bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anterior Cervical Discectomy and Fusion Using an “Oversized” PEEK Cage: Radiological and Clinical Outcome
Authors: El-Sharkawi Mohammad , Gad Wael 
Published: April 2016

Introduction There has been controversial data about the effect of cage size on radiological and clinical outcome of anterior cervical discectomy and fusion (ACDF). Oversized cages have been linked to higher incidence of non-union, adjacent segment disease, and unfavorable clinical outcomes. The aim of this work is to evaluate the effect of an oversized PEEK cage on the radiological and clinical outcomes in ACDF. Patients and Methods Between January 2012 to July 2014, 57 patients (29 single level, 15 double levels, 8 three levels, 5 four levels) underwent ACDF using a stand-alone oversized PEEK cages. They were 35 males and 22 females with mean age 56 ± 13.5 years. The minimum follow up period is one year. The following parameters were measured preoperatively, postoperatively and at final follow up: cervical lordosis (in degrees), disc height (in mm), motion at operated level (in degrees), radiological ASD (present or not) and VAS for neck pain, VAS for arm pain. All complications were as well recorded. Results The mean cervical lordosis changed from 25°±5.5 postoperative to 7°±4.5 at final follow up. The mean disc height was 5± 2 mm preop, 7 ± 1.5 mm postop and 6 ± 1 mm at final follow up. Residual motion at operated level was observed at 1 year follow up X-rays in 2 patients (one double level and one 3-level) with average 5°. None of them had neck pain and no revision was required. In the postoperative X-rays, the suprajacent level was always observed to be slightly narrowed; this narrowing gradually diminished during the follow up. Radiological ASD developed in 9 patients (16%), all of them remained to date asymptomatic. The average improvement in VAS for neck pain was 27%±8.5 and the average improvement in VAS for arm pain was 33%±9.5. At the final follow up, fusion was achieved in 55 patients (96%) and clinical outcome was excellent. Radiological loss of the postoperative disc height and cervical lordosis and development of radiological ASD did not correlate to poor clinical outcome. No single case of cage dislodgement was observed in this series. Conclusion The use of a stand-alone oversized PEEK cage in ACDF seems to minimize the incidence of cage dislodgment even in multiple levels ACDF. Despite some radiological settlement and loss of cervical lordosis, an excellent clinical outcome was maintained.
Identifying the Best Treatment in Adult Spinal Deformity: A Decision Analysis Approach
Authors: Acaroglu Emre , Yavuz Aysun Çetinyürek , Güler Ümit Özgür , Yuksel Selcem , Yavus Yasemin , Ayhan Selim , Sabat Montse Domingo , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Alanay Ahmet , Obeid Ibrahim , Kleinstuck Frank ,   European Spine Study Group (ESSG)
Published: April 2016

Introduction Adult spinal deformity (ASD) is a major public health problem. There are pros and cons of the available treatment alternatives (surgical or non-surgical) and it had been difficult to identify the best treatment modality. Aim of this study is to construct a statistical decision analysis (DA) model to identify the optimum overall treatment in ASD. Material and Methods From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical –NS), 164 surgical –S), constitute the population of this study. DA was structured in two main steps of: 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference –utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Results 432 patients (309 NS, 123 S) had baseline and 1 year follow-up ODI measurements. Overall, 104 (24.1%) were found to be improved (a decrease in ODI > 8 points), 225 (52.1%) unchanged (−8 > ODI > 8) and 65 deteriorated. Surgery presented with a higher chance of improvement (54.2%) versus NS (9.7%) (Table 1a). The overall QALE ranged from 56 to 69 (of 100 years) and demonstrated better final outcomes in the NS group, although this group had also started with higher QALE. There were improvements in overall QALE in both groups but this was significant only in the surgical group (Table 1b). In addition, in the subgroup of patients with significant baseline disability (ODI > 25) surgery appeared to yield marginally better final QALE (Table 1c). Conclusion This study demonstrated that a single best treatment modality for ASD may not exist. Conservative treatment appears to yield higher (up to 6%) QALE compared with surgery, probably secondary to a higher baseline QALE; except in patients with significant disability at baseline. On the other hand, surgery provides a significantly higher increase in QALE and chances of improvement at 1st year are significantly lower with NS treatment.
A Multicenter Prospective Randomized Controlled Clinical Trial to Evaluate the Effectiveness and Safety of a Standalone Percutaneous Interspinous Spacer versus Decompressive Surgery in Degenerative Lumbar Spinal Stenosis with Neurogenic Intermittent Claudication
Authors: Meyer Bernhard , Le Huec Jean Charles 
Published: April 2016

Introduction The objective of this study is to show that a minimally invasive percutaneous IPD is safe and non-inferior to SDS with regards to clinical outcomes in patients suffering from Degenerative Lumbar Spinal Stenosis with NIC (Neurogenic Intermittent Claudication), relieved by flexion. (Design: Multicenter international randomized controlled trial) Methods One hundred and sixty three patients enrolled by 19 sites across 10 countries (mean age 65 ± 11 years, 51% female, mean duration of leg symptoms 2.5 years) were randomly assigned to IPD or SDS group and are followed until 24 months. Physical function, symptom severity and patient satisfaction were assessed by Zurich Claudication Questionnaire (ZCQ) at baseline, 14days, 6 weeks, 6 months and 12 months follow-ups. Leg, buttock/groin and back pain were assessed by VAS scores. SF-36v2 questionnaire was used to assess quality of life. In addition, physical examination data was collected at all-time points. Percentage of re-operations at index level at follow-up was determined. (Trial registration NTC00905359) Results ZCQ physical function mean percentage change from baseline to 12 months (primary outcome variable) decreased equally and without statistically significant difference over all points in time for IPD and SDS group (respectively, −32 ± 32%, −37 ± 23%, p = 0.158, CI −5, +15). As for secondary outcomes the IPD group showed lower mean surgical time and mean blood loss (respectively, 24 ± 11 minutes and 6 ± 10 ml, p < 0.001) compared with the SDS group (70 ± 39 minutes and 157 ± 145 ml, p < 0.001). Symptom severity improved in both groups equally (−31 ± 27%, −36 ± 25%, p = 0.140, CI −4, +14). No differences in patient satisfaction were observed. VAS leg pain score improved with 59% for the IPD and 66% for the SDS group from baseline to 12 months follow-up. SF-36 v2 physical and mental aggregated score improved equally over time for both treatment groups. At 12 months, 47 SAEs were reported, in 36 patients. Re-operations at index level occurred in 9% of the patients in the IPD group and in 7% in the SDS group. In 6 patients the IPD was explanted. Conclusions This study confirms two prior recent RCTs. Implantation of an IPD as well as open decompression achieve both equally satisfying results in patients with NIC. Both seem to be appropriate procedures with an advantage in some secondary outcomes for IPDs. So far the significantly higher reoperation rate for IPDs could not be confirmed in this study, which opens a window of indication in a subset of patients with NIC, i.e., those with cardiac or other comorbidities.
The Surgical Management of Low Grade Single Level Adult Degenerative Spondylolisthesis: Posterolateral Fusion versus Posterior Lumbar Interbody
Authors: ElAbed Khaldoun 
Published: April 2016

Introduction Posterolateral Fusion (PLF) and Posterior Lumbar Interbody Fusion (PLIF) are procedures that can be undertaken for the surgical management of degenerative low grade spondylolisthesis. Although there is tentative evidence in the literature that PLIF provides an increased fusion rate and therefore an improvement in symptomology, PLIF surgery does carry an increased peri- and post-operative complication rate. The aim of this study was to establish which surgical intervention has the better outcomes. Materials and Method A prospective cohort study was undertaken of patients who underwent a single level instrumented fusion for low grade degenerative lumbosacral spondylolisthesis between 2008 and 2010. There were 56 patients in total, with 36 patients in the PLF group (group1), and 20 patients in the PLIF group (group 2). Follow-up was at 3 month, 1 year and 3 year post operatively. Visual analogue leg pain score (VAS), Oswestry Disability Index (ODI) for back pain, and SF 12 Health Survey were measured pre and 3 year post operatively. All patients were assessed by MRI scans preoperatively. Standardized lumbosacral radiographs were taken preoperatively, and at 3 month, 1 year and 3 year postoperatively, to assess radiological union. Results In the PLF group, the VAS score improved from 8 to 2, the SF 12 score from 25 to 76, and the ODI score from 36 to 8. In the PLIF group, the VAS score improved from 8 to 4, the SF 12 score from 27 to 72, and the ODI score from 38 to 12. All improvements were statistically significant. There was a statistically larger improvement margin in all scores in the PLF group than in the PLIF group. Radiological union was demonstrated in 91% of all patients, with 95% of patients in each group demonstrating at least, unilateral lateral mass bone graft incorporation. Conclusion We conclude that PLF surgery is superior to PLIF surgery for the surgical management of low grade single level degenerative spondylolisthesis
A Novel, Objective, Quantitative Method of Evaluation of the Pain Component and Paresthesia Coverage using Comparative Computerized Multiparametric Tactile Mapping and Database Analysis: The “Neuro-Mapping-Tools” Software (N3MT)
Authors: Roulaud Manuel , Guetarni Farid , Nivole Kévin , Monlezun Olivier , Lorgeoux Bertille , Rigoard Philippe 
Published: April 2016

Introduction One of the major challenges of neurostimulation is actually to address the back pain component in patients suffering from refractory chronic back and leg pain. Facing a tremendous expansion of neurostimulation techniques and available devices, implanters, patients and even industrial companies can still remain confused as they need to select the right tool for the right indication. To be able to evaluate and compare objectively patient outcomes, depending on therapeutical strategies, it appears essential to develop a rational and quantitative approach to pain assessement and neurostimulation outcomes for those who undergo neurostimulation implantation. Material and Methods Our neuroinformatics laboratory (N3Laboratory) located in Poitiers University Hospital, Department of Neurosurgery, enabled us to develop the Neuro-Mapping Tools software (N3MT) (Inter Deposit Digital Number: IDDN FR 001–1600002–000-R-P-2013–000–31230; Patent Applications n°PCT/EP2014/067231, n°PCT/FR 14/000 186 and n°PCT/FR 14/000 187). This tool consists of touch screen mapping, allowing the patient and/or the physician to interact by means of a tablet computer to delineate painful zones and paraesthesia coverage in the thoracolumbar region and legs. Results The Neuro-Mapping Tools software (N3MT) (Neuro-Pain'T, the Neuro-Mapping Locator and the Neuro-Data-Base) have been put together and used in more than 190 patients since 2012, leading us to describe new measurement parameters, divided into two categories: (1) Technical parameters, evaluating the implanted device itself, as “Device Performance, XP,” “Device Specificity, XS” and “Persistence of the Paresthesia Perception” on the long term (XP3). (2) Clinical parameters, evaluating patient response to the therapy: (a) pain surface reduction. This parameter is called YS. (b) pain intensity reduction. This parameter is called YI. (c) pain characteristics redistribution after implantation. This parameter is called YPC. Conclusion The N3MT software could help to guide tomorrow's treatment options by transforming personal convictions into a more robust scientific rationale based on data collection and data mining techniques.
Survival and Clinical Outcomes in Patients with Metastatic Epidural Spinal Cord Compression: Results from the AOSpine Prospective Multi-Centre Study of 142 patients
Authors: Fehlings Michael , Nater Anick , Tetreault Lindsay , Kopjar Branko , Arnold Paul , Dekutoski Mark , Finkelstein Joel , Fisher Charles , France John , Gokaslan Ziya , Rhines Laurence , Rose Peter , Massicotte Eric , Sahgal Arjun , Schuster James , Vaccaro Alexander R. 
Published: April 2016

Introduction Although surgery is being increasingly used in patients with Metastatic Epidural Spinal Cord Compression (MESCC) as a complementary strategy to radiation and chemotherapy, the impact of surgery on quality of life (QoL) is not well established. This study aimed to prospectively evaluate survival, neurological, functional, and QoL outcomes in MESCC patients undergoing operative management. Material and Methods A total of 142 surgically treated patients with a single symptomatic MESCC lesion enrolled in a prospective North American multi-center study were followed for 12 months. Clinical data, such as Brief Pain Inventory (BPI), ASIA, SF-36, Oswestry Disability Index (ODI), and EQ-5D scores, were obtained both pre- and post-operatively. Results The median survival was 7.7 months. The 30-day and 12-month mortality rates were 9% and 62%, respectively. Six weeks post-operatively, ambulatory status ( p = 0.02) and bladder control ( p = 0.03) were significantly improved. Overall, 67.5% of ASIA B, C, or D patients gained at least 1 grade after surgery, 25% remained stable, and 7.5% deteriorated. ODI, EQ-5D, BPI scores were significantly improved at each follow-up (p ≤ 0.01). SF-36 scores were generally higher after surgery for mental and physical components, and for all domains except energy/fatigue. The incidence of wound complications was 10% and 2 patients required a second surgery (screw malposition and epidural hematoma). Conclusion Surgical intervention, as a complementary adjunct to radiation and chemotherapy, provides immediate and sustained improvement in pain, neurological, functional, and QoL outcomes with acceptable risks in patients with a focal symptomatic MESCC lesion.
Biomechanical Evaluation of the Transpedicular Nucleotomy with Intact Anulus Fibrosus
Authors: Russo Fabrizio , Vadalà Gianluca , Hartman Robert Allen , Bell Kevin M. , Sowa Gwendolyn A. , Vo Nam , Kang James D. , Denaro Vincenzo 
Published: April 2016

Introduction Mechanical loading represents a crucial part of intervertebral disc (IVD) homeostasis. However, traditional regenerative strategies require violation of the annulus fibrosus (AF) resulting in significant alteration of joint mechanics. The transpedicular nucleotomy represents a suitable method to create a cavity into the nucleus polposus (NP), as a model to study IVD regeneration with intact AF. The aim is to study how the transpedicular tunnel (TT) and the novel mechanical nucleotomy affects the biomechanics of the NP. Material and Methods 60 ovine lumbar FSUs (L1-L6) randomly assigned to 5 groups: Control; TT; TT + polymethylmethacrylate (PMMA), to repair the bone tunnel; Nucleotomy; Nucleotomy + PMMA. The robotic spine testing system consists of a robotic manipulator (Staubli RX90) and a six-axis load cell (JR3 Inc.). Flexion/extension, lateral bending and axial rotation were evaluated under adaptive displacement control. Axial compression was applied for 15 cycles of preconditioning followed by 1 hour of constant compression. Viscoelastic properties were determined. Results TT has minimal effects on rotational biomechanics. The nucleotomy increases ROM and NZ displacement width while decreasing NZ stiffness. TT + PMMA has small effects in terms of ROM. Nucleotomy + PMMA brings ROM back to the control, increases NZ stiffness and decreases NZ displacement width. The nucleotomy tends to increase the rate of early creep. TT reduces early and late damping. The use of PMMA increased late elastic damping (S2) and reduced viscous damping (η2) culminating in faster resolution of creep. Conclusion Biomechanical properties of NP are crucial for IVD repair. TT does not affect rotational stability. Mechanical changes that occur with nucleotomy are similar to those characteristics of early degeneration. These findings confirm that the NP is crucial for segmental stability in physiologic rotations.
Review of Patient Transfers from Spinal Surgery to the Spinal Injuries Unit
Authors: Grandidge Lisa , Breakwell Lee , Athanassacopoulos Michael , Chiverton Neil , Cole Ashley , Michael Antony 
Published: April 2016

Introduction To review the length of time patients are awaiting spinal injury reviews on the spinal surgery ward and awaiting beds on the spinal injuries unit. Materials and Methods A list of all spinal surgery patients with a spinal injuries episode within the same spell during the period 01/04/12 to 26/11/14 were gained by coding ( n = 37). Three patients were excluded from the data (one under neurosurgery, two were transferred from the spinal injuries unit (SIU) and were both discharged from the spinal surgery ward) ( n = 34). Data was obtained via a case note review. Results The mean number of days patients were awaiting a SIU bed (calculated from spinal injuries review to transfer) was 19 (+/−14). The maximum time waiting on the spinal surgery ward was 39 days, and one patient waited 48 days for a ventilator bed. The later the admission the longer patients were waiting, with a positive correlation but this was not significant (r = 0.28, p = 0.18). The mean waiting time was 9 days in 2012, 17 days in 2013 and 24 days in 2014. There was a positive correlation between the length of time patients were awaiting a SIU bed and their length of spinal injuries stay (r = 0.105, p = 0.39). The mean time awaiting a spinal injuries review was 5.9 days. However often there was limited documentation regarding how patients were referred and so was not clear when referrals were received by the spinal injuries team. Two patients had no documented review before transfer. The most frequent type of injury which resulted in patients requiring transfer for rehabilitation was fracture (44%), followed by infection (29%). 47% of injuries were in the thoracic spine. 71% received surgery during their admission. Conclusions This review shows patients are waiting considerable amounts of time awaiting SIU beds and the delays are increasing each year. Delays cause significant implications for patients such as psychological issues and risk of complications including pressure sores, contractures and infections, all of which can impact on functional outcomes. Delays are a high cost to the NHS (the cost of a critical care bed is over £800 more than a ventilated SIU bed). Further work can be performed reviewing reasons for delays and to look at delays in SIU discharges. Patients could benefit from an increase in spinal injury reviews while beds are awaited. An audit on the management of SCI patients while they are on an orthopaedic ward could ensure care meets current recommendations.
Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-analysis
Authors: Evaniew Nathan , Belley-Côté Emilie P. , Fallah Nader , Noonan Vanessa K. , Rivers Carly S. , Dvorak Marcel F. 
Published: April 2016

Introduction Previous meta-analyses of methylprednisolone for patients with acute traumatic spinal cord injuries (TSCIs) have not addressed confidence in pooled effect estimates and new primary studies have been recently published. We performed a systematic review and meta-analysis to determine whether methylprednisolone improves motor recovery and is associated with increased risks for adverse events. Material and Methods We searched MEDLINE, EMBASE, and The Cochrane Library for eligible randomized controlled trials (RCTs) and controlled observational studies. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. We pooled outcomes from RCTs and controlled observational studies separately using random effects models. We quantified heterogeneity using the chi-squared test and the I-squared statistic, and we pre-specified subgroup hypotheses to explain potential high heterogeneity. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to evaluate confidence. Results We included four RCTs and 17 observational studies. Methylprednisolone did not increase long-term motor score recovery (two RCTs: 335 participants, mean difference [MD] -1.11, 95% CI -4.75 to 2.53, p = 0.55, low certainty; two observational studies: 528 participants, MD 1.37, 95% CI -3.08 to 5.83, p = 0.55, very low certainty) or improvement by at least one motor grade (three observational studies: 383 participants, risk ratio [RR] 0.84, 95% CI 0.53 to 1.33, p = 0.46, very low certainty). Evidence from two RCTs demonstrated superior short-term motor score improvement if methylprednisolone was administered within eight hours of injury (two RCTs: 250 participants; MD 4.46, 95% CI 0.97 to 7.94, p = 0.01; low certainty), but risk of bias and imprecision limit confidence in these findings. Observational studies demonstrated a significantly increased risk for gastrointestinal bleeding (eight studies: 2727 participants, RR 2.53; 95% CI 1.48 to 4.32; p < 0.01, very low certainty), but RCTs did not. Risks for other adverse events were not significantly increased. Conclusion Methylprednisolone does not provide significant long-term benefit to patients with acute TSCIs and may be associated with increased gastrointestinal bleeding. These findings support current guidelines against routine use, but strong recommendations are not warranted because confidence in the effect estimates is limited. This meta-analysis advances current understanding because it includes recent studies not pooled previously and it is the first to consider confidence in the pooled effect estimates. Further research could increase confidence and clarify the influence of potential confounders or effect modifiers.