bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thinning, Peeling and Carving Technique for the Treatment of Thoracic Myelopathy Caused by Ossification of Ligamentum Flavum
Authors: Wang Dechun 
Published: April 2016

Introduction To introduce a novel technique of thinning, peeling and carving to remove the ossification ligamentum flavum(OLF) nidus easily, safely and completely for the treatment of thoracic myelopathy caused by OLF. This surgical procedure avoids aggressive irritating the most seriously compressed spinal cord caused by OLF nidus especially. The epidural venous plexus bleeding and the bleeding from the pedicle can be seen clearly and controlled easily during the decompression. Material and Methods Thoracic myelopathy caused by OLF was diagnosed in 28 patients using plain radiography, 3D CT, and MRI from January 2009 to January 2012. The lamina, the lower and the upper facet joint of the involved segment were thinned with the bigger neuro drill(diameter 3.5mm) first, The shell was so thin that the feeding blood vessels of the dura can be seen clearly. Second, the thinned shell was peeled off with the curette piece by piece. The upper facet joint and the OLF nidus were carved by the smaller neuro drill (diameter 2.5mm)and the thinned bony nidus compressing the spinal cord was removed finally, Spinal cord monitoring (SEP and MEP)was performed intraoperatively in all cases. The operating time and blood loss were recorded during the operation. The Frankel scoring system was used to assess the neurological status before the operation and in the follow up. The S F-36 were also used to assess the general health status. Results Of the 28 cases of OLF,3 were single level, 10 were double level, and 15 were multilevel. Of the 71 ossified segments in this study, 16 (22.5%) were located in the upper thoracic spine (T1–4), 9 (12.7%) were located in the midthoracic spine (T5–8), and 46 (64.8%) were located in the lower thoracic spine (T9-L1). The mean operating time was 145 ±32min. The mean intraoperative blood loss was 280 ± 48.6 ml. The neurological status improved during follow-up (mean 46.1 months) from a preoperative mean mJOA score of 5.39 ± 1.52 to 8.97 ± 1.22 points (t = 18.39, p < 0.05). The neurological function recovery rate ranged from 28.6% to 100%. Conclusion Thinning, peeling and carving technique was effective, safe and may be a reasonable choice for the treatment of thoracic myelopath y caused by OLF
Preoperative Embolization in Spinal Tumour Surgery
Authors: Kumar Naresh , Zaw Aye Sandar , Gopinathan Anil , Tan Barry 
Published: April 2016

Introduction Preoperative embolization has been shown to be effective in reducing intraoperative blood loss during metastatic spinal tumor surgery. However, the majority of studies investigating preoperative embolization for spinal metastases have preferentially selectedsecondaries fromrenal and thyroid as these are highly vascularized tumors. There is paucity of literature describing utility of embolization in other tumors. We aimed to determine the effect of preoperative embolization on intraoperative blood loss indifferent spinal tumors by type of surgical approaches. Materials and Methods We retrospectively evaluated 221 patients undergoing surgery for primary or metastatic spine tumors. Patients were analyzed for the effect of embolization agents, extent, level of embolization and timing between embolization & surgery, on estimated blood loss. Estimated blood loss and transfusion requirements were compared between embolized and non-embolized cases for different types of spinal tumor (metastatic lung, breast, renal, hepatocellular, thyroid, other epithelial tumors, myeloma/lymphoma and primary spine tumors) and surgical approaches (Type I: Cervical spine surgery either anterior and/or posterior stabilization with or without corpectomy, Type II: Thoracolumbar posterior instrumentation and decompression, and Type III: Thoracolumbar corpectomy). Results Preoperative embolization was performed in 48 patients. Hypervascular angiographic appearance was found in 22 (46%) and capillary blush in 26 (54%) embolized patients. Total embolization (>80% reduction of tumor blush) was achievable in more than half of the embolized patients (61%), and less amount of blood loss was observed in these patients (median blood loss = 900ml) compared with those who achieved partial (<50%) and subtotal (50–90%) embolization (1600ml and 1350ml respectively). Blood loss was also lower in those who achieved proximal embolization and those who underwent surgery between 13–24 hours after embolization. When stratified by type of tumor and surgical approaches, blood loss and transfusion requirement were lower in embolized cases of spinal secondaries from HCC & thyroid; and primary spine tumors. In multivariate linear regression, after adjusting for tumor type, type of surgical procedure, invasiveness index, preoperative haemoglobin and operative time, there were no significant differences in the blood loss as well as blood transfusion units between embolized and non-embolized groups. Conclusions Success of embolization in reducing blood loss depends on the extent of embolization, which should be total; and time interval between embolization and index surgery, which should be within 13–24 hours. Preoperative embolization is a useful modality in decreasing intraoperative blood loss in cases of spinal metastases from HCC, thyroid and primary spine tumors.
Operative Management of Post-tumor Spinal Deformity
Authors: Zaborovskii Nikita , Ptashnikov Dmitry , Mikhaylov Dmitry , Smekalenkov Oleg , Masevnin Sergei , Lapaeva Olga 
Published: April 2016

Introduction The purpose of our research is evaluation of the outcome after surgery and health-related quality of life (HRQOL) parameters in patients with post-tumor spinal deformity. Material and Methods Retrospective clinical and radiographic data were collected for 33 patients (15 male and 18 female, average age of 61.4 years) with spinopelvic malalignments (SRS-Schwab sagittal modifiers: 2 grade and more) who underwent spinal deformity surgery. Patients were divided into two groups. The first group included 13 patients ( n = 12 after chemotherapy of plasmacytoma, n = 1 patient after radiotherapy of cervix uteri cancer metastasis) with confirmed spinal oncology diagnosis by biopsy. All patients have had oncology remission with a 3-year minimum follow-up. Spinal deformity was developed in the period between 1 and 6 years after conservative treatment. Repeated biopsy did not show tumor cells, this was evaluated as local control of tumor. Low scores of HRQOL and unsuccessful nonoperative approach were indications for surgical intervention. The second comparative group consisted of 20 patients with “de novo” degenerative or posttraumatic spinal deformity. The aim of surgical management was to achieve sagittal balance, using osteotomies and transpedicular instrumentalization. Groups were evaluated with HRQOL-scales including VAS, ODI, SF36 and SRS-24. Radiographical assessment included Cobb coronal angle, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), sagittal vertical axis (SVA). Radiographical, HRQOL-parameters and complications were analyzed and compared between two groups. The comparisons were done by using independent sample Student t-test. A p-value of less than 0.05 was accepted as significant. Results Both groups showed a restoration of global spinal alignments without significant differences in TK, LL, PI, PT, SS, SVA parameters (p > 0.05). In addition, HRQOL-scores (VAS, ODI, SF36, SRS-24) of the patients were increased after operation. The HRQOL-scores after 2 years are slightly higher in the first group, but we did not get significant difference between groups (p > 0.05). The number of complications in the form of implant instability, proximal and distal junctional disorders was comparable (p > 0.05). However, general medical complications in the first group was significantly higher than in the second one ( p < 0.05). It is important that no patients had local recurrence or metastasis of tumor during follow-up in the first group. Conclusion Spinal tumor under local control is not contraindication for spinal deformity surgery. Realigning of the sagittal plane is paramount, especially because of the sagittal balance impact on quality of life.
Prognostic Factors for Survival in Surgical Series of Symptomatic Metastatic Epidural Spinal Cord Compression: A Prospective North American Multi-Centre Study in 142 Patients
Authors: Nater Anick , Fehlings Michael , Tetreault Lindsay , Kopjar Branko , Arnold Paul , Dekutoski Mark , Finkelstein Joel , Fisher Charles , France John , Gokaslan Ziya , Rhines Laurence , Rose Peter , Schuster James , Vaccaro Alexander R. , Sahgal Arjun , Massicotte Eric 
Published: April 2016

Introduction Symptomatic Metastatic Epidural Spinal Cord Compression (MESCC) afflicts up to 10% of all cancer patients and is associated with shortened survival and worsened quality of life. This study aims to identify the key survival prognostic factors in MESCC patients who were surgically treated for a single symptomatic lesion. Material and Methods 142 MESCC patients were enrolled in a prospective North American multi-center study and followed postoperatively for 12 months. Using univariate analyses, Kaplan-Meier methods, and log-rank tests the prognostic value of various clinical predictors were assessed. Non-collinear predictors with p < 0.05 in univariate analyses were included in the final Cox proportional hazards model. Results The overall median survival was 7.7 months (range: 3 days – 35.6 months); breast cancer had the longest median survival (12.1 months). Ten patients (7%), whose primary cancer were lung (3), kidney (3), sarcoma (2), prostate (1), and breast (1), died within 30-days postoperatively and 88 had died at 12 months (62%). Univariate analyses yielded eight significant predictors for survival: the growth of primary tumor (Tomita Grade 1 vs Grade 2 and 3), BMI, gender, preoperative SF-36 physical component, EQ-5D, and ODI scores as well as the presence of either visceral or extraspinal bony metastasis. The multiple regression analysis revealed that the Tomita grade (Grade 1 vs Grade 2 and 3; HR: 2.81, p = 0.007), the absence of visceral metastasis (HR: 2.01; p = 0.0044), and higher score on SF-36 physical component (HR: 0.95, p < 0.0001) were independent predictors for longer survival regardless of the selection method used (backward, forward, or stepwise). Conclusion Slow growing tumor (Tomita Grade 1), absence of visceral metastasis, and lower degree of preoperative physical disability, as reflected by a higher score on the SF-36 physical component questionnaire, are good prognostic factors for survival in selected patients who underwent surgical treatment for a focal symptomatic MESCC lesion.
Morphology and TGF-beta1 Concentration's Analysis of Ligamentum Flavum of Patients with Lumbar Canal Stenosis and Lumbar Disc Herniation
Authors: Carletti Sandro , Ciampini Alessandro , Di Muro Licia , Delfinis Catia Pompea , Tinella Elettra , Caputo Nevia , Rispoli Rossella 
Published: April 2016

Introduction The most common spinal disorder in elderly patients is lumbar spinal canal stenosis, causing low back and leg pain, and paresis. The etiology of degenerative changes occurring in lumbar stenosis still remain unclear: some authors hypothesize the hyperplasia and others the hypertrophy of Ligamentum flavum (LF). The change of LF is known to be related to degenerative changes that are secondary to the aging process or mechanical instability. The study's objective is to analyze the LF of patients with lumbar canal stenosis and lumbar disc herniation to evaluate the morphology and the concentration of the Transforming Growth Factor-β 1 (TGF-β 1). Material and Method:The study is characterized by three phases: (A) Measurement of the thickness of the LF of patients with lumbar stenosis and/or herniated lumbar disc through the axial, T1 weighted images of the lumbo-sacral magnetic resonance imaging (MRI); (B) Removal of LF in patients undergoing intervention for lumbar stenosis and lumbar disc herniation (control group); (C) Optical microscopy study of the morphology of degenerated ligamentum and immunohistochemical analysis to assess the concentration of TGF-β 1 in the same. The analysis of the morphology of the ligamentum (meant as the increase of the fibers number or distension and relaxation of the same as a result of degenerative processes) and the presence or absence of a high concentration of TGF-β1 (then more fibroblasts involved in the degenerative process) can be important to clarify if there is an hypertrophy or hyperplasy of ligamentum flavum in lumbar canal stenosis. Results In the current study we have showed that decreased elasticity of LF in the elderly is due to the loss of elastic fibers that are degenerated and a concomitant increase of collagenous fibers (hypertrophy); the concentrations of TGF-β1 of the LF measured in both lumbar spinal stenosis and disc herniations was higher than that of the latter. Conclusion The current results suggest that LF of lumbar canal stenosis is hypertrophic: LF hypertrophy could be due to the thickening of the normal elastic layer as well as of the abnormal collagenous layer and to higher expression of TGF-β 1 by fibroblasts
An Analysis of the Spinal Nerve Roots in Relation to the Adjacent Vertebral Bodies with Respect to a Posterolateral Vertebral Body Replacement Procedure
Authors: Awwad Waleed 
Published: April 2016

Introduction This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help to improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement via either a transpedicular or costo-transversectomy approach, The major challenge to a total posterior approach vertebrectomy and vertebral body replacement in the thoracolumbar spine lies in the preservation of important neural structures. Materials and Methods Retrospective analysis of 100 normal MRI spinal studies (T1-L5) on sagittal T2 weighted MRI images were studied to quantify: 1) mid-sagittal vertebral body (VB) dimensions (anterior, midline and posterior vertebral body height); 2) midline VB and associated intervertebral discs height; 3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE) and 4) posterior approach expansion ratio (PAER). Results 1) The mean anterior VB height gradually increased cranio-caudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. 2) Midline VB and intervertebral disc height gradually increased from T1 to L4. 3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. 5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level. Conclusions The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VB replacement from a posterior approach should take into account the specifications at each spinal level.
Which Factors Influence the Surgery vs. Non-surgery Decision for Adult Idiopathic Scoliosis Patients with Gray Zone (40-55°) Main Thoracic Curves?
Authors: Yilgor Caglar , Enercan Meric , Hamzaoglu Azmi , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Acaroglu Emre , Obeid Ibrahim , Kleinstuck Frank , Alanay Ahmet ,   ESSG European Spine Study Group
Published: April 2016

Introduction To analyze the factors that may influence surgical vs non-surgical treatment for AdIS patients within gray zone (40–55°) main thoracic (MT) curves. Material and Methods A retrospective analysis of a multicenter, prospective, consecutive patient series. Inclusion criteria were: AdIS, ≥18 years of age, major curve to be MT, Cobb between 40 and 55°. Ninety-one patients (69 Non-surgical and 22 Surgical) were included. Non-surgery group had 57F and 12M; mean age: 28.3 (18–47), mean Cobb: 46.8° (40- 55). Surgery group had 19 F and 3M; mean age: 31.1 (18–71), mean Cobb: 49.2°(42–55). All patients completed SF-36, SRS-22 and ODI when they were first seen in the clinic. AP and lateral Cobb measurements and sagittal plane parameters were measured. Independent samples t-test was used to compare groups. Variable importance analysis was done using classification and regression tree algorithm to predict factors that influence surgical decision. Results ODI, SF-36 PCS and SRS-22 subtotal, function, pain, self-image scores were significantly different between the groups ( p < 0.05). Age, MT curve Cobb, Lumbar curve Cobb, trunk shift, SVA, coronal balance, SF-36 MCS and SRS22 mental health were not statistically different (p > 0.05). Most important variable that created a tendency toward surgery was SRS-22 functional status followed by ODI, SRS-22 pain score, SF-36 PCS and SRS-22 self image score ( Fig. 1 ). Conclusion AdIS patients having a curve magnitude in the gray zone (40–55°) with decreased SRS-22 function, pain, self-image and SF-36 PCS and increased ODI scores had a predilection toward surgery. Most important variable was SRS-22 function score. [Figure: see text]
Increased Apoptosis, Expression of Matrix Degrading Enzymes and Inflammatory Cytokines of Annulus Fibrosus Cells in Genetically Engineered Diabetic Rats: Implication for Intervertebral Disc Degeneration
Authors: Park Jong-Beom , Park Eun-Young 
Published: April 2016

Introduction Diabetes mellitus is thought to be an important etiologic factor in intervertebral disc degeneration. However, what is little known is whether diabetes has an effect on annulus fibrosus (AF) cells. The purpose of our study was to investigate the effect of diabetes mellitus on apoptosis, expression of matrix degrading enzymes and inflammatory cytokines of AF cells in age-matched genetically engineered OLETF (diabetic) and LETO (control) rats. Material and Methods Lumbar disc tissues (L1–2 through L5–6) were obtained from 6-month old OLETF and LETO rats (10 each). We examined the AF cells and tissues using Masson trichrome stain, TUNEL, Western blotting, and reverse transcription polymerase chain reaction. The apoptosis index and the degree of expression of matrix degrading enzymes and inflammatory cytokines of AF cells were evaluated by semiquantitative method. Results OLETF rats showed increased body weight and abnormal 2-hour glucose tolerance tests compared with LETO rats. The apoptosis index and the degree of expression of Fas of AF cells were statistically higher in the OLETF rats. The degree of expression of matrix metalloproteinase-1, -2, -3 and -13 and tissue inhibitor of metalloproteinase-1 and -2 was statistically higher in the OLETF rats. The expression of interleukin-1 and -6 and tumor necrosis factor-α was statistically higher in the OLETF rats. Finally, histological analysis showed more severe fibrosis and loss of lamellar pattern in AF tissues of OLETF rats. Conclusion Our results suggest that diabetes mellitus is associated with increased apoptosis and expression of matrix degrading enzymes and inflammatory cytokines in AF cells. This results in more severe fibrosis and loss of lamellar pattern of AF, which leads to intervertebral disc degeneration. Strict DM control might be important to delay or prevent early intervertebral disc degeneration in patients with DM.
Surgical Management of Spinal Dural Arteriovenous Fistulae with Intraoperative Indocyanine Green Angiography: Single Institute Experience
Authors: El-Maghraby Hussien , Bletechi Radu 
Published: April 2016

Introduction Spinal dural arteriovenous fistula (DAVF) is the most common vascular malformation of the spinal cord. We performed an observational study of patients with spinal DAVF who were treated by microsurgical obliteration with intraoperative indocyanine green (ICG) angiograph with the aim of complete obliteration of the fistulae. Material and Methods 10 patients were included from May 2012 to May 2015. They were treated surgically with intraoperative intravenous administration of ICG. Direct microsurgical exploration was employed to identify the intradural fistulous connection and intravenous ICG was then injected to verify the identification of the lesion. Repeat ICG angiography was performed after the fistula had been obliterated using bipolar electrocautery. Results In all patients, ICG angiography correlated reliably with preoperative catheter angiography and intraoperative direct visualization and the fistulous connection was identified and successfully treated surgically. Conclusion ICG angiography in the setting of surgical management of spinal DAVF is a simple and effective technique for intraoperative confirmation of the relevant lesion. Post resection ICG angiography reliably demonstrated technical success and may replace formal postoperative catheter angiography.
The Effect of Post Operative Sand Bag Pressure on CSF Leak after Spinal Surgery
Authors: Mousa Hussein 
Published: April 2016

Introduction Dural tears are most common complications of lumbar spine surgery and have been successfully managed using several techniques. These include primary repair, closed subarachnoid drainage, tissue grafting, fibrin-adhesive sealant, and bed rest. In this study a new method with post operative sand bag pressure to prevent Cerebrospinal fluid (CSF) leak is used. Methods A prospective study of 96 patients admitted to the Department of Neurosurgery at the Alsadr Teaching Hospital in Basrah/Iraq had CSF leak following different lumbar spine surgeries. Fifty two patients between March 2006 and March 2010 treated with the classical methods and 44 consecutive patients who had a post operative CSF leak between March 2010 and March 2013 treated with sand bag pressure. Results Classically treated group (13.5%) patients stopped CSF leak as compared with post operative sand bag pressure group (68.2%) patients stopped CSF leak in the first day. Regarding post operative complications, classically treated group had headache (55.8%), Photophobia (25.0%), nausea (32.7%), vomiting (15.4%), meningitis (5.8%) and revision surgery (9.6%) while post operative sand bag pressure group had headache (20.5%), Photophobia (9.1%), nausea (11.4%), vomiting (2.3%), meningitis (2.3%) and revision surgery (0%). Conclusions and bag pressure is an excellent method to decrease duration and complications of CSF leak.