bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphometry of Vertebrae in Saudi Population with a Comparison to Other Population
Authors: Hasen Mohammed , Al-Habeeb Husam , Molani Fadhel 
Published: April 2016

Introduction Precise anatomical knowledge of human vertebra is necessary for the safe placement of screws, pre-surgical planning and designing surgical instruments. There are no existed reports about the morphometry of vertebrae in Saudi population. Methods This is a descriptive study. A total of 50 spine CT was collected from the PACS system and reviewed for any abnormal pathology. Any CT with major pathology like tumor, fracture and deformity was excluded. Each vertebra was measured for the following parameters: 1- Pedicle Width. 2- Distance from Pedicle to Ant. Vertebrae. 3- Ant. Vertebrae width. 4- Canal Diameter. 5- Height of Pedicle. 6- Angle of Pedicle. All data was entered in statistical analysis program (SPSS) and compared with the existed date of other population. Result and Conclusion: The values of the parameters with the standard deviation have been concluded and compared with the Korean, Mexican, Israeli and Indian populations which shows remarkable difference and characteristic pattern important to be addressed in safe placement of screws, pre-surgical planning and designing surgical instruments. References Kang KS, Song KS, Lee JS, Yang JJ, Song IS. Comparison of radiographic and computed tomographic measurement of pedicle and vertebral body dimensions in Koreans: the ratio of pedicle transverse diameter to vertebral body transverse diameter. Eur Spine J 2011;20(3):414–421 Wolf A, Shoham M, Michael S, Moshe R. Morphometric study of the human lumbar spine for operation-workspace specifications. Spine 2001;26(22):2472–2477 Vega EU, Elizondo Omaoa RE, De la Garza Castro O, Lopez SG. Morphometry of pedicle and vertebral body in a Mexican population by CT and fluroscopy. Int J Morphol 2009;27(4):1299–1303 van Schaik JJ, Verbiest H, van Schaik FD. Morphometry of lower lumbar vertebrae as seen on CT scans: newly recognized characteristics. AJR Am J Roentgenol 1985;145(2):327–335
Biomechanical Study Examining the S2 Alar Iliac Screw Insertional Torque
Authors: Ledonio Charles , Donguyen Huy , Santos Edward , Sembrano Jonathan , Morgan Robert , Polly David 
Published: April 2016

Introduction Prior biomechanical studies have examined the role of the iliac screw in lumbosacral fixation [Lebwohl, 2002; Cunningham, 2010] and while found to be significant, the ideal screw device and fixation technique have yet to be identified. An initial effort to define this biomechanical fixation includes measurements of current screw insertion torque across screw length was developed. The objective of this study was to measure the intraoperative torque required to place an S2-Alar iliac screw for spino-pelvic fixation. This fixation method often results in variable screw fixation strength and an improved understanding of the local torques required along the length of the screw will aid in improving this surgical fixation. Materials and Methods This IRB approved study involves obtaining informed consent of patients receiving long spinal fusions either for adult deformity. The surgical trajectory for the S2-Iliac screw will be identified as is currently practiced using O-arm Stealth Navigation. Next, the insertion torque of the iliac screw will be measured using the standard driver handle fitted with a torque cell sensor by the surgeon under 3D navigation (Stealth). Results There were 6 patients who underwent spino-pelvic fixation. 12 S2-Iliac screws were placed however Insertional torque was recorded in only 6 screws. Screw maps show that peak torques range from 0.71 to 9.73 Nm. Highest torques recorded were when the head of the screw approached the bone during insertion. These peak torques recorded are 1.91 times higher than Iliac screw insertional torques reported in a previous study. Conclusion Peak insertional torques range from 0.71 to 9.73 Nm and occurred as head of the screw approached the bone during insertion. However higher insertional torques were not recorded because it went beyond the capacity of the driver.
Results of Posterior Occipito-Cervical Decompression and Fusion in Case of Basilar Invagination: A Case Series
Authors: Patel Ankit 
Published: April 2016

Introduction The term “Craniovertebral Junction” includes bony and neuro-vascular structures from base of occiput to 2nd cervical vertebrae. The subject of CV junction anomalies is under discussion and evaluation for over a century. Several classical reviews have attempted to clarify a variety of complex associated issues. Despite the volumes of publications on the subject, it appears that the last word has not yet been said. Basilar invagination is the most common craniovertebral junction anomaly. Basilar invagination implies that the floor of the skull is indented by the upper cervical spine, & hence the tip of odontoid is more cephalad protruding into the foramen magnum which causes the compression of medulla and brainstem. There are two types of basilar invagination: primary invagination, which is congenital or developmental and more common, and secondary invagination, which is acquired mostly due to trauma. Primary invagination can be associated with occipito-atlantal fusion, hypoplasia of the atlas, a bifid posterior arch of the atlas, odontoid anomalies. In basilar invagination, all three parts of the occipital bone (basiocciput, exoccipital & squamousoccipital bone) are deformed. Material and Methods Our study is short term prospective study. Study period extends from July 2012 to May 2015. Total 20 patients {male+female} of various age group {8 year to 65 year} with diagnosed cases of basilar invagination were taken for study purpose. Results Clinical outcomes: 17 patients showed improvement in their symptoms or gait with improved mJOA score, RANAWAT's neurological class and NURICK'S functional scale. 2 patients did not show any signs of improvement. 1 patient who had severe basilar invagination with os odontoideum with kyphotic deformity expired on 3rd postoperative day due to respiratory insufficiency. 1 patient had wound related complication with opening of stitches and exposed implant which required excision of exposed implant and wound recovered by secondary healing. On long term follow up 1 patient had loosening of implant from occiput bone on X-ray but she had no any clinical symptoms. Rest of patients had no long term complications. Radiologically: Using Mcrae, chamberlain line and Ranawat index, all 19 patients had reduction of dens below foramen magnum. Bone graft fused in all 19 patients between 6 to 8 months. So all over mortality rate of our study was 5%. Conclusion Basilar invagination anomalies are commonly occurring but rarely diagnosed anomalies. Developmental and congenital anomalies are more common than traumatic events. As per our prospective study excellent to good short term results can be achieved with acceptable safety but it needs further long term follow up in larger series to confirm good long term results. Good results depend on proper patient selection, good surgical skill, proper use of implants and post operative care.
Is There a Correlation between the Apical Vertebral Rotation and the Pelvic Incidence in Adolescent Idiopathic Scoliosis?
Authors: Kharrat Khalil , Sebaaly Amer , Assi Ayman , Ghanem Ismat , Rachkidi Rami 
Published: April 2016

Background Vertebral rotation is an important parameter in adolescent idiopathic scoliosis as it affects the hump and thus the esthetic aspect of the deformity. Nonetheless, it is one of the least explored parameters due to the difficulty of assessment using conventional AP and lateral standing radiographs and the high radiation of CT-scans. With the advent of EOS® technology, vertebral rotation is easily assessed using the 3D reconstruction with high accuracy and low irradiation. The objective of this study is to evaluate the apical vertebral rotation and study its correlation to the pelvic parameters. Materials and Methods This is a descriptive transversal study. 73 patients with adolescent idiopathic scoliosis patients (Cobb > 10°) aged between 9 and 36 years old with no prior history of spinal operation at initial examination were included. Subjects underwent antero-posterior and lateral radiographs of the whole spine and pelvis using the EOS® system. On the AP radiograph, the thoracic curve angle, the lumbar curve angle and the number of the involved vertebrae were measured. On the lateral view, pelvic incidence was measured. The rotation of the apical vertebra was obtained by stereoradiographic 3D reconstruction of the spine. Results The mean age of the cohort was 14 years and 11 months and 90% were females. The mean Cobb of the primary curve was 38.98 (16.9–104) with a mean vertebral rotation of 15.5° (0.3–43.5°). The mean Cobb of the compensatory curve was 31.35 (9.2–64°) with a mean vertebral rotation of 9.32° (0.1°-40.5°). While the apical vertebral rotation showed a strong correlation to the Cobb angle of the affected curve (r = 0.72, p < 0.001 for the main curve; r = 0.74, p < 0.001 for the compensatory curve), it correlated moderately to the pelvic incidence (r = 0.31; p < 0.05). Furthermore, apical vertebral rotation had the most strong correlation to pelvic incidence in thoracic curves (apex T5-T10; r=0.4, p < 0.05), whether in lumbar curves (apex L2-L4) there were a tendency to a negative correlation (r = −0.2, p > 0.05). Finally, the pelvic incidence did not correlate to the curve Cobb angle (r = 0.34, p = 0.08 for the primary curve; r = 0.27, p = 0.055 for the compensatory curve) Conclusions To our knowledge, this is the first study evaluating the correlation between apical vertebral rotation and pelvic incidence. Pelvic incidence is a well-known pelvic parameter that correlates significantly to the apical vertebral rotation in adolescent idiopathic scoliosis.
Three Column Fixation: A Dynamic Method in Scoliosis Surgery
Authors: Alam Shah , Karim Rezaul , Jonayed Sharif Ahmed , Munir Hasan Khalid Md. , Chakraborty Shubhendu , Alam Tashfique 
Published: April 2016

Introduction Scoliosis is a complex three dimensional deformity characterized by coronal, sagittal and horizontal plane deviation. Non operative treatment is a widely accepted approach. A significant number of cases need surgical intervention. Revolutionary design & capability of spinal instruments have drastically changed the principle of scoliosis correction by surgical intervention. Material and Methods During the period February 2009 to November 2014, 64 cases of different types of Scoliosis underwent surgical intervention at NITOR, BSOH and other private hospitals in Dhaka. 45 were female and 19 were male and age ranged from 14 to 38 years. Results The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved 3D correction and it has been accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complication. So, all cases were corrected by transpedicular screws and rods and 1 case stabilized by sub laminar wring. 61 cases were managed by only posterior approaches and 3 cases required both anterior releases, costoplasty, posterior stabilization as well. In every case fusion was done in selected segments. Conclusion Total follow up time was ~5 years (6 months-5yrs). All patients were assessed in terms of correction of deformities, cosmesis, and functional outcome. 64 patients had average coronal plane cobb's angle measuring ~70 degree pre-operatively and 17.12 degree immediate post-operative period. 4 patients (5.7%) developed neurological deficit. 3 regained completely but another one regaining her neurological deficit very slowly. There were malposition of screws in 9 (14%) cases, Painful prominence of screws in 6 cases (9%), full flexion lack in 8 cases (12.5%) & superficial infection in 1 case (1.5%). 80% patients improved cosmetically.
Video-Assisted Thoracoscopic Surgery (VATS) for Anterior Release of Rigid Thoracic Scoliosis
Authors: Elbadrawi Ahmed , Wafa Mohamed 
Published: April 2016

Introduction Standard anterior approach to the dorsal spine using thoracotomy carries a great morbidity; video-assisted thoracic surgery (VATS) has been used as a less invasive approach for many intrathoracic disease processes; among which anterior releases in rigid dorsal scoliosis. The authors performed (VATS) in patients with Adolescent Idiopathic Scoliosis (AIS), attempting to reduce the morbidity attributable to standard open thoracotomy surgery for anterior curve release; reporting their experience with thoracoscopy as part of the treatment for adolescent idiopathic scoliosis with rigid thoracic curves. Material and Method: A prospective randomized study of 34 cases of AIS with rigid thoracic curves underwent VATS for anterior release surgery between March 2008 and April 2013 was performed. The ages of the patients ranged from 11 to 27 years with a mean of 16.3 +/− 4.2 SD years. Spinal flexibility was assessed by the fulcrum bending technique. Cobb angle before and after the anterior release was compared. All patients had an anterior spinal release and posterior spinal fusion at two separate surgeries to evaluate the flexibility after anterior release without posterior instrumentation. Results The average follow up ranged from 22.3 to 39.2 months (mean 30.33 +/− 4.64 SD months). The mean preoperative Cobb angle was 78.4° +/− 8.87° SD on standing radiographs and 70.3° +/− 8.48° SD with the fulcrum-bending radiograph. After anterior release, the fulcrum bending radiograph showed reduction of mean Cobb angle to mean angle of 41.6° +/− 6.98°. The mean fulcrum bending flexibility index was improved from 10.41% +/− 3.97 SD (prior to VATS release) to 46.97% +/− 5.23 SD after release. VATS was successfully completed in all patients without major morbidities. The mean operative time for the anterior procedure was 123.96 minutes +/− 28.77 SD. The average number of excised discs was four. Conclusion Anterior spinal release using VATS may reduce postoperative morbidity and produces satisfactory degree of flexibility for rigid thoracic curves. It can be considered as a good and safe alternate to open thoracotomy for anterior release.
The Effect of Waiting for Surgery on Patients with Adolescent Idiopathic Scoliosis
Authors: Fallatah Salah , Sait Mohammed , Almutairi Fawaz 
Published: April 2016

Introduction The waiting time for surgical procedures is becoming longer in most specialities. This may have adverse effect on patients with Adolescent Idiopathic Scoliosis (AIS) with additional procedures being required or more complex surgery being performed. Material and Method This retrospective study was performed in the period between December 2007- January 2010 looking on the surgical waiting time on patients with AIS and its effect on curve progression and the type of surgery performed and the final outcome. Results 215 patients met the inclusion criteria and have complete medical records to be included in the study. Mean age was 13.6 years, 184 patients (86%) were females, 172 were treat in public hospitals and 43 in a private hospital, mean cobb angle of the main curve was 71°. During the study period, 55 patients underwent surgery for scoliosis correction, with a statistical difference in the waiting time between public and private hospitals (36 and 9 weeks respectively), average curve progression was 24° during the waiting period with additional fusion levels being required in 15 cases. Patients with underlying intra spinal pathology and young patients showed the most significant curve progression. Conclusion Our study support the previous report of the optimal waiting time for surgical correction of scoliosis being less than 6 months and it suggest that younger patients and those with intra spinal pathology and the ones at higher risk for progression.
Impact of Longer Surgical Wait-List Times on Length of Hospitalisation, Return to Function and Cost of Surgical Treatment in Patients with Adolescent Idiopathic Scoliosis undergoing Posterior Spinal Fusion
Authors: Tarrant Roslyn , Moore David , Kiely Patrick 
Published: April 2016

Introduction Despite the known clinical and functional benefits of timely surgery in adolescents with idiopathic scoliosis (AIS), several patients still undergo surgery for scoliotic deformity correction when curves have progressed beyond 70°. More evidence is needed assessing the effect of long surgical wait-list times on patient outcomes including return to function, intrasurgical factors and cost of surgical treatment. This study aimed to report on surgical wait-list times in a cohort of patients with AIS undergoing posterior spinal fusion (PSF), and examine potential correlations with selected patient outcomes including: intrasurgical factors, length of hospitalisation, return to function and cost of surgical treatment. Material and Methods A prospective longitudinal cohort study involving the recruitment and follow up of 77 consecutive and eligible patients with a diagnosis of AIS, from two tertiary centres, over a two year period, until return to function (e.g., school/college, physical activity) was reported. Surgical wait-list times were analyzed in relation to timing of return to function, cost of surgical treatment (€), intrasurgical factors (surgical duration, estimated blood loss) and length of hospitalisation. In accordance with local criteria, a long surgical wait list time was defined as ‘greater than 6 months’. SPSS® was used to analyze the data; non-parametric Spearman correlation coefficient was used in all correlation analyses (rs). Results The median surgical wait-list time in the cohort was 33 weeks (interquartile range 19–56 weeks). Almost two thirds of patients waited beyond 6 months for surgery (62.3%; n = 48); twelve patients (15.5%) waited beyond 18 months. Patients who waited beyond 6 months had a significantly larger preoperative curve (65° ± SD 14 versus 58° ± SD 10) and the cost of surgical treatment per patient was significantly greater (mean €32,652 versus €27,629, P < 0.0001). In addition, longer surgical wait list times strongly correlated with a significantly longer surgical duration (rs = 0.565, P < 0.0001) and higher blood loss (rs = 0.27, p = 0.044). No significant correlations were found between surgical wait-list times and length of hospitalisation, timing of return to school/college or physical activity. Conclusion Efforts to support waiting list initiatives in the AIS population are likely to give rise to significantly reduced surgical cost, less complex surgeries and more manageable curvatures being dealt with in a timely fashion.
Posterior Vertebral Column Resection (PVCR) in Early Onset Spinal Deformities (EOSD)
Authors: El-Sharkawi Mohammad , Koptan Wael , Elkott Amer , Tammam Hamdy , Gad Wael , Aboloyoun Nariman , Shawky Ahmed 
Published: April 2016

Introduction Early onset spinal deformities (EOSD) are spinal deformities before five years. Early surgical intervention is often necessary to avoid the eventually disastrous complications due to deformity progression like restrictive pulmonary functions. Posterior vertebral column resection (PVCR) achieves the best correction in severe and complex deformities. We present our experience in PVCR in five cases with EOSD. Patients and Methods PVCR was done in five cases (2 males and 3 females) with congenital hemivertebra with a mean age of 4.3 years. Two cases were only kyphotic while the other three cases had additional scoliosis. One case presented with progressive lower limb spasticity. All cases were managed by one level PVCR. Shilla growth guiding technique was done in two cases to allow future growth. One patient had short segment fusion, and two had long segment fusion. The patients were followed up for a mean of 21 (12–36) months. Results The patient with paraplegia improved completely over the three postoperative months. The local kyphosis improved by 92% (59° to 4.5°). The mean thoracic kyphosis improved by35% (38.25° to 24.5°). The mean sagittal vertical axis decreased by 71% and 19% (38.37 to 11 to 30.8 mm) postoperatively and at last follow up respectively. Lumbar lordosis reduced by 22% (47.5° to 37°). The associated scoliosis completely corrected from 29° to 0°. The mean operation time was 482.5 minute, with 3075 ml blood loss. One patient with myelocele had pseudarthrosis and metal failure necessitated revision. The patient with short segment fixation developed an asymptomatic, non-progressive proximal junctional kyphosis immediately postoperatively. No revision or extension of fusion was needed. Conclusion PVCR appears to be an effective technique to treat severe EOSD with limitation of fused segments to allow further growth.
Management of Early Onset Scoliosis using Growing Spine Profiler (GSP)
Authors: El-Sharkawi Mohammad , Koptan Wael , Shawky Ahmed , Mostafa Amer , Tammam Hamdy , Gad Wael , Aboloyoun Nariman 
Published: April 2016

Introduction Achieving adequate surgery for early onset scoliosis (EOS) is difficult because of many challenges including the need to correct the deformity, the need to allow adequate spine growth, to allow adequate lung development, and the need to minimize complications. GSP system was found to solve these troubles with minimal complications in comparison with other techniques. This is a preliminary analysis and report about the efficacy and safety of GSP system in treating patients with early onset scoliosis Patients and Methods This is a combined prospective and retrospective study of 15 patients (9 females and 6 males) with EOS. The age ranged between 3.5 and 7 years old. All patients were treated with GSP system in our hospital and were prospectively followed for a minimum of 1 year. The following parameters were measured both preoperatively and posteoperatively and at each follow up visit. 1- Cobb's angle correction. 2-T1-S1 height. 3-apical vertebral translation (AVT). 4-space available for the lung (SAL) ratio. 5-shoulder and pelvic balance. Also all surgical details were recorded including, single or dual rod technique used, operative time, blood loss, and intraoperative complications. Post-operative follow up schedule at 8 weeks and every 6 months for serial lengthening and assessment of the previous parameters after each lengthening. Any complication during follow up is recorded. This group was compared with a similar historical cohort treated earlier by Growing Rods. Results Surgical details -blood loss 90ml (80–300). -operative time 1.5 hours. -number of rods (3 cases single rod and 7 cases dual rods). -number of lengthening procedures 0–4 times. -number of additional procedures 4. Follow up - Mean follow up 4months (3–18) months. - Cobb's angle corrected from (90.4) to (44). -AVT improved from 54mm to 34mm -T1-S1 height improved from 210mm to 305mm. -SAL ratio improved from 89% to 84%. Intraoperative complications. -pleural injury 5 cases. -others 0. Postoperative complications -Screw pull-out 2 cases. -hook dislodgement 0. -neurological injury 0. -infection 2 cases (superficial wound infection). -prominent metal 1 case. -metal failure 2 cases (single rod group) Conclusion GSP seems to be a good and economic option for management of EOS with proper patient selection and proper surgical technique