bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interspinous Motion Assessment in Anterior Cervical Discectomy and Fusion: Anterior Plate versus Zero Profile Implant
Authors: Ballesteros Vicente , Munjin Aleksandar , Lecaros Javier , Zamorano Juán José , Lecaros Miguel Angel , Larraín Cristián 
Published: April 2016

Introduction Anterior cervical discectomy and fusion's (ACDF) reported pseudarthrosis rate rises up to 20% for single-level and 50% for multi-level procedures. Interspinous motion based on functional cervical spine X-rays analysis has been proposed as tool for assessing spine fusion. Previous studies comparing this assessment with direct intra operative visualization during ACDF revision surgery in patients treated with an anterior plate report that an interspinous motion of less than 1 mm correlates with complete fusion. To our knowledge, there is no literature regarding this assessment in patients undergoing an ACDF using zero profile implants. The purpose of this study is to compare interspinous motion in patients treated with an ACDF using zero profile implants to those operated with an anterior plate, after complete spinal fusion confirmation with a computed tomography (CT). Material and Methods Cross-sectional study of 22 patients with a CT-confirmed spinal fusion after ACDF. Twelve patients (16 levels) were treated with an anterior plate, while a zero profile implant was used in the remaining ten patients (17 levels). Interspinous motion at the instrumented levels was evaluated in functional cervical spine X-rays for both groups, stratified by fused level (Student's t-test, ANOVA, Stata 12). Motion values were obtained independently by a radiologist and an orthopedic surgeon, following Song's guidelines (Song et al. J Bone Joint Surg Am 2014;96:557–63). Results Patients treated with an anterior plate had an interspinous motion of less than 1 mm, while those patients in which a zero profile implant was used presented a statistically significant greater motion at the fused level ( p = 0.0082). The instrumented level did not affect interspinous motion ( p > 0.05). Conclusion Patients treated with an anterior plate had an interspinous motion of less than 1 mm, while those patients in which a zero profile implant was used presented a statistically significant greater motion at the fused level ( p = 0.0082). The instrumented level did not affect interspinous motion ( p > 0.05).
Treatment of Thoracolumbar Osteoporotic Vertebral Compression Fractures with Vertebral Body Stenting: A Prospective Study
Authors: Alobaid Abdulrazzaq , Shehata Eslam , Almutair Abdulaziz 
Published: April 2016

Introduction Balloon kyphoplasty is a procedure to stabilize osteoporotic and/or cancer related VCFs. However, there is a technique inherent problem with the amount of reduction; when filling the balloons, an acceptable reduction is achieved. However, the resulting final reduction after cementing is ~25% lower due to the partial collapse after balloons deflation. To avoid loss of reduction, a newer technique has been introduced, based on the principles of balloon kyphoplasty and vascular stenting. Methods A prospective cohort study of clinical and radiographic results after vertebral body stenting(VBS) for treatment of vertebral compression fractures(VCFs). To evaluate effectiveness of VBS as a new technique to treat symptomatic VCFs. A total of 33 patients with 52 symptomatic VCFs were enrolled in a prospective study of VBS. Clinical outcomes were measured pre- and postoperatively using the visual analogue scale (VAS), Oswestry Disability Index (ODI) and ambulatory status (AS). All outcomes were assessed before the procedure, and at 1, 12, 24, and 36 weeks after the procedure. Results The median VAS scores went from 10.0 preoperatively to 1.0 at last follow-up. The pre-operative ODI score was 80 preoperatively, improved to 18 at last follow up. The ability to move independently and ease of ambulation significantly improved after the procedure (P ˂ 0.001). The median kyphosis angle was 15.0 degrees preoperatively and decreased by a median of 4.5 degrees postoperatively. Conclusions Patients with symptomatic VCFs had significant improvements in back pain, function, and quality of life following VBS. The results of percutaneous vertebral body stenting in osteoporotic fractures may encourage surgeons in future to widen the indications and use these techniques to successfully restore anterior column in traumatic non-osteoporotic fractures in conjunction with posterior instrumentation.
Combined Endovascular and Surgical Treatment of Spinal Dural Arteriovenous Fistulas
Authors: Vukic Miroslav , Ozretic David , Rados Marko , Marasanov Sergej , Rozankovic Marjan 
Published: April 2016

Introduction Type I spinal dural arteriovenous fistulas (SDAVFs) are the most common form of spinal vascular malformations. Even so, they are rare and still underdiagnosed. They are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Left untreated, they can lead to progressive neurological decline and considerate morbidity. We present our experiences and results in combined endovascular and surgical treatment of such lesions. Material and Methods We conducted a retrospective review of data from 14 adult patients with the diagnosis of SDAVFs who underwent treatment at University Hospital Center Rebro Zagreb between January 2012 and June 2014. We compared complication rates, recurrence rates and data on clinical and imaging follow up in these patients. Results 12 out of 14 patients underwent endovascular embolization (Onyx was used in 1 patients and NBCA in 11 patients) as the first line therapy. Two patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status after treatment (using the Aminoff-Logue Scale score). One patient in endovascular group developed spinal infarction due to accidental embolization of posterior spinal artery. Six patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group had recurrence of fistula during the course of follow- up and were reoperated. Conclusion Despite most fistulas are amenable to endovascular embolization, microsurgical obliteration is the treatment of choice in specific anatomic situations and usually the only solution in recurrent cases. A combined approach offers the best results after careful selection of patients based on imaging.
“Capac Ñan” Stairway Fashion Hemilaminectomy: A New Minimally Invasive Multilevel Option to Treatment of Cervical Stenosis. A Study with 24 Months of Follow-Up
Authors: Pesantez Carlos Fernando Arias 
Published: April 2016

Introduction There are many options to decompress the cervical spine on posterior way in multilevel disease, however the muscular injury and instrumentation is a big problem in traditional surgery, the minimally invasive procedures can achieve optimal decompression without muscle injury, preserving the posterior ligamentous tension band with less pain, bleeding and hospitalization, providing improvement in short time. Materials And Methods: We present an study with 15 patients with symptoms of multilevel cervical stenosis and MRI shows multilevel stenosis too, All the patients underwent minimally invasive uniportal multilevel decompression. We use VAS, Neck Disability index and Nurick clinical scale with follow up of 24 months. We made POP early (2 weeks) MRI and dynamics rx. Results The Vas preop was mean 9 and 2 on 24 monts. Neck Disability index was 20 preop and 10 POP 24 months. The Nurick clinical scale shows improvement of one time line. The surgical time was mean 22 minute(mean) each level, blood lose 11cc (mean) each level, hospital discharge on 23 hours after surgery and return to daily activities mean 10 days. Conclusions The “Capac Ñan” starway fashion minimally invasive hemilaminectomy procedure can be safe and efective to decompress a cervical spinal cord on multilevel disease without instability, muscular injury and let a better time to recovery and return to daily activities. We need more experience to make a final conclusions.
Results of Ballon Kyphoplasty in Osteoporotic Fractures with Posterior Wall Injury
Authors: Shawky Ahmed , Krajnovic Branko , Ezzati Ali 
Published: April 2016

Introduction Cement augmentation techniques are standard treatment for cases of osteoporotic vertebral fractures. Compared with vertebroplasty, kyphoplasty is associated with decreased rates of cement leak. Cases with posterior wall fractures are relative contraindications for both techniques. The aim of this study was to evaluate the results of balloon kyphoplasty in cases of osteoporotic fractures with posterior wall involvement Patients and Methods Forty-eight patients with osteoporotic fractures with injury of the posterior vertebral wall were included. Fractures between T4 and L5 were included. Cases with posterior ligamentous complex injury were excluded. Preoperative evaluation included plain X-rays, CT, MRI, and laboratory diagnosis of osteoporosis. All cases were operated upon with balloon kyphoplasty. Bilateral (bi-pedicular) approach was used in all cases. Injected cement volume and incidence of cement leak were evaluated. The minimum follow-up period was 6 months. Results 18 males and 30 females were operated upon. The average age was 72.4 years. The most common affected vertebra was T12 in 19 patients. The average volume of injected cement was 6.2 ml. Posterior cement leak (in spinal canal) occurred in 2 cases and was asymptomatic. There were no neurologic or embolic complications. Conclusion Balloon kyphoplasty is safe in cases of osteoporotic fractures with posterior wall fractures. Type A3 and A4 fractures (according to AO classification) were not associated with increased incidence of cement leak in spinal canal. The volume of injected cement should not exceed the volume injected to inflate the ballon.
Treatment of Vertebral Body Metastases in Palliative Patients: Radiofrequency Ablation, a New and Secure Treatment Option
Authors: Müller-Broich Jacques Dominik , Kretschmar Tobias , Porten Marius , Demukaj Sadri , Saxler Guido 
Published: April 2016

Introduction About a quarter of all people dying in germany succumb to cancer. In 40% metastases of the spine are present. Potentially vertebro- or kyphoplasty in combination with a tumorablation may be a treatmentoption in painful metastases or metastases with fractures. Cementing alone leads to dislocation of metastases and scattering of tumoral mass in the patient. (Principle of Archimedes) Therefore local reduction of tumoral mass should be performed whenever possible.The use of ablation systems in the vicinity of nervous and vascular structures is potentially dangerous. The presented observational study is to assess the security and effectivity of a new spinal intravertebral radiofrequency-ablation sonde. Materials and Methods During the period from 11/2013 until 6/2015 we treated 24 patients (14f, 10m) with 58 vertebral bodies with the radiofrequency-ablation system followed by radiofrequency-kyphoplasty. The mean follow-up was 7,04 months (total 169 mon.). Mean age 67 years (Range 51–84 years). All vertebral bodies were treated unipedicular. Cancers treated were breast cancer (8), multiple myeloma (7), lung cancer (3), chondrosarcoma (1), prostate (1), urothel (1), cancer of unknown primary (1), gastric cancer (1) and fibrous dysplasia (1). In two patients this technique was combined with minimal-invasive percutaneous osteosynthesis. The ablationsystem contains a navigable, bipolar electrode with two temperature detection sondes, which allow for real-time temperaturemonitoring at the proximal end of the ablation zone. The ablation zones were planned preoperatively via computertomography and mri. Patients were examined for neurological or other deficits postopertively and during follow-up outpatient clinic visits. Results The ablation of the preoperatively determined areas were intraoperatively radiologically and via monitoring of temperature securely performed. The maneuverability of the ablation device allowed via unipedicular access the exact positioning of the device in the planned ablation zone. No patient presented neurological deficits or vascular lesions due to radiofrequency-ablation. One cementextravasation, while performing kyphoplasty at a site where the lateral wall of the vertebral body had already been preoperatively destroyed by the tumor, lead to affection of a peripheral nerve with intercostal neuralgia (<7 days). Conclusions The treatment of 24 tumorpatients in the advanced stadium of the cancer disease with percutaneous, minimally-invasive radiofrequency-ablation followed by cementaugmentation could be verified as secure treatmentoption for vertebral body metastases. The combination of a unipedicular access for radiofrequency-ablation and –kyphoplasty facilitates the careful and safe treatment of palliative cancer patients.
Routine Bone Biopsy during Percutaneous Vertebroplasty or Kyphoplasty in the Treatment of Osteoporotic Vertebral Fractures. Does it Change the Management Plan? Do we Know the Costs?
Authors: Shakokani Majeed , Robinson Tom , Cumming David , Lovell Robert , Bhagat Shaishav , Powell John , Kaleel Saajid 
Published: April 2016

Introduction According to the WHO, osteoporosis causes more than 8.9 million fractures annually worldwide. The lifetime risk for a wrist, hip or vertebral compression fracture (VCF) has been estimated to be in the order of 30% to 40% in developed countries. It is estimated that up to 2 people per 100,000 in England are currently treated with percutaneous vertebroplasty and percutaneous balloon kyphoplasty. There are other causes of vertebral compression fractures, and therefore a bone biopsy is recommended to rule out pathologies such as malignancy. There is debate about the necessity of routine biopsy and its cost- effectiveness. Material and Methods We conducted a retrospective study on a cohort of consecutive patients undergoing vertibroplasty/kyphoplasty and bone biopsy over a 2 year period between 2013 and 2015 at The Ipswich Spinal Unit. Patient's demographics, indication for surgery, level of augmentation, histopathology results, complications and outcomes were extracted from electronic records. Patients were grouped in to 2 major groups; suspected malignancy and unsuspected malignancy group. Subgroups included non-biopsy group, and routine biopsy group. The non-biopsy group was followed up until last point of care. Cost of a routine biopsy was calculated based on theater, surgeon, consumables and histopathology costs. Results 64 patients, Mean age of 64, 129 levels were augmented, length of stay of 3 days, follow up of 22 weeks, and mean last point of care was 60 weeks. All underwent imaging and were discussed in a multi-disciplinary meeting (MDT). Out of the 64 patients, 22 malignancy group, 18 patients underwent biopsy. Out of the 42 patients in whom malignancy was not suspected, routine biopsy was performed in 17 patients. No malignancies (0%)found in the unsuspected malignancy group vs 5 positive samples in the suspected group. Routine biopsy did not change the management plan. Average Total cost of a routine biopsy was between £210 and £310. Conclusion Contrary to the previously published reports, our study shows that there is no specific role for routine biopsy during vertebroplasty procedure. This is a reflection of our MRI reporting and MDT approach. Therefore, we believe selective biopsy is more cost effective and value added approach in vertebral compression fractures.
Is Preoperative Duration of Symptoms a Significant Predictor of Functional Status and Quality of Life Outcomes in Patients Undergoing Surgery for the Treatment of Degenerative Cervical Myelopathy?
Authors: Tetreault Lindsay , Kopjar Branko , Wilson Jefferson , Arnold Paul , Fehlings Michael 
Published: April 2016

Introduction Longstanding compression of the spinal cord in patients with degenerative cervical myelopathy (DCM) may result in irreversible neural tissue damage. This study aims to analyze whether a longer duration of symptoms is associated with poor surgical outcomes and to determine the optimal timing for decompressive surgery. Material and Methods Three hundred and fifty patients with symptomatic DCM were prospectively enrolled in either the CSM-North America or International study at 12 sites in North America. For each patient, extensive demographic information was collected, including age, co-morbidities, and a self-reported estimate of preoperative duration of symptoms. Postoperative functional status and quality of life were evaluated at 6-, 12- and 24-months using the modified Japanese Orthopaedic Association (mJOA), Nurick grade, Neck Disability Index (NDI) and Short-Form-36 (SF-36) Physical (PCS) and Mental (MCS) Component Scores. Change scores between baseline and 12-month follow-up were computed for each outcome measure. Duration of symptoms was dichotomized into a “short” and “long” group at several cut-offs. An iterative mixed model analytic approach procedure was used to evaluate differences in change scores on the mJOA, Nurick, SF-36 MCS and PCS and NDI between duration groups in 1-month increments. Two models were constructed: 1) an unadjusted model between duration of symptoms and surgical outcome and 2) a model adjusting for significant independent covariates identified through stepwise regression analysis. Results Our cohort consisted of 201 (57.43%) men and 149 (42.57%) women, with a mean age of 57.49 ± 11.77 years (range: 29–87 years). The mean duration of symptoms was 25.71 ± 36.68 months (range: 1–240 months). In unadjusted analysis, patients with a duration of symptoms shorter than 4 months had significantly better functional outcomes based on the mJOA ( p = 0.04) than patients with a longer duration of symptoms (>4 months). On average, patients with a shorter duration of symptom improved by 3.71 on the mJOA, whereas those with a duration 4 months or longer only exhibited a 2.96 mean gain. Twelve months was identified as the next important cut-off beyond which patients had a significantly worse outcomes on the mJOA; however, this difference was smaller. Following adjusted analysis, cut-offs of 4 and 12 months remained significant. Duration of symptoms was not associated with Nurick or SF-36 PCS or MCS in either the unadjusted or adjusted models. Conclusion Patients who are operated on within 4 months of symptom presentation have better mJOA outcomes. It is recommended that patients with DCM are diagnosed in a timely fashion and referred early for surgical consultation. Our study does not support the traditional conservative “watchful waiting” approach to symptomatic patients with DCM.
Lumbar Spondylolisthesis: Radiographic Criteria of Instability
Authors: Hajj Rabih , Assaf Yara , Lahoud Jean-claude , Hoyek Fadi 
Published: April 2016

Introduction The goal of this study was to compare the radiographic criterias of “static” and “dynamic” lumbar degenerative spondylolisthesis. The sensitivity of standing lateral flexion/extension (SLFE) radiographs and magnetic resonance imaging (MRI) was used to categorize the spondylolisthesis to provide the patient with the ideal treatment. Material and Methods Prospective study where patients were screened using standing lumbar spine SLFE radiographs and MRI. They had their plain films assessed for the degree of spondylolisthesis and were designated “dynamic” or “static” based on the current literature criteria. Axial and sagittal T2 MRIs were evaluated for associated facet fluid (FF) and interspinous fluid (ISF). We compared then the radiographic results with our per-op findings and studied the sensitivity of SLFE radiographs and MRIs. Results 22 patients were included and evaluated for the presence of spondylolisthesis. Patients with greater than 3mm of instability on SLFE films were more likely to have FF ( p = 0.026) and ISF ( p = 0.027). If ISF was present on MRI, there was a positive predictive value (PPV) of 83.3% that there would be greater than 3mm instability on plain films. Absence of FF on MRI has a PPV of 75% for instability less than 3 mm on plain films. If ISF is present on MRI, the likelihood ratio of finding greater than 3mm instability on plain films was 3.45. The presence of FF on MRI had a likelihood ratio of 2.53 for instability. The presence of both parameters FF and ISF increased the likelihood ration to 5.08. Conclusion The presence of FF and/or ISF on MRI is associated with instability greater than 3mm on SLFE films. The presence of 1 or more of the following criteria: slip distance greater than 3mm, FF greater than 3mm and positive ISF permit us to consider the spondylolisthesis as dynamic and allow us to perform a posterior spinal fusion.
Long Term Experience with Reduction Technique in High Grade Spondylolisthesis in the Young
Authors: Sudarshan Pramod , Panda Aditya , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan 
Published: April 2016

Introduction Surgical management of high grade spondylolisthesis in the young is not only challenging but also controversial, from in-situ fusion to complete reduction. It is fraught with dangers such as neurological injury, pseudoarthrosis and progressive deformity with subsequent global sagittal imbalance. We describe our experience of progressive reduction technique and restoration of lumbosacral alignment. Material and Methods A retrospective review of patients who underwent surgery between 1998 and 2012. The surgical technique involved positioning the hips in extension with traction, pedicle screw fixation, correction of lumbosacral kyphosis with a specific distraction maneuver, wide decompression, and gradual reduction of the deformity and maintenance of reduction with interbody fusion. All patients were serially assessed at 1, 3, 6 months and yearly thereafter with clinical, radiological and outcome measures (ODI and VAS). Results 27 patients with high grade spondylolisthesis at L5-S1 (3 cases Grade 3, 7 Grade 4, 17 Grade 5) with an average age of 13.9 years were reviewed. Mean follow-up was 120 months (range 24–192). All patients presented a solid fusion at the 6 month visit; mean slip percentage was reduced from 89% to 23%, with all cases reduced to grade 2 or less. The slip angle improved from 45° to 3° postoperatively, with improvement in sacral slope from 13° to 35°. 4 spondyloptosis patients had concomitant scoliosis which corrected spontaneously after the surgery and did not need further intervention. All but one patient (96.2%) had good functional outcomes and returned to their full normal activities. One patient developed a deep infection necessitating implant removal, with eventual deformity progression leading to a poor outcome. Three patients (11.1%) suffered partial drop foot that resolved in full by 12 weeks. Conclusion Our technique demonstrated a significant reduction of high grade spondylolisthesis, with restoration of global sagittal balance via correction of the lumbosacral kyphosis. Though surgically demanding, it is safe, reproducible and gives satisfying outcomes.