. Furthermore, the strength of this ligament is decreased at the lower spinal levels. Considering these anatomical characteristics and slack spinal cord is shown commonly at the caudal site of spinal cord, we guess the conus medullaris move to cranial side like redundant nerve root. Conclusion Slack spinal cord is rarely observed as the secondary change with spinal canal stenosis.