bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrinsic Sacral Deformity in L5 Istmic Lythic Spondylolysthesis
Authors: Díez-Ulloa Máximo-Alberto , Barahona-Lorenzo Daniel , Gallego-Goyanes Adrian 
Published: April 2016

Introduction A deformity in the sacrum has been reported in patients with spondylolysthesis (Antoniades, Spine 2000) Hypothesis Besides sagittal profile, the sacrum in itself is deformed, probably due to a fixed point in the sacoiliac joints acting as fulcrum and deforming force from ventral displacement of gravity line. Matherial and Methods A control group (group C), matchable for age and gender, was compared with a series of 83 patients with L5 istmic lythis spondylolysthesis (group A), which was later subdivided in low grade (Meyerding types I and II, group A1, n = 67) and high grade (Meyerding III or IV, group A2, n = 16) Variable Proximal sacral kyphosis measured by the angle formed by the S1 posterior wall and the S2 posterior wall, if S1 was kyphotic on S2 then it was considered a positive angle, other wise being negative. Statistics SPSS 21.0, working with means or medians and appropriate tests after studying whether the variable showed a normal distribution. Results Group C lordosis -2° (minimum -8°; maximum +7°). Group A kyphosis +10° (minimum -11°; maximum +30°). And then: Group A1 kyphosis +10° (minimum -11°; maximum +30°). Group A2 kyphosis +15° (minimum +5°; maximum +26°). There were statistically relevant differences between group C and group A and also between groups A1 and A2. Conclusion Besides spinopelvic balance issues, there is an intrinsic deformity in the sacrum of patients with L5 istmic lythic spondylolysthesis, even more in high grade lysthesis.
How Much Deformity Correction and Maintenance Can We Obtain by LLIF and will it be Affected by Approach Side or Levels?
Authors: Cho Woojin 
Published: April 2016

Introduction Lateral lumbar interbody fusion (LLIF) is one of the minimally invasive surgeries that have shown the successful surgical outcome. The purpose of this study is to report the amount of deformity correction achieved with LLIF, and to compare the effect of convex versus concave approach side on the magnitude of correction. Methods Out of 512 LLIF cases, 100 stand-alone LLIF cases for degenerative lumbar scoliosis were identified after excluding previous fusion, posterior fixation, and cases without scoliosis. Radiographic and clinical data were analyzed retrospectively. In each patient, overall and segmental deformity correction (difference between postop and preop) and maintenance (difference between final and postop) were measured, and the amount of segmental correction and maintenance was compared in terms of approach side (convex versus concave). Also, correction was compared between groups with or without end plate fracture, and maintenance was compared between the groups with or without subsidence. Results Total 34 patients with follow up were included, and a total of 86 levels were treated. The amount of overall and segmental correction and maintenance is illustrated in Table 1 . Overall and segmental scoliosis correction was more predictable than lordosis creation. The upper levels had the tendency of more segmental scoliosis correction, but not significant. There was no difference in the amount of segmental correction and maintenance in between convex and concave side. The group without the endplate fracture showed more segmental scoliosis correction significantly, the group without the subsidence showed more segmental scoliosis and lordosis maintenance significantly. Conclusion We report the amount of overall and segmental deformity correction and maintenance by LLIF procedure. Segmental scoliosis correction is very predictable unless endplate breakage occurs during surgery. Segmental deformity correction maintained well until final follow up unless subsidence occurs. Overall or Segmental lordosis creation is less predictable as we proposed it is dictated by the position of the cage. There was no difference in the amount of segmental correction and maintenance in between convex and concave side. [Table: see text][Figure: see text]
Influence of the Level of Pedicle Subtraction Osteotomy on Pelvic Tilt Change in Adult Spinal Deformity
Authors: Sebaaly Amer , Kharrat Khalil , Kreichati Gaby , Rizkallah Maroun 
Published: April 2016

Background Spine osteotomy is used for patients with rigid severe spinal deformity. Pedicle Subtraction Osteotomy (PSO) is performed by removing the posterior elements and both pedicles, removing a wedge from the vertebral body, and closure of the osteotomy by hinging on the anterior cortex. This technique is demanding and have very steep learning curve. We analyze the effect of the level of PSO on the change of pelvic tilt Methods this is a retrospective study of 35 patients (mean age, 60.7 years; range, 45–81 years) undergoing thoracolumbar PSO at a single institution in the past 4 years. One patient underwent PSO at T11, two patient underwent PSO at L2, and 16 patients underwent PSO at L3 and 16 at the L4 level. Seventy percent of the patients had undergone at least one previous spine surgery in the region of the PSO. Results the mean pelvic incidence in the cohort was 54.5. There was no change in the pelvic tilt between the preoperative and postoperative state (24.8 vs 22; p > 0.05). On the other hand, lumbar lordosis (26 vs 44), thoracic kyphosis (27 vs 38.8) and T1 pelvic angle (26.6 vs 14.7) had all significant improvement. Mean PSO resection was 35°. With subgroup analysis, mean pelvic tilt change -3.3° at the L3 level and -8.6 ° at the L4 level. Conclusions The degree of PSO resection correlates greatly with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, and T1PA). More importantly, PSO level impacts postoperative PT correction; L4 level PSO have shown a better correction of the pelvic tilt than L3 PSO.
How Reliable is the Surgeon's Ability to Differentiate between Idiopathic and Degenerative Deformity in Adults; What Parameters Help them Decide?
Authors: Acaroglu Emre , Güler Ümit Özgür , Ayhan Selim , Mmopelwa Tiro , Sabat Montse Domingo , Pellise Ferran , Perez-Grueso Francisco Javier Sanchez , Alanay Ahmet , Obeid Ibrahim , Kleinstuck Frank 
Published: April 2016

Introduction Adult spinal deformity (ASD) may be classified as idiopathic (I) or degenerative (D) (or other) based on classifier's perception, the reliability of and factors inherent to which remain unknown. Aim of study is to evaluate the inter and intraobserver reliability of surgeons' perception in differentiating I from D ASD and to identify the determinants of it. Material and Methods From a multicentric prospective database, 179 patients were identified with the diagnosis of I ( n = 103) or D ( n = 76); no previous surgery; and a lumbar coronal curve > 20°. Standing AP and lateral X-Rays were sent to five experienced spine surgeons to be identified as D or I (or other); followed by a second round after reshuffling. Weighted Kappa statistics was used, after which the patients were stratified by number of agreements as perfect (10/10) and very good (≥8/10); these were further compared for additional radiological parameters. Results Four observers completed both rounds while the 5th did only the first (a total of 10 observations/pt including the record). Agreement levels were moderate to good for intra but fair to moderate for interobserver comparisons (Table 1). There were 42 perfect and 80 with very good agreements for I patients but only 6 perfect and 17 very good agreements for D. Upon comparison of these, it was seen that they were different for some coronal parameters such as lumbar Cobb angle (larger in I, p < 0.001), CSVL modifier (C more common in I, p = 0.007) and presence of rotatory subluxation (less common in D, p = 0.017) but very different for sagittal parameters (lumbar lordosis, sagittal vertical axis, T2-sagittal tilt, pelvic tilt, sacral slope and global tilt; increased sagittal imbalance in D, all p≤0.001). Conclusion Surgeons in this study demonstrated reasonable intraobserver agreement but only fair agreement amongst them. These findings suggest that especially in patients with significant coronal curves, determination of curve etiology with only radiological data may not be accurate. In patients with good agreement, the most consistent radiologic determinant appeared to be the presence of sagittal imbalance.
Multiple Regression Analysis of Factors Affecting the Mental Component Score Constituents of SF-36 in Adult Spinal Deformity
Authors: Ayhan Selim , Yuksel Selcem , Niyazi Asli , Nabiyev Vugar , Güler Ümit Özgür , 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 As surgical decision-making and preoperative planning for adult spinal deformity (ASD) need strongly be interrelated to health related quality of life (HRQOL), there are multiple studies focusing on factors with an impact on it. Based on the general perception of association between the treatment results and the psychological condition of patients with ASD, analyzing the factors governing the baseline psychological status of this group may be worthwhile. Aim of study is to develop an understanding of which factors have a greater impact on the SF-36 mental component score (MCS) and to establish a hierarchy of these parameters through multiple regression analysis. Material and Methods Prospectively collected data from a multicentric adult deformity database was analyzed using multiple regression analysis with SF-36 MCS designated as the dependent variable and demographic, radiological and the HRQOL parameters as independent variables. The regression model was started with a correlation analysis between SF-36 MCS and all independent variables then conducted by introducing the variables with the highest correlation with SF-36 MCS, sequentially. Results A total of 229 patients (181♀, 47♂) with a mean age of 49.4 (18– 85) years, were analyzed. A strong correlation between SF-36 MCS and Scoliosis Research Society (SRS)-22, Oswestry Disability Index (ODI), gender, and diagnosis were found ( p < 0.05). The distribution graph and results of regression analysis are summarized in Fig. 1. The overall R2 of this model was 0.254 ( p < 0.001). Conclusion This study has demonstrated that, among the evaluated parameters, the overall HRQOL (SRS-22 and ODI) as well as thoracic kyphosis (TK) and gender are the most important parameters affecting the mental component summary of SF-36 in ASD population. Although the strong association with SRS-22 and/or ODI was to be expected, less strong associations with TK (as a token of appearance?) and gender (due to different mechanisms of coping with disability?) were less expected and may warrant further consideration in our understanding of the population of ASD.
Mental Health and Self Image Perception of Non-disabled Adult Idiopathic Scoliosis Patients Having Mild to Moderate Curves Compared to Normal Population
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 There is little information about the effects of scoliotic curves on self image (SI) and mental health (MH) based on validated questionnaires. Aim was to analyze the effect of scoliosis on MH and SI in a non-disabled adult idiopathic scoliosis (AdIS) population having curves under surgical indication threshold (Main Thoracic (MT) Cobb (≤ 55°), and Thoracolumbar/Lumbar (TL) curve (≤ 45°). Material and Methods A retrospective analysis of a multicenter, prospective, consecutive patient series. Inclusion criteria were: non operated AdIS, ≥ 18 years of age, MT Cobb 20–55°, TL Cobb 20–45°, ODI <20, SRS 22 Pain score > 4. ODI and SRS22 pain score were used to distinguish patients that have pain and disability from the ones that do not. SRS- 22 and SF-36 normative data for different age groups were used for comparison. AP and lateral Cobb measurements, sagittal plane parameters and demographic data were analyzed in terms of correlations with SI and MH parameters. Results 76 patients (64F, 12M) met the inclusion criteria. Mean age was 25.9 (18–44), mean MT Cobb was 38.5° (21–55) and TL Cobb was 34.6° (25–44). SRS-22 MH, SI and other domains were similar with SRS normative data (p > 0.05). SF-36 MCS and PCS domains for age groups 18–24, 25–34 and 35–44 were not significantly different than normative data (p > 0.05). None of the demographic and radiographic parameters were correlated with changes in SRS-22 function, SI, MH and SF 36 MCS, PCS parameters. Conclusion AdIS does not affect mental health and self-image in non-disabled patients with curve magnitudes below the surgical threshold. [Figure: see text]
Laminoplasty for the Treatment of Cervical Myelopathy. 5 Year Experience at University Clinic Colombia
Authors: Uribe Jorge E. , Chaparro Walter , Herrera Mario 
Published: April 2016

Introduction Cervical myelopathy affects primarily elderly people, caused mainly by a degenerative process of spondylosis in which both static (disc, ligament ossification, congenital stenosis, tumors) and dynamic (flexion-extension of cervical spine adaptive changes, nervous fiber elasticity, ischemia, trauma) factors that lead to the compression and diminished blood supply of the spine cord. The symptoms can range from mild paresthesias according to the compromised cervical level, gait disturbances, pain to as severe as paraplegia, with a natural history of chronic progression, Surgical treatment of this entity include anterior or posterior decompression with arthrodesis and laminoplasty. In this study we aim to report the result obtained with Cervical Laminoplasty described by O'brien during de years 2010 to 2015. Material and Methods An observational retrospective descriptive study was performed, reviewing the clinical records from preop to postop of patients with cervical myelopathy, Functional information was gathered using the scale of the Japanese Orthopaedic Association and Pain Analog Visual Scale. X-rays were evaluated measuring canal diameter, Chiba's line, Pavlov index and signs of instability. MRI studies were used to measure canal diameter in the axial plane and to identify signs of myelopathy. Inclusion criteria were patients older than 18 years, that had both clinical and image diagnosis for cervical myelopathy in which the O'brien laminoplasty was performed Results 10 patients with an average age of 74 (64 to 84yrs) completed follow up according to our inclusion criteria. AVS improved from 7 to 3. The JOA Scale showed improvement in all the patients from 10 to 14 in the global score, which corresponds to a progression from a Functional class II to I. Images evaluation showed widening of the cervical canal as seen with a 0.76 Pavlov index preop to 0.96 postop and a 33% widening in the MRI sagittal view. Conclusion For the management of cervical myelopathy, proper documentation of the pathology both clinical and images allows to decide the adequate management of the patient. The O'brien technique for cervical laminoplasty proved to be an effective alternative in the treatment of this entity.
Rationale, Design and Early Trial Performance of AOSpine North America Multi-Center Double Blind Randomized Controlled Trial of Safety and Efficacy of Riluzole in CSM (CSM – Protect Trial)
Authors: Fehlings Michael , Kopjar Branko 
Published: April 2016

Introduction While surgical decompression is an effective treatment for CSM, many patients have substantial residual neurological and functional impairment. Compelling evidence from preclinical models suggest a benefit of adding a neuroprotective drug which targets sodium/glutamate excitotoxicity to the treatment of patients with CSM. The purpose of this study is to evaluate efficacy and safety of sodium-glutamate antagonist riluzole in improving neurological outcomes in patients with cervical spondylotic myelopathy (CSM) undergoing surgical treatment. Material and Methods Prospective multi-center double-blind randomized controlled trial in which a total of 300 patients undergoing surgical decompression for CSM will be randomized 1:1 to riluzole 2x50mg daily for 14 days before the surgery and 28 days after the surgery or to the placebo. Primary outcome measure is change in mJOA between baseline and 6 months. Secondary outcomes include ASIA, SF36v2, NDI, Eq. 5D, Pain VAS and complications. The sample size of 270 completed subjects will have 80% power to detect absolute difference of 0.9 in mJOA score between the investigational and the control group. The statistical analysis is organized as a sequential adaptive trial with one interim analysis at 65% of the accrued sample for early futility and efficacy. Adaptive statistical design allows for sample size adjustment at the time of interim analysis. Results To date, 212 subjects have been enrolled. Average age of the enrolled subjects is 58.1 years (SD 10.2); 56% males. The baseline mJOA is 11.9 (SD 1.5). Baseline NDI is 42.5 (SD 20.4) and the baseline SF36v2 Physical Component Score (PCS) is 32.8 (SD 9.9). Conclusion In spite of the benefits of the surgical intervention, patients with CSM experience significant residual impairment and neurological compromise. Adding neuroprotective treatment with riluzole may improve outcomes of surgery. This talk will emphasize the unique study design and the biological rationale for considering riluzole as a potential neuroprotective adjunct for patients undergoing surgery for CSM
Results of Multi-Level (Three and Four Levels) Cervical Disc Arthroplasty: Age-Weighted Linear Regression Analysis: Results from a Single Centre
Authors: Rajesh Mangattil , Khan Shoaib , Friesem Shabtai , Bhatia Chandra , Reddy Guru 
Published: April 2016

Introduction The clinical outcomes of Multi-level disc arthroplasties are variable in the literature. However, the outcome results related to age would have a significant bearing on our decisions in considering patients for surgery. We reviewed 51 patients who had 3 & 4-level cervical disc arthroplasties at our center. Methods The study involved a retrospective review of prospectively collected data on Multi-level (three and four levels) cervical arthroplasty patients with an average age of 54.64 (median age: 52, range: 34–80). Fifty one patients were followed up for 2 to 5 years based on clinical outcomes scores which were reviewed using data including NDI (Neck Disability Index), Depression, Anxiety, Bodily Pain, Visual Analogue score for Neck (VAS Neck), and Visual Analogue score for Arm (VAS Arm). Scores were collected pre-operatively and at each follow up at 3 months, 6 months, 1st and yearly afterwards. Linear Regression Analysis was performed to look at the impact of age on these scores. Results The study consisted of 24 females and 27 males. The average duration of symptoms was ~62 months (range: 0–300months) for Multilevel Cervical Arthroplasty patients. The indication for surgery was radiculopathy and a combination of radiculopathy and myelopathy. Linear Regression Analysis for NDI and age showed a Pearson Co-relation (r = 0.243); P Value: 0.051, for VAS Neck (r = 0.251); P Value: 0.044, VAS Arm (r = 0.392); P Value: 0.001. The slope on the scatter plots for these 3 outcome scores showed there was a better outcome with age. There was significant improvement in the score with age (< 0.05). Conclusion Our results indicate that there is a strong co-relation between age of the patient and their NDI, VAS Neck and VAS Arm scores in Multi-level Cervical Disc Arthroplasty. It would appear that the advancing age results are better. The reason is most likely multifactorial including duration of pre op symptoms, severity of pathology and patient expectations.
Change in Function, Pain, and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review
Authors: Tetreault Lindsay , Shamji Mohammed , Rhee John , Wilson Jefferson , Anderson Ian , Dembek Anna , Pagarigan Krystle , Dettori Joseph , Fehlings Michael 
Published: April 2016

Introduction The role of structured nonoperative treatment for the management of DCM is not well defined, and surgery is typically recommended as the default treatment option for patients with moderate and severe myelopathy. This study aims to conduct a systematic review of the literature to determine (1) the change in function, pain and quality of life following structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) the variability of change in function, pain and quality of life following different types of structured nonoperative treatment; (3) the differences in outcomes observed between certain subgroups (i.e baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from structured nonoperative treatment. Material and Methods A systematic search was conducted in Embase, PubMed, and the Cochrane Collaboration for articles published between January 1, 1950 and February 9, 2015. Studies were included if they evaluated outcomes following structured nonoperative treatment, including therapeutic exercise, manual therapy, cervical bracing and/or traction. Outcomes of interest were functional status (Japanese Orthopedic Association (JOA), Nurick), pain in upper extremities and neck, quality of life (Neck Disability Index), and/or conversion to surgery. The quality of each study was evaluated using the Newcaste-Ottawa Scale and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation Working Group. Results Of the 570 retrieved citations, eight met the inclusion criteria and were included in this review. There is very low evidence to suggest that structured nonoperative treatment for DCM results in a positive or negative change in function, pain and quality of life as evaluated by the JOA score. There is also limited evidence from three studies indicating that early structured nonoperative treatment (duration of symptoms < 1 year) may be associated with positive clinical outcomes. There were no studies that directly compared structured nonoperative treatment types and no studies that explored outcomes based on patient subgroups. The rate of conversion to surgery was reported to be between 23-54% in mostly cases of mild or moderate myelopathy (JOA≥12). Conclusion There is a lack of evidence to determine the role of nonoperative treatment in patients with DCM. However, in the majority of studies, patients did not achieve clinically significant gains in functional status following structured nonoperative treatment. Furthermore, rates of failed conservative treatment were between 23-54%.