bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health-related Quality-of-life in Adolescent Idiopathic Scoliosis Patients 25 years after Treatment
Authors: Simony Ane , Carreon Leah Y. , Christensen Steen Bach , Andersen Mikkel Ø. 
Published: April 2016

Introduction The purpose of this study was to evaluate the long-term clinical outcomes using validated measures of health-related quality of life (HRQOL), 25 years after termination of scoliosis treatment, in a cohort of Adolescent Idioapthic Scoliosis Patients. Material and Methods 219 consecutive patients treated with Boston brace or posterior spinal fusion using Harrington-DTT between 1983–90, were invited to participate in a long-term evaluation study. A validated Danish version of the Scoliosis Research Society 22R (SRS22R) and Short Form-36 (SF36V1) were administered to the patients two weeks before the clinical and radiological examination. Results 159 (72,6%) patients participated in the clinical follow up and questionnaires, 11 patients participated only in the questionnaires, 8 emigrated, 4 were excluded due to progressive neurological disease and 2 were deceased. The total follow up was 170 patients (83%), average follow up was 24,4 years (22–30 years). SRS 22-R domains scores were within the range described as normal for the general population with no statistical difference between the two treatment groups except in the Satisfaction domain, were the PSF group had better scores than the braced group. The SF 36 PCS and MCS scores in both AIS cohorts were similar to the scores for the general population. Conclusion HRQOL, as measured by the SRS 22-R and SF-36, of adult AIS patients treated with Boston brace or PSF during adolescents were similar to the general population. No clinical progression of the deformity has been detected during the 25-follow up period. The PSF group had a small but statistical significant higher score in the Satisfaction domain compared with the braced group.
Quality of Life after Scoliosis Surgery in Cerebral Palsy
Authors: Wood David Ian , Cooke George , Michael Antony Louis Rex , Breakwell Lee , Cole Ashley 
Published: April 2016

Introduction Radiological correction of scoliosis in quadriplegic cerebral palsy (CP) after posterior instrumentation is well established but patient and caregiver outcomes are required to justify this high risk and high cost surgery. The aims of surgical correction is to improve the patients sitting postion and pain from costo-pelvic impingement by reducing the spinal deformity and pelvic obliquity. Material and Methods To use the modified DuPont Hospital questionnaire to evaluate the quality of life, physical function and caring demands of patients who had undergone instrumented scoliosis correction for CP. Patients were identified and after initial contact, the parent completed the modified DuPont Questionnaire. The outcome measures were DuPont Questionnaire, Cobb angle and pelvic obliquity from radiographs before and after surgery. Results Between Jan 2003 – Sept 2013, 83 operations were undertaken by 4 Spinal Surgeons at Sheffield Children's Hospital in patients with quadriplegic CP. Two died during surgery (cardiac arrest) and two had died by follow-up from causes unrelated to the surgery. 79 families were contacted and 63 families agreed to be involved (80% return rate). 87% felt that their child's deformity was very much improved. 77% felt that their child's overall appearance was much improved. 60% felt it had improved their child's ability to feed and breathe. 64% felt that it was easier to bathe and dress their child. 94% said they would recommend surgery to another member of their family in similar situation. Cobb angle improved from 70° to 30° (47%) and pelvic obliquity from 24° to 11° (46%). Conclusion Surgical correction is still reserved for significant and progressive deformity with decreasing function. This remains a high risk intervention in patients at the severe end of CP spectrum with an on table mortality of 2%. Parental satisfaction scores were high and similar to currently published literature. High Satifcaction levels were found in those families who chose to undertake surgery.
Spinal Cord Drift after Non Instrumented Posterior Cervical Laminectomy
Authors: Kharrat Khalil , Sebaaly Amer , Moussa Ronald 
Published: April 2016

Objective To assess the mean value of spinal cord drift after laminectomy for cervical spondylitic myelopathy and its relation to preoperative alignment and postoperative neurologic recovery rate. Materials and Methods 35 patients with a mean age of 62 were operated for cervical spinal myelopathy (CSM) by laminectomy with evaluation of preoperative and postoperative MRI (Min 6 months). Functional outcome was measured (Japanese Orthopedic Association score (JOA), Nurick score, and recovery rate) and radiological analysis was also made (Cobb angle and postoperative cord migration). The mean follow up period was 58.7 months Results The mean preoperative JOA score was 11.3 and the mean postoperative JOA score was 14.6 with a mean recovery rate of 63%. The Nurick score went from 2.11 to 0.65 with a recovery rate of 69%. The postoperative cord migration was 3.82 mm. Younger age, more than four level laminectomy were correlated with better prognosis. While spinal cord drift to more than 3 mm was correlated with better outcome and to the extent of the laminectomy Conclusion Cervical laminectomy is an indirect way of relieving the anterior compression since it allows posterior spinal cord displacement while widening of the canal. This displacement is greater when lordosis rather than kyphosis is present with positive correlation with neurological outcome.
Determination of the Center of Rotation for Flexion/Extension before and after Insertion of 3 Different Types of Disc Prostheses, and Comparison with In-Vivo MRI-Derived Data from Healthy Volunteers
Authors: Muhlbauer Manfred , Tomasch Ernst , Sinz Wolfgang , Trattnig Siegfried , Steffan Hermann 
Published: April 2016

Introduction An in-vivo biomechanical study is presented investigating the Center of Rotation (COR) for flexion/extension before and after insertion of 3 different types of cervical disc prostheses. The aim of the study was to investigate whether the pre-operative coordinates of the COR deviate from that of Healthy Volunteers (COR-HV), and further whether and how the COR-coordinates change after insertion of the different disc prostheses. Material and Methods 15 healthy volunteers underwent MRI-investigation of their cervical spines. Data for flexion/extension were collected in 5 different positions from maximum extension to maximum flexion for determination of the COR-HV. Further, from 30 patients with a one-level cervical disc prosthesis (10 respective patients who received a Bryan-, Discover- or Prestige-prosthesis) the routinely taken pre- and post-operative cervical flexion/extension X-rays underwent graphical analysis for determination of the respective COR from C3/4 to C6/7. The pre- and post-operative CORs were compared with the corresponding CORs-HV. Results Concordant to the literature a different COR-HV was determined for each respective level from C3/4 to C6/7, and it could be demonstrated that the COR for flexion/extension shows migration during motion. In the patient-study, in all 3 subgroups (Bryan-, Discover-, Prestige-prosthesis) the pre-operative COR for flexion/extension deviated considerably from the COR-HV. After prosthesis insertion the coordinates of the COR changed in all levels from C3/4 to C6/7 regardless of the operated segment; in the Bryan-group the COR was shifted toward the COR-HV; in the Discover-group it was shifted away from the COR-HV; and in the Prestige-group it was shifted partly toward and partly away from the COR-HV. Conclusion It must be presumed that in patients who are candidates for cervical arthroplasty the COR is not congruent anymore with the COR in healthy individuals. Further, the insertion of a disc prosthesis can change the position of the COR in all levels of the lower cervical spine, irrespective from the level of insertion. It seems that the biomechanical design of the implant can considerably influence the way how the COR changes its position: prosthesis with a simple ball-socket design could shift the already abnormal COR to an even more unphysiological position; devices with a more flexible biomechanical design however can contribute to normalize the COR toward the coordinates that were found in healthy individuals. Further studies on this topic with higher numbers of datasets should be undertaken to support the improvement of the biomechanical design of cervical disc prostheses.
Postoperative Evaluation of Sagittal Spinal Balance in Lenke 1A and 5C Type of Adolescent Idiopathic Scoliosis: A Prospective Study
Authors: Mezentsev Andriy , Petrenko Dmytro , Demchenko Dmytro , Krishnappa Vijaykumar 
Published: April 2016

Introduction The aim of the study to evaluate the effect on sagittal spinal balance parameters postoperatively between short segment Bone-On-Bone anterior spinal fusion (ASF) and selective posterior spinal fusion (PSF) treated adolescent idiopathic scoliosis (AIS) (Lenke1A & 5C) patients. Material and Methods This prospective study evaluates radiographs (lateral and AP view) for sagittal spinal balance parameters pre and postoperatively on 36 AIS (Lenke1A & 5C) patients, who were divided into two groups of 18 each according to the treatment underwent in a single clinical institute since 2006–2013. Group 1 underwent short segment Bone-On-Bone ASF (mean age 17 years, 12–25) and Group 2 with selective PSF (mean age 16 years, 12–27). Results In Group 1, lumbar lordosis and sacral slope decreased (mean pre-op 50.4 & 38.6 to mean post-op 36.0 & 35.4), pelvic tilt increased (mean pre-op 12.8 to mean post-op 14.5), whereas thoracic kyphosis and pelvic incidence were similar enough to pre-op values. In Group 2, lumbar lordosis, sacral slope, pelvic incidence and pelvic tilt were decreased(mean pre-op 41.9, 35.5, 56.1 & 16.0 to mean post-op 34.1, 29.7, 52.7 & 12.1), whereas thoracic kyphosis similar enough to pre-op value. Conclusion According to our study, no significant difference found in sagittal spinal balance parameters postoperatively on radiographs between two groups except with slight decrease in lumbar lordosis post-op mean value in both groups. So, our study suggest that short segment Bone-On-Bone ASF and selective PSF procedures do not affect the sagittal spinal balance significantly in the treatment of Lenke1A and 5C type AIS cases postoperatively.
Junctional Kyphosis after Long Segment Fusion
Authors: El-Sharkawi Mohammad , Gad Wael , Elkott Amer , Tammam Hamdy , El-Meshtawy Mohamed 
Published: April 2016

Introduction The incidence of junctional kyphosis (JK) varies in the literature from 7% to 40%. We here present our experience with JK. The aim of this work is investigate the incidence of JK after long spinal segment fusion, to identify the underlying factors leading to its development, and to discuss treatment outcome. Patients and Methods This combined retrospective/prospective cohort study included sixty-four consecutive patients (40 women and 24 men) with a mean age of 20.7 years, who underwent long segment spinal fusion (≥ 5 vertebrae) for treatment of spinal deformity. The average length of follow-up was 2 years. Risk factors analyzed included patients’ factors, surgical factors, and radiographical parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis, pelvic tilt, and pelvic incidence. Results Radiological JK occurred in 14 patients (22%). Ten cases were proximal junctional kyphosis (PJK), two cases were intercalary junctional kyphosis (IJK), and two cases were distal Junctional Kyphosis (DJK). Only seven patients (50%) out of the 14 with JK were symptomatic. Six cases have undergone revision surgery. In nine cases, the original deformity was kyphosis (1 Ankylosing spondylitisS, 1 post-tuberculous, 3 Sheuermann's kyphosis, 4 congenital kyphosis). The other 5 cases were scoliosis (3 idiopathic and 2 congenital). Preoperative TK more than 40 ° was associated with PJK. In all cases PI, PT, SS, SVA were within normal range, but it was noticed that SVA had negative values in 5 cases. LIV in the dorsolumbar junction was associated with DJK. Conclusion Pre-existing TK more than 40°was identified as an independent risk factor. Negative sagittal balance may be a risk factor for PJK. A surgical strategy to minimize Junctional kyphosis may include careful preoperative planning for reconstructions with a goal of optimal postoperative alignment.
Incidental Dural Tears during Lumbar Surgery: Incidence and Management
Authors: Elfalaky Omar , Elzarief Ashraf 
Published: April 2016

Background In spite of the fact that Incidental dural tears (IDTs) is being a well known intra-operative complication during lumbar surgery, true incidence is not accurately known, and different techniques have been suggested for management. Aim of the Work: Detect incidence of incidental dural tears (IDTs) in lumbar surgery with evaluation of our intraoperative technique used for management. Materials and Methods A total number of 834 degenerative lumbar spine cases were reviewed, during the period from 2008 till 2013 in our institutions. Among those cases 191 were recurrent cases. Cases complicated with IDTs were identified, managed intra-operatively using our technique that was based on many layers tight closure, cases with persistent leak that needs re-operation are identified and reviewed. Results The incidence of ITDs during lumbar surgery in our series was 7.3% (61 of 834 cases) During primary surgery it was 5.9% (38 of 643 cases), among recurrent cases it was 12% (23 of 191 cases), all cases were repaired intra-operative using 3–0 vicryle suture and a muscle graft was sutured as an enforcing layer, tight closure of fascia, subcutanous, subcuticular layers and skin, no sub-fascial drains used. One case showed persistent leakage and 2 cases complicated with pseudomeningocele, cases of pseudo meningocele were managed conservatively and the case of leakage re-operated, with no further complications. Conclusion IDTs is a common complication in lumbar surgery with a higher incidence in recurrent cases. The corner stone in the management of IDTs is intra-operative identification and tight closure in many layers that was proved by our surgical technique, a success rate was 98.4%, one case of 61 cases (1.6%) needed a second operation.
Plate Construct versus Stand-Alone Cage in ACDF. Does the Plate Maintain a Sagittal Plane Correction: Clinical Outcome and Radiological Findings Correlation
Authors: Alhammoud Abduljabbar , Aboulebda Mohanad , Baco Abdul Moeen 
Published: April 2016

Introduction Anterior cervical discectomy and fusion (ACDF) is the treatment of choice of cervical degenerative disc disease which cause neurological symptoms include radiculopathy and myelopathy, and it can be done by different techniques which includes several options for implants like disc spacers made of autograft or allograft bone, porous metal, polyether ether ketone (PEEK) and anterior plates and screws. The purpose of this study is to compare the role of anterior plate constructs (ACDF-CPC) and stand-alone cage (ACDF-CA) in maintain of Sagittal plane correction, clinical and radiological findings. Material and Methods Retrospective study of 24 patients who underwent ACDF in Hamad General Hospital, 16 cases with ACDF-CA and 8 cases ACDF-CPC. Radiological findings (cervical lordosis, segmental lordosis, cage subsidence, disc height) and clinical outcome (Odom's criteria, dysphagia and swallowing problems) are compared (pre-op, 3–6 months post op, 12–18 months post op). Results Cervical Lordosis, segmental lordosis, and disc space height at the operated levels increased an average of 5.4°, 3.1°, and 1.5 mm in ACDF-CA and 3.2°, 3.4°, 3.5 mm in ACDF-CPC, with good to excellent result in ACDF-CA and fair to good result in ACDF-CPC according to Odom's criteria, with more dysphagia and dysphonia in ACDF-CPC. The maintaining of sagittal plane correction, disc space height, and cage subside are decrease during follow up in both groups, but clinical outcome was stable in most of the cases comparing to immediate post op finding. Conclusion Anterior cervical discectomy and fusion by stand-alone cage or anterior plate is achieved good clinical outcome and significant correction in sagittal plane and disc space height, but no significant difference between two groups in maintaining the sagittal plane correction and disc space.
Cognitive Impairment following Adult Spinal Deformity Surgery
Authors: Nabiyev Vugar , Ayhan Selim , Yuksel Selcem , Mmopelwa Tiro , Sabat Montse Domingo , Pellise Ferran , Alanay Ahmet , Perez-Grueso Francisco Javier Sanchez , Kleinstuck Frank , Obeid Ibrahim , Acaroglu Emre ,   European Spine Study Group (ESSG)
Published: April 2016

Introduction Elderly patients undergoing major surgery may experience cognitive deterioration due to lesser plasticity in their brain tissue. This so called postoperative cognitive dysfunction (POCD) syndrome is characterized with non-specific dysfunction in memory, concentration and analysis skills. It is not known whether adult spinal deformity (ASD) surgery is associated with POCD. Purpose of this study is to analyze the cognitive abilities of older patients undergoing spinal deformity surgery before and after the surgery so as to understand whether ASD surgery is associated with POCD. Material and Methods A prospective longitudinal study was performed on surgical patients older than 50 years enrolled in a prospective multi-centric database. Mini mental state examination (MMSE) was performed to assess cognitive functions in addition to the health related quality of life (HRQOL) tests (SF-36, ODI and SRS-22) at preoperative, post-operative 6th week and 6th month points. Demographics, preoperative health status, comorbidities, surgical characteristics were also analyzed. Descriptive statistics and repeated measures of variance analysis were performed. Results A total of 90 patients with a mean age of 67.4 ± 8.2 were enrolled in the study; all had 6th week and 58 had both 6th week and 6th month follow-up MMSE evaluations. Averages (standard deviation) of surgical time, estimated blood loss (EBL), number of screws used and hospital stay were 240.1 (111.9)min, 1621.2 (1058.7)ml, 11.2 (4.4) and 14.2 (11.45)days respectively. On analysis, it was seen that there was even a slight increase in mean MMSE score (p > 0.05) between time points (Table 1). There was a decrease of > 2 points (3 or 4 points) in 6 patients (6.7%) at both time points. Conclusion Although ASD surgery in older patients is recognized as challenging, this study suggests that it is not necessarily associated with a significant deterioration in the cognitive abilities of patients undergoing it. These results are different compared with those reported for other major surgical interventions. This may be due to the relatively minor influence of ASD itself on the cognitive abilities of the patients involved as well as to the relatively stable hemodynamic conditions obtainable during modern ASD surgery.
Reduction of Pelvic Tilt after Surgical Correction of Low-grade Isthmic Spondylolisthesis is Correlated with Rather Improvement of Back Pain than Quality of Life
Authors: Maciejczak Andrzej 
Published: April 2016

Introduction It is generally believed that the restoration or improvement of sagittal spino-pelvic alignment may impact clinical outcomes of surgical treatment of high-grade isthmic spondylolisthesis. Little is known about the impact on low-grade slips. The purpose of the study was to determine whether clinical outcomes are correlated with the restoration or improvement of pelvic balance after surgical correction of low-grade isthmic spondylolisthesis. Material and Methods Prospective non-randomized study based on a single-institution series of consecutive patients with isthmic spondylolisthesis during a 10-year period from 2002–2012. 63 adult patients with a low-grade isthmic slip and adequate pre- and postoperative radiograms were available for measurement of spino-pelvic parameters and final assessment of their clinical outcomes. The latter were assessed at least 1 year after the surgery with the use of the Oswestry Disability Index (ODI) and a back pain visual analogue scale. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbosacral angle (LSA) and lumbar lordosis were measured on standing lateral view radiograms. We assumed postoperative reduction in pelvic tilt (PT) to reflect improvement in pelvic balance. The Spearman's rank correlation test was used to assess the correlation between the improvement in pelvic balance and the improvement in ODI and back pain. The Mann–Whitney U test was used to identify significant differences in clinical outcomes between patients (i) with a balanced and unbalanced pelvis postoperatively, (ii) who regained and did not regain pelvic balance postoperatively, (iii) who maintained and lost pelvic balance postoperatively, and (iv) with an improved (reduced PT) and worsened (increased PT) pelvic balance postoperatively. Results There were no significant differences in clinical outcomes between patients with a balanced and unbalanced pelvis postoperatively regardless of whether they lost, maintained, or regained pelvic balance after the surgery. However, we found a weak (R= -0.3) but statistically significant ( p = 0.035) negative correlation between the degree of reduction in pelvic tilt and intensity of postoperative back pain and a weak (R=0.2) but statistically significant ( p = 0.034) positive correlation between the degree of reduction in PT and reduction in back pain. No correlation was found between improvement in pelvic balance and quality of life Conclusions Postoperative reduction of pelvic tilt may impact improvement of rather back pain than quality of life in low-grade isthmic spondylolisthesis. The latter might be a result of rather neural decompression and stabilization of the affected segment than improvement of pelvic balance.