bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ilio-sacral Stabilization of Sacral Jumper's Fractures using the AO-Spine Fracture System: A Novel Surgical Technique
Authors: Mameghani Alexander T. , Jeanneret Bernhard , Schären Stefan 
Published: April 2016

Introduction Jumper's fractures are severe dissociation injuries of the spinopelvic junction. These U-shaped fractures are due to an axial trauma. The treatment of these fractures associated with neurological complications includes emergency decompression combined with reduction and stabilization of the fracture-dislocation. Usually, stabilization from L4 or L5 to the ilium combined with decompression of the spinal canal is advocated, thus fusing one or two additional healthy lumbar motion segments. We report on three patients with jumper's fractures, in whom we successfully performed a posterior decompression and open stabilization from S1 to the ilium, therefore sparing the motion segments L4/S1. Material and Methods 3 patients (40, 45 and 49 years old) had been admitted to the emergency room after they attempted suicide and jumped from a greater height. All three had a jumper's fracture with fragments into the sacral canal and epidural hematoma. Indication for emergency decompression was present. In prone position a midline incision was performed and decompression of the sacral canal was achieved. After decompression bilateral long monoaxial USS II screws were placed into the ilium. Schanz’ screws from the USS fracture system were then introduced bilaterally in S1. The rods were rigidly mounted to the monoaxial ilium-screws. Fracture reduction and stabilization was performed under fluoroscopic control with the same maneuver as used for reduction of lumbar burst fractures. Fracture reduction and healing was examined with postoperative CT scan and controlled after 3 and 9 month. Results Bony healing was achieved in all three patients. In all 3 cases implant removal was performed after bony healing was proved as seen in computed tomography. At 1 year follow-up, neurological exam was normal in 2 patients. 1 patient still had persistent incomplete bladder and bowel function disorders. All patients were able to walk without assistance. Conclusion Ilio-sacral stabilization seems to be a reliable way of achieving reduction and bony healing in jumper's fractures. The reduction manoeuver is the same as described by Magerl and later on by Dick for lumbar burst fractures. As the lumbosacral motion segments (L4/5 and L5/S1) remain untouched, this technique offers the advantage of sparing important motion segments of the lumbar spine, thus being less invasive than the usually advocated techniques. However, this technique only is possible, if the segment L5/S1 is intact.
Outcomes of Lumbopelvic Fixation in the Treatment of Complex Sacral Fractures Using Minimally Invasive Surgical Techniques
Authors: Jazini Ehsan , Nwodim Emeka , Tannous Oliver , Banagan Kelley , Koh Eugene , Ludwig Steven , Gelb Daniel 
Published: April 2016

Introduction Complex sacral fractures with vertical and anterior pelvic ring instability treated with traditional fixation methods are associated with high rates of failure and poor clinical outcomes. Supplemental lumbopelvic fixation(LPF) has been utilized for additional stability to help with fracture union. The purpose of this study was to determine if minimally invasive LPF provides reliable fracture stability and acceptable complication rates in complex sacral fractures. Methods Twenty-eight patients were retrospectively chosen from a pool of 105 at our level 1 trauma center (2008–2014) who had undergone LPF. Patients underwent posterior sacroiliac fixation, with or without anterior fixation, followed by minimally invasive LPF. Main outcomes were return to the operating room (OR) for instrumentation revision secondary to loss of correction or failure of fixation, return to the OR for treatment of infection, radiographic evaluation to assess for loss of reduction. ISS score, transfusion requirements, length of hospital stay, postoperative day at mobilization, and mortality were also evaluated. Results Three patients returned to the OR for infection (11%). One patient required revision surgery for instrumentation malposition and neurologic deficit (3.5%). No patients required return to the OR for revision due to failure of instrumentation or loss of correction. The average length of surgery was 3.9 hours and estimated blood loss was 192 mL. The average transfusion requirement was 2.2 units of packed red blood cells and the majority of patients were mobilized at postoperative day 4. There were no mortalities. Conclusion This is currently the largest series of high energy complex sacral fractures treated with minimally invasive LPF. The results demonstrate reliable maintenance of reduction with a low complication rate.
Non-contiguous Cervical Spine Injury in a 14-month old Child; Case Report and Review of the Literature
Authors: Shawky Ahmed , Ezzati Ali 
Published: April 2016

Introduction Cervical spine injuries in children are relatively rare. Pattern, severity and level of these injuries are age dependant. Most of the available literature differentiates between two age groups, younger and older than 8 years. The incidence of upper cervical injuries is higher among children younger than 8 years. Most of the available literature is retrospective analysis of databases or case reports. Patients and Methods: a 14-month old child was presented to our emergency unit after involvement in a road-traffic accident. A stiff neck cervical collar was applied at the accident scene. The child was conscious, oriented. He had tendency to move the right upper and lower limb better than the left side. He had torticollis with the head rotated to the left side. Neurological examination revealed a left-sided hemiparesis. He had no other injuries. Under general anesthesia CT and MRI of the skull and the cervical spine were done. These investigations showed a fracture of the axis with a rotary subluxation of C1/2, cord edema at the level of C1 predominantly on the left side and a disco-ligamentous injury at the level of C3/4. Controlled closed reduction under image intensifier and Minerva cast was applied for 3 weeks, and then replaced with a modified Minerva-Hartmann orthosis for another 3 weeks. A review of the literature for patients below the age of 3 years with cervical spine injuries was done in a trial to define an algorithm to clear the cervical spine and to outline the management of this age group. Results The patient was followed for one year with normal MRI findings at 6 months and normal clinical findings at one year follow-up with complete improvement of the neurological deficits. Conclusion Clearance of the cervical spine after trauma in children below the age of 3 is challenging. Articulation and cooperation during clinical examination and imaging investigation is limited. Imaging should be done under general anesthesia. Immobilisation is also demanding and definitive immobilisation for conservative treatment is usually using custom-made orthoses. results of conservative treatment are excellent if closed reduction and immobilisation were achieved.
Validity and Reliability of Spine Raster-stereography in Adolescent Idiopathic Scoliosis Patients
Authors: Tabard Anne , Bonnefoy-Mazure Alice , Lascombes Pierre , Armand Stéphane , Dayer Romain 
Published: April 2016

Introduction Previous studies have evaluated the validity and reliability of the Formetric-4D system. They concluded to a good accuracy compared with radiographs and a high intra- and inter-day reliability in healthy volunteer patients. However, to the best of our knowledge, the validity and reliability were not assessed on patients with Adolescent Idiopathic Scoliosis (AIS). Therefore, the aim of this study was to evaluate the validity and reliability of the Formetric 4D system on AIS adolescent patients with Cobb between 10¡ and 40¡ in terms of sagittal, frontal and transverse parameters. Materials and Methods This study included 35 AIS adolescents (male=13) aged 13.1 ± 2.0 years. To evaluate the validity of scoliosis angle (SA) provided by the Formetric-4D System, a comparison was performed with the Cobb Angle of major curve (CA) on a 2D EOS¨ radiography (XR). Mean differences of measurements computed by each system were evaluated using paired Student t-test and Pearson correlation coefficient. To evaluate interrater reliability three repeated-measurements were independently performed in a neutral orthostatic position using the Formetric-4D System by two operators the same day. To evaluate the intrarater reliability three more repeated-measurements were performed by the first operator one week later. The parameters measured were vertebra surface rotation, thoracic kyphosis, lumbar lordosis, pelvic obliquity, trunk length and the scoliosis angle. The data analyses used were Intraclasse Correlation Coefficients (ICC). Results The 2D radiographic Cobb Angle (CA) and its rasterstereographic equivalent Scoliosis Angle (SA) were strongly correlated (R = 0,70) with a non-significant difference. The ICC for intrarater (same day: ICC (1, 1), n = 35, one week later: ICC (1, 3), n = 29) as interrater reliability coefficients (ICC (3, 3), n = 16) were excellent (ICC > 0.75) for all variables except for pelvic obliquity with the highest for sagittal and rotation parameters and lowest for the pelvis obliquity. Conclusion This study showed that the Formetric 4D system allows evaluating AIS patients with a good validity and an overall excellent intra- and interrater reliability. Based on these results, this automatic, fast and non-invasive system will not replace XR clinical analysis but it can reduce the exposure to radiation for the patients and can improve the monitoring of scoliosis evolution with no limits of use, no risks for patients and at lower price than XR.
Case Series of First Trolley Gliding Vehicle Device used in Patients with Early Onset Scoliosis as a Growth Guiding System
Authors: Aoude Ahmed , Simoes Leonardo , Aldebeyan Sultan , Ouellet Jean 
Published: April 2016

Introduction Current surgical treatment modalities available for the treatment of early onset scoliosis, either spine based Duel Growing Rods, or rib based VEPTR construct, require repetitive lengthening surgeries with no apical control of the deformity. The overall results of these techniques have shown to provide some benefits. However they remain with a high rate of complications, in part related to frequent repetitive surgeries. A new gliding spinal anchor know as Trolley Gliding Vehicle (TGV) and a new surgical technique has been developed with the hope to address some of these short coming. Here we present this innovative device and the new surgical technique. Material and Methods Six patients with Early Onset Scoliosis were treated with TGV by a single surgeon at three institutions. The implant was made available via a special access program from Health Canada, as the implant is only available in Europe (CE mark). Patient perioperative data was collected for all patients. Any intra-operative or immediate post-operative complications were also documented. Results The average age of the patients was 8.3 years of age. The pre-operative diagnoses included congenital myopathy, congenital idiopathic scoliosis, Padder Willi syndrome, cerebral palsy, “cri du chat” syndrome, and idiopathic early onset scoliosis. The average age of the patients at time of surgery was 8.3 years of age (5–14 years old). The average follow-up was 6 months. The average pre-operative Cobb angle was 71.33 degrees with average correction at last follow up equal to 29.66 degrees. No intra-operative complications were noted. One patient required one revision surgery consisting of adding TGV for fluctuating bursa over distal fixation due to excessive motion. Conclusion We present early results of a new spinal gliding implant in six patients. The Trolley Gliding Vehicle showed good correction of spinal deformity with low short-term complications rate. Results cannot provide any long term conclusion. A prospective clinical study has been started in Europe and will be undertake in Canada once Health Canada approves the implant.
Morphometric Study of Lumbar Vertebrae Pedicle through Tomographic Exams of Outpatients from a Brazilian University Hospital Center
Authors: Sandon Luiz Henrique , Brock Roger Schmidt , Teixeira Manoel Jacobsen 
Published: April 2016

Introduction The knowledge of the pedicle size in the lumbar vertebrae is important for safe and effective placement of screws in cases of instrumentation in this region. This importance is even more relevant when it is about fixing through a minimally invasive way. Most of the minimally invasive techniques for lumbar spine instrumentation is described recommending parameters for introduction of pedicle screws (25mm) based on measurement of the pedicle length in model populations (North American / European mostly). It is our purpose in this work to establish the morphometric parameters of the lumbar vertebrae pedicles in the Brazilian population, which has no such parameters well studied yet. Material and Methods Cross-sectional study of 100 adult patients (between 26 and 90 years old), 50 males and 50 females (all without trauma, tumor, inflammatory / infectious diseases or post-surgical condition) who underwent simple tomography of the lumbar spine from January to December 2012 at the Institute of Radiology of the Hospital of São Paulo in Brazil, 1000 pedicles of lumbar vertebrae were evaluated. And Literature Review conducted by PUBMED by Keyword: Lumbar Spine pedicles Results We describe for each lumbar level (L1 through L5) two measure: (Measurements made for both sides (left / right) of each pedicle): Measure A (length of the longitudinal axis of the pedicle base to the intersection of 90 ° with the imaginary line that goes from the anterior border of the spinal foramen) / Measure B (length of the longest longitudinal axis of the pedicle, the base to the junction with the anterior cortex of the vertebral body, line tangential to the spinal foramen and without crossing the midline). Measurements were obtained by electronic measurement system in iSITE Radiology in the axial plane of the major axis of each pedicle on CT scans without contrast cut standard 0.5mm Based on this assessment, we noticed that the average measure (to measure A) of the pedicles in the studied population was 17,12mm to L1, L2 to 16,22mm, 15,40mm to L3, 14,83mm to L4, L5 to 14,64mm Conclusion Thus the measure advocated for introduction of pedicle screws in minimally invasive techniques is appropriate for this population
A Novel Quantitative Automated Measurement of CSF Area for the Diagnosis of Lumbar Spinal Stenosis
Authors: Pei-Ching Lin , Jiann-Her Lin , Yung-Hsiao Chiang , Chao-Cheng Wu 
Published: April 2016

Introduction A grading system for LSS is needed to allow precise communication between clinicians and for assessment of treatment responses. At present, there are two categories of grading systems- qualitative and quantitative. However, there are always individual subjectivity of radiologists in those qualitative classifications systems. The quantitative classifications systems are time-consuming and not relevant to clinical symptoms even with the same values for DSCSA or DSAPD. Herein, we propose a novel quantitative automated method to measure the cross-section area of the CSF. This study is to introduce this novel quantitative automated method, evaluate its reliability, and compare it to other two semiquantitative CSF-based classification systems. Methods All lumbar MRI studies were selected at random. Each study included T1/T2-weighted axial and sagittal images taken between April 2012 and July 2013. Two practicing neurosurgeons with spine specialty participated in this study and did the reviews of the grading for each disc level. Each of two neurosurgeons independently measured DSCSA (dural sac cross-sectional area, mm2) on T2-weighted axial images manually. The final DSCSA were the average of two results at each disc level of the lumbar spine. They also graded each disc level according to the qualitative grading system- the Lee's and Schizas' grading systems. The final grading of each disc level of the lumbar spine was determined by the most consistent grade out of the four results obtained from the two trials of two neurosurgeons. CSF area of each disc level (ACSFA) was calculated automatedly by the algorithm we developed. For each disc level, linear regressions were performed between DSCSA and ACSFA, and ACSFA was categorized based on the final grading of Lee's and Schizas' grades. Results Seventeen female and six male patients were studied (mean age, 65.21 ± 12.1years). The inter-reader reliability of Lee's and Schiza's grading systems were “moderate” and “good” (o.437 and 0.739), respectively. ACSFA was correlated well with DSCSA linearly (r=.8988,p,.001)(Fig. 1). Using one-way ANOVA, ACSFA was able to differentiate each grade of Lee's or Schizas' systems ( p < .0001 and p < .0001)(Fig. 2 & 3). Conclusion This novel automated quantitative measurement of CSF area can provide at least the some diagnostic value for the diagnosis of LSS, and, at the same time, it avoids the variability of the quantitative system between readers and overcomes the disadvantages of the present qualitative system (DSCSA). This method can serve as a useful diagnostic tool for the clinicians.
Pendulum Rule versus Spinopelvic Parameters how the Explain the Sagittal Shape of the Spine?
Authors: Norotte Gilles 
Published: April 2016

Introduction Usually, the analysis of the spinal sagittal shape is based on a vertebral semantic, focusing on the curves (lordosis, kyphosis) and the spinopelvic parameters (pelvic incidence, sacral slope, pelvic tilt, sagittal balance). This analysis failed in defining a normal shaped spine, and in relating strictly the incidence to the lordosis. The author proposes a very different analysis of the sagittal spinal shape, named “ the Pendulum Law.” It enables to define an ideal biomechanical shaped spine and classify the sagittal shape precisely. Material and Methods 300 sagittal shapes have been studied. A vertical analysis (according to gravity) is performed, reintegrating the spine into an analysis of the muscular body's scheme and relating it to the respiration. The biomechanical spine is assimilated to three intricated Mongol bows. Different apex (contact between the vertebral body and the plumb line) are defined. They are related to muscular tension lines or attaches. The lungs apex are paramount to explain the spine. The trunk is always swaying but lungs pressure (when breathing in) stabilizes it either in an anteroposterior plan or in the sagittal plane. The repartition of the apex has been assessed in all the spine drawing specific lines. Results More than 95% of the studied spine abide by the “Pendulum law” which states that: “ whatever the spine is (including the common variation or abnormalities), the standing position consists in placing the Superior Lung apex according to the following rules: In the anteroposterior view: the plumb line equidistant from the lung apex is maintained above the sacral apex. In the sagittal view: the plumb line from the superior lung apex is equidistant of the thoracic apex and the lumbar apex. The two Pelvico-thoracic lines (the line linking the sacrum apex to the antero-inferior lung apex and the line linking the center of the femoral head to the postero-inferior lung apex) cross each other in the point “E,” exactly above the plumb line dropping from the superior lung apex and in front of the lumbar apex. Therefore, the Pendulum Law relates the sagittal shape to the gravity, the muscular body's scheme and the breathing. An ideal biomechanical sagittal shape lines up the thoracic apex and the sacral apex vertically. The alignment of the symphysis, the lumbar apex and the thoracic apex cross the vertebral bodies obliquely and harmoniously. The lumbar apex (in front of the upper plate of L4) is placed above the center of the femoral head. Conclusion The Pendulum Law relates the sagittal shape to gravity, the muscular body's scheme and respiration. Most of the commons Abnormalities are integrated according to this rule. The Pendulum is the “vertical tension” of the body's scheme that enables us to move harmoniously. (As the length of the femur is strictly related to the ideal flexion/extension of the Knee). Lordosis is related to pneumatic stabilization of the trunk and definitively not to the pelvic incidence.
An imaging Study of Partiallythreaded Screw Fixation of C2 Pedicle Fracture
Authors: Wang Qing , Xu Shuang , Wang Gaoju 
Published: April 2016

Introduction The purpose of this study was to observe the imaging features of partiallythreaded screw fixation using in various kinds of C2 pedicel fracture. Material and Methods CT image materials of 160 Chinese Han patients who suffered from atlantoaxial injury without vertebral body and pedicle fracture of C2 was included in this study, including 120 males and 40 females.Pedical trajectory selected according to Ebraheim method in three dimensional CT reconstruction was analyzed in ADW 4.4 workstation.The posterior wall fracture of C2 vertebral body, isthmus fracture and fractures under C2 laminar were simulated according to clinical observation.The trajectory length(partially threaded screw length)from entry point to anterior cortical bone of C2, bolt shank length from entry point to fracture line simulated and fillet of screw length from fracture line to anterior cortical bone of C2 were measured. Relations between height gender and partiallythreaded screw length bolt shank and fillet of screw length was evaluated. Results Male height was 167.0 ± 7.9cm on average and female was 156.0 ± 6.6 cm.The length of partiallythreaded screw was 29 mm in male and 25 mm in female on average.Height and gender was positively correlated with partiallythreaded screw length.In posterior wall fracture of C2 vertebral body, length of bolt shank was an average of 17 mm in male and 15mm in female, while fillet of screw length was 12 mm in male and 10 mm in female. The mean length of bolt shank was 14mm in male and l 3 mm in female. while mean fillet of screw length was 15 mm in male and 12 mm in female in isthmus fracture. In fractures under C2 laminar, length of bolt shank was 10 mm in male and 9 mm in female on average. while mean fillet of screw length was 18 mm in male and 15mm in female. Conclusion:The length of partiallythreaded screw used in posterior axial pedicle fracture may have a close correlation to length and height. The length of bolt shank and fillet of screw was different aecording to the position of the fracture.