bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Clinical and Radiographical Results of Single Level Cervical Arthroplasty with Discocerv®
Authors: Oh Sung Kyun 
Published: April 2016

Introduction Cervical disc arthroplasty has been shown to be as effective as fusion in radiculopathy in appropriately selected patients. Discocerv(Alphatec Spine, Carlsbad, USA) was introduced to reduce the difficulty of end plate preparation. Aim of this study is to evaluate the early results of clinical and radiographic outcome in patients implanted with Discocerv, which is semiconstrained mobile prosthesis made of ceramic bearings. Material and Methods From December 2008 to June 2012, 14 patients were enrolled in this retrospective study. They all suffered from single level radiculopathy due to acute disc rupture, and underwent total disc replacement with Discocerv. The mean follow-up period was 28 months (12~60 months). There were 8 males and 6 females and the mean age was 46.9 years old (39–66). The clinical outcomes were analyzed by using preoperative and postoperative follow up Korean version of neck disability index(K-NDI) and visual analogue scale(VAS). Also segmental motion was assessed by using dynamic flexion –extension lateral view, and heterotopic ossification or other complications were assessed. Results The mean VAS score improved significantly from 8 preoperatively to 0.3, 0.6 at one year, two years respectively and mean NDI score also improved from 28 preoperatively to 9, 6.4, 8.75 at three months, one year, two years respectively after operation. The mean segmental motion was 3.2 degree preoperatively and 4.7, 4.6, 6.6 degree at postoperative six months, one year, two years respectively and after 3 years, mean segmental motion decreased to 3.1 degree and to 1.9 degree at four years. Heterotrophic ossification was not detected in all cases, but anterior osteophyte formation at implanted segment was seen in 3 cases after three years. There was no radiologic complication related to wear. But 2 patients complained subjective discomfort as if they felt friction sound of their artificial joint. Conclusion Single level cervical arthorplasty with Discocerv showed good clinical outcomes and motion preservation sustained up to postoperative 3 years. Also, there were no major complications or no heterotopic ossification. However, 14% of patients felt friction sound by themselves.
Hybrid Constructs in the Surgical Treatment of Degenerative Cervical Disc Disease: Five-Year Clinical and Radiological Follow Up
Authors: Szollosi Balazs , Varga Péter Pál 
Published: April 2016

Introduction In most of the patients with multisegmental cervical degenerative disc disease the certain segments can show different stages of degeneration and instability. This condition may require an individual surgical strategy and the use of hybrid constructs with the combination of fusion and motion presevation implants. Our study was designed to investigate the clinical and radiological outcome of the combination of cervical fusion and arthroplasty in a prospective cohort. Material and Methods 36 patients with symptomatic cervical radiculopathy and/or myelopathy underwent hybrid cervical surgery between 2007 and 2010 (14 two-level, 16 three-level and 6 four-level surgeries were performed). VAS for pain, Neck Disability Index, neurologic function and the radiographic parameters (range of motion at the level of prosthesis and the cranial adjacent segment, the intervertebral disc height of the adjacent segment, cervical lordosis, heterotopic ossification) were evaluated during the study period. Results Improvement in pain was significant and sustained 5 year after the surgery (dVAS= 5.0, p < 0.05). The segment of the prosthesis ultimately showed the preservation of motion when compared with preoperative values (the preoperative mean flexion/extension ROM was 8.2° while the postoperative ROM was 7.6°). The mean cervical spine lordosis was preoperatively 1.7°, postoperatively 16.2° ( p < 0.05). None of the patients has required further surgery because of symptomatic adjecent segment disease. Conclusion The results of the study support the theoretic advantage of the use of hybird constructs in selected cases. In our cohort, the 5-year clinical and radiological outcome of the multilevel cervical hybrid surgeries are promising. However, long-term follow up studies are required to prove its role in the surgical treatment of the multisegmental degenerative cases.
Adjacent Segment Degeneration and Adjacent Segment Disease in Patients with Cervical Arthroplasty with 5 Years Follow-Up
Authors: Isais Abraham , Gonzalez-Moga Amado , Santos Hugo 
Published: April 2016

Introduction Among the practical advantages of the cervical arthroplasty, the preservation of the movement could reduce the presentation of cases of adjacent segment disease and adjacent segment degeneration compared with anterior cervical fusion. It is estimated that ~90% of patients managed with anterior cervical fusion will present a new onset or progression of a degenerative adjacent levels, exhibiting symptoms during the first 10 years. Currently there are reports of reoperation of cases treated with this technique due to the presence of nonunion, bone collapse, migration of the implants and the development of adjacent segment disease. Material and Methods During the period between January 2005 and July 2010 were included 153 patients with an average age of 47.69 years (range 40–60 years, 56 men), who had a diagnosis of symptomatic cervical disc disease of 1 or 2 levels. All were treated by cervical arthroplasty prosthesis using the Mobi-C, Activ-C and ProDisc-C systems, searching for the presence of adjacent segment disease or degeneration according to the classification of Hillbrand. The monitoring was performed with clinical examination and radiological control in all patients with visits at 15, 30 and 60 days and periodically thereafter 6 months. Results The follow-up time was 60 months and only 11 cases (9.40%) of the 117 patients who were managed with radiculopathy in 1 level showed adjacent segment degeneration during the 5 years of follow up. The average time that the degeneration was observed was 30 months, without observing changes in the first year of follow-up in any of the cases. In patients where 2 levels were handled, we found 3 cases of degeneration (8.33%), drawing attention that these were presented earlier manner (12–18 months) compared with only 1 level affected group. We found 7 cases (5.98%) in which adjacent segment disease was presented in patients with 1 level affected and 4 cases (11.11%) of involvement in patients with 2 levels affected. It was observed that 81.81% occurred in the upper segment and 18.19% in the lower segment. All patients who developed adjacent segment disease required revision surgery (11 cases), showing a positive trend during the monitoring period. No infections, spinal injuries or dural tears occurred. We did not observed the presence of collapse or migration of the implants. No mortality was documented during the study. Conclusion Cervical arthroplasty is an excellent tool for management of cervical radiculopathy, favoring the intervertebral movement and reducing stress, whereby the occurrence of adjacent segment degeneration and adjacent segment disease are diminished compared with anterior cervical fusion according to that reported in the literature.
Clinical and Radiological Outcome at the 10 Year Follow up of Total Cervical Disc Replacement
Authors: Mehren Christoph , Heider Franziska , Zillner Bernhard , Siepe Christoph , Korge Andreas , Mayer Michael 
Published: April 2016

Introduction There is still a lack of facts about long term impacts after implantation of a total cervical disc replacement (cTDR). The aim of this current analysis was to evaluate the long- term clinical results and efficacy, the radiographic findings of the index level as well as the adjacent level in a cohort of cTDR patients treated with ProDisc C (Synthes, Paoli, USA) 10 years after surgery. Material and Methods Clinical outcome scores and patient satisfaction rates were acquired within the framework of an ongoing single center prospective non randomized clinical trial. The patient's employment status, complications, reoperations and further treatments due to symptomatic adjacent segment disease (ASD) were recorded. X-ray evaluation included the incidence of heterotopic ossifications (HO) according as well as the rates and timing of ASD. Follow up was recorded 1, 5 und 10 years after surgery. Results 38 patients were available for final FU, resembling a 80,8% FU rate after a mean FU of 122,9 months. The overall results revealed a highly significant improvement from baseline VAS and NDI levels at all postoperative FU stages ( p < 0,0001). VAS scores demonstrated a statistically significant improvement (VAS neck 6.4 to 1.9; VAS arm 6.3 to 2.1 at the last FU). The NDI baseline values showed a stable improvement (21/50 to 6/50). Patient satisfaction rates remained stable throughout the postoperative course, with 78.9% of patients reporting a ‘highly statisfactory’ or a ‘satisfactory’ outcome in 21,1%. The radiographic results demonstrated a noteworthy incidence of HO as well as a progression of the HO in process of time. HO Grade I appeared in 10%, Grade II in 10%, Grade III in 32%, and Grade IV in 26%. The overall complication rate (excluding HO) was 12%. The incidence of ASD was 32.3%. 70% of ASD were asymptomatic, none of the ASD patients need further surgery. Within this group of patients with ASD 80% of the patients presented with a high-grade HO with loss or reduced function of the prosthesis in the 5 year FU. Conclusion The results demonstrate that cTDR is a viable treatment option resulting in improved clinical outcomes and low rates of subsequent surgical procedures. The progression of HO with a high amount of non functional TDR may leads to the high figures of ASD.
Surgical Treatment for Cervical Dislocation with Quadriplegia in a Young Child Aged 5 Years Old: a Case Report and Review of the Literature
Authors: Elmorshidy Essam 
Published: April 2016

Introduction Cervical dislocations with quadriplegia are extremely rare in young children (5 years and less) and many surgeons have no experience with this type of injury. Here we report on a case of a boy 5 years old with dislocated C3/C4 with incomplete quadriplegia and its treatment. Material and Methods The clinical and radiological findings were described. Because closed reduction failed, we decided to perform open reduction and fixation with a simple wiring technique through a posterior approach. We also reviewed the related literature. Results There was a significant improvement in neurological function during the follow-up period, and no complications developed. The boy was able to walk supported after 3 month although there is some residual spasticity Conclusion Cervical dislocation with quadriplegia in young children is a great challenge. Closed reduction and rigid immobilization remains the 1st choice, however surgery may be indicated in children if closed reduction fails, marked instability or neurological deterioration.
Correlation between Spinal Coronal Profile and Proximal Femur Bone Mineral Density in Adolescent Idiopathic Scoliosis
Authors: Andalib Ali 
Published: April 2016

Introduction Although Adolescent Idiopathic Scoliosis patients have lower Bone Mineral Density (BMD) but relationship between BMD and curve pattern, intensity of curve, or its progress in these patients is controversial. Some studies have shown a significant difference between left and right proximal femur BMDs in AIS patients. Since the curve pattern relationship with density of bilateral proximal femur has not been identified, this study aims to investigate the relationship between Spinal Coronal Profile and differences in BMD on either sides of proximal femur in patients with AIS. Material and Methods This study is prospective and included 50patients with AIS who underwent posterior or anterior and posterior correction and fusion surgery between December 2013 and december 2014. The mean age at the time of surgery was 16.6 ± 5.8 years. Bilateral proximal femur BMD and Z-score was calculated before surgery by dual-energy X-ray absorptiometry. We evaluated correlations between coronal parameters, obtained from preoperative radiographs, and the BMD ratio using Paired Samples Test analysis. Results Patients with Lenke type 1 curve (28; all with a right convex curve)have no significant difference between bilateral proximal femur density but in patients with Lenke type 5curve(22;all with a left convex curve)have greater bone mineral density on right side(concave). Conclusion The bilateral proximal femur BMD difference was significantly correlated with the coronal balance in AIS patients. When the patient have coronal imbalance the proximal femur BMD was greater in the concave side.
Low-density Pedicle Screw Constructs for Adolescent Idiopathic Scoliosis: Evaluation of Effectiveness and Cost
Authors: Tannous Oliver , Jazini Ehsan , Banagan Kelley , Belin Eric , Gelb Daniel 
Published: April 2016

Introduction Optimal screw density and technique in treatment of idiopathic scoliosis remain unknown. We sought to find if low-density (LD) screw construct can achieve curve correction similar to that achieved with high-density (HD) constructs in adolescent scoliosis at substantial cost savings. Materials and Methods Patients treated operatively for idiopathic scoliosis at our center between 2007 and 2011 were identified through a retrospective database review. Each patient was treated with an LD screw construct. Radiographic outcomes included assessment of screw density, percent correction of major and fractional lumbar curves at follow-up, T5−T12 kyphosis, and angle of lowest instrumented vertebra (LIV). Costs were calculated and compared with costs of HD constructs. Results Forty-five patients met inclusion criteria. Ages ranged from 12 to 19 years (mean age, 14.9 years). Average construct density was 1.2 screws per fused level (range, 1.07−1.33 screws). Mean percent curve correction at latest follow-up: major curve, 67.2%; fractional lumbar curve, 69%. Average postoperative thoracic kyphosis: 30 degrees. Mean LIV angle: 5.6 degrees. Total screw cost was $13,370 per case in the LD group compared with $22,340 per case if all levels had been instrumented with 2 screws. Conclusions Our LD screw construct is among the lowest density constructs reported in the literature and achieves curve correction comparable to that reported for HD constructs at substantially lower cost.
Selection of Lowest Instrumented Vertebra in the Management of Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis using Pedicle Screw Instrumentation
Authors: Nadeem Umair , Shah Abdullah , Zaman Atiq uz Zaman , Aziz Amer 
Published: April 2016

Introduction The aim of surgical treatment for adolescent idiopathic scoliosis (AIS) is correction of the three dimensional deformity, achievement of stability and preservation of as many distal motion segments as possible. In Thoracolumbar/ Lumbar adolescent idiopathic scoliosis (TL/L AIS) correction of C-shaped coronal curve into S-shaped saggital curve is a considerable challenge to a spine surgeon. In this regard, selection of Lowest Instrumented Vertebra (LIV) is of particular importance and remains controversial in literature. We conducted a retrospective study involving Lenke V patients to determine the exact distal fusion level (LIV) in the management of thoracolumbar/lumbar adolescent idiopathic scoliosis (TL/L AIS) using pedicle screw instrumentation. Material and Methods Analysis of radiographic parameters of 32 TL/L AIS was done. The patients were grouped according to the Lowest Instrumented Vertebra; Group I (fusion to L3, n = 25) and Group II (fusion to L4, n = 7). The Group I was subdivided into Group IA (L3 crosses the mid-sacral line with rotation of less than grade II on bending films, n = 14) and Group IB (L3 does not cross the mid-sacral line or rotation is grade II or more on bending films, n = 11). All of the patients in the Group II had the same location and rotation of L3 in bending films as that of patients in the Group IB. Patients with lowest instrumented vertebral tilt (LIVT) of more than 10° or coronal balance of more than 15 mm were considered to have unsatisfactory results. Results In these 3 groups, there was a significantly lesser correction in the TL/L curve and LIVT in the Group IB. Unsatisfactory results were obtained in 1 patients (7.1%) of the Group IA, in 7 patients (63.3%) of the Group IB, and in 1 patient (12.5%) of the Group II, which was found to be statistically significant. Conclusion In TL/L AIS patients undergoing treatment with pedicular screw instrumentation, the curve can be fused to L3 with good radiographic outcomes when L3 crosses the mid-sacral line with rotation of less than grade II on bending films. Otherwise, L4 should be selected as the Lowest Instrumented Vertebra.
Intra-wound Vancomycin Reduces the Infection in Growth-Friendly Spine Surgery
Authors: Haller Justin , Hulet Andy , Ding Qian , Presson Angela , Heflin John , Smith John 
Published: April 2016

Introduction Patients with Early Onset Scoliosis (EOS) who require growth-friendly spine surgery are known to be at high risk for infections and/or wound dehiscence. Several studies in pediatric and adult patients undergoing spine surgery have shown that vancomycin powder applied to the wound before closure significantly reduces the risk of post-operative infection. There are currently no studies that evaluate the efficacy of intra-wound vancomycin in reducing infection for patients undergoing growth-friendly spine surgery. Methods Data from 116 patients in a prospectively collected database with EOS of multiple diagnoses were reviewed. Patients were divided into two groups. From May 2002 through June 2013, there were 1036 VEPTR procedures in which no patient received intra-wound vancomycin. Beginning in June 2013, there were 161 consecutive EOS procedures having VEPTR surgery and all had intra-wound vancomycin powder. Patient groups were compared based on age, gender, diagnosis, type of surgery, ambulatory status, and bowel/bladder incontinence. Additionally, complications related to intra-wound vancomycin powder were reviewed. Results The pre- and post-vancomycin groups were similar with regard to age, gender, diagnosis, ambulatory status, and bowel/bladder incontinence. The groups were significantly different with regard to type of surgery (Table 1). Prior to the use of intra-wound vancomycin, the infection rate in VEPTR surgery was 5.7%. The patients receiving intra-wound vancomycin had a significantly reduced infection rate of 1.2%. ( p < 0.031). Using multivariate logistic generalized estimating equation model to control for surgery type, infection rate was lower in the patients who received intra-wound vancomycin as compared with the patients who did not receive intra-wound vancomycin (1.2% versus 4.4%, p = 0.066). There were no complications related to the administration of intra-wound vancomycin. Conclusion Intra-wound vancomycin is safe and reduces infection rates for patients undergoing growth-friendly spine surgery.
Assessment of a Learning Strategy among Spine Surgeons
Authors: Gotfryd Alberto , Corredor José Alfredo , Teixeira William Jacobsen , Martins Delio Eulálio , Milano Jeronimo , Lutaka Alexandre Sadao 
Published: April 2016

Introduction AOSpine educational program was developed to expand knowledge and to promote integration among spine surgeons around the world. Nowadays, however, there are no available data of the effectiveness of the learning process and the level of competence acquired by participants in such activities. The aim of this study is to evaluate, objectively, the knowledge transfer provided thorough theoretical and practical activities during AOSpine courses for spine surgeons. Material and Methods During two principles courses of spine surgery, sixty-two participants underwent to pre-course assessment about their professional experience and preferences of adolescent idiopathic scoliosis (AIS) classification, as well as a test of curves by means of Lenke classification of two AIS clinical cases. Two learning strategies were used during the course: oral lectures and practical exercises. A post-course questionnaire was applied to retest the same deformity cases. Differences of correct answers of clinical cases between pre and post course were analyzed, revealing the number of participants who improve in the accuracy of the classification after the course. Results A total of 62 participants were included in the study, wherein 51 (82%) were orthopedic surgeons and 11 (18%) neurosurgeons. Analysis showed a decrease in the number of participants with wrong answer in both cases, after the course. In the first case, statistical significant differences were observed in both, curve pattern (83.3%, p = 0.005) and lumbar spine modifier (46.6%, p = 0.049). No statistical significant improvement was seen in sagittal thoracic modifier (33.3%, p = 0.309). On the second case, statistical improvement was obtained in curve pattern (27.4%, p = 0.018). No statistical significant improvement was seen regarding lumbar spine modifier (9.8%, p = 0.121) and sagittal thoracic modifier (12.9%, p = 0.081). Conclusion This study showed, objectively, that learning strategies used during AOSpine courses, improved the knowledge of participants. This knowledge acquisition was demonstrated through the decreased number of participants with wrong answers of two clinical cases, after the course. Teaching strategies must to be continually improved to ensure optimal level of knowledge transfer.