bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence, Predictors and Post-Operative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 14,249 Patients from the ACS-NSQIP Database
Authors: Aoude Ahmed , Nooh Anas , Fortin Maryse , Aldebeyan Sultan , Jarzem Peter , Ouellet Jean , Weber Michael H. 
Published: April 2016

Introduction Hemorrhage and transfusion requirements in spine surgery are common. This is especially true for thoracic and lumbar fusion surgeries. There is limited data in the literature concerning predictive factors for transfusion and their effect on short-term post-operative outcomes. Material and Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent lumbar or thoracic fusion surgery from 2010 to 2013. Univariate and multivariate regression analysis was used to determine predictive factors and post-operative complications associated with transfusion. Results A total of 14,249 patients were included in this study; 13,586 had lumbar fusion and 663 had thoracic fusion surgery. The prevalence of transfusion was 35% for thoracic fusion and 17.5% for lumbar fusion. The multivariate analysis showed that age between 50–60 (OR 1.38, CI: 1.23–1.54), age between 61–70 (OR 1.65, CI: 1.40–1.95), dyspnea (OR 1.11, CI: 1.02–1.23), hypertension (OR 1.14, CI: 1.02–1.27), ASA class (OR 1.73, 1.18–1.45), pre-operative blood transfusion (OR 1.91, CI: 1.04–3.49), and extended surgical time (OR 4.51, CI: 4.09–4.98) were predictors of blood transfusion requirements for lumbar fusion. While only pre-operative BUN (OR 1.04, CI: 1.01–1.06) and extended surgical time (OR 4.70, CI: 3.12–6.96) were predictors of transfusion for thoracic fusion. In contrast, higher pre-operative hematocrit was protective against transfusion. Patients transfused who underwent lumbar fusion had an increased risk to develop superficial wound infection, deep wound infection, venous thromboembolism, myocardial infarction and had longer length of hospital stay. Patients transfused who underwent thoracic fusion were more likely to have venous thromboembolism and extended length of hospital stay. However, mortality was not associated with blood transfusion. Conclusion This study used a large database to characterize the incidence, predictors and post-operative complications associated with blood transfusion in thoracic and lumbar fusion surgeries. Pre- and post-operative planning for patients deemed to be at high-risk of requiring blood transfusion should be considered to reduce post-operative complication in this population.
Adjacent Segment Degeneration after Lumbar Spinal Fusion Compared with Motion-Preservation Procedures: A Meta-analysis
Authors: Hai Yong , Pan Aixing 
Published: April 2016

Introduction Adjacent segment degeneration (ASDeg) or adjacent segment disease (ASDis) is a matter of concern after lumbar fusion. Whether the motion-preservation procedures could reduce the prevalence of ASDeg or ASDis is still controversial. This meta-analysis aimed to evaluate the efficacy of motion-preservation procedures preventing the ASDeg or ASDis compared with fusion in lumbar spine. Methods: PubMed, Embase, the Cochrane Library were comprehensively searched and a meta-analysis was performed of all randomized controlled trials (RCTs) and well designed prospective or retrospective comparative cohort studies assessing the lumbar fusion and motion-preservation procedures. We compared the ASDeg/ASDis rate, reoperation rate, operation time, blood loss, length of hospital stay and VAS/ODI improvement of the two procedures. Results A total of 15 studies consisting of 1474 patients were included in this study. The meta-analysis indicated that the prevalence of ASDeg, ASDis and reoperation rate on the adjacent level were lower in motion-preservation procedures group than in the fusion group ( p = 0.001; p = 0.0004; p < 0.0001). Moreover, shorter length of hospital stay was found in motion-preservation procedures group ( p < 0.0001). No difference was found in terms of operation time ( p = 0.57), blood loss ( p = 0.27), VAS ( p = 0.76) and ODI improvement ( p = 0.71) between the two groups. Conclusions The present evidences indicated that the motion-preservation procedures had an advantage on reducing the prevalence of ASDeg, ASDis and the reoperation rate due to the adjacent segment degeneration compared with the lumbar fusion. And the clinical outcomes of the two procedures are similar.
Anterior Lumbar Interbody Fusion (ALIF): Biometrical Results and Own Experiences
Authors: Kapustka Bartosz , Pawel Chodakowski , Kiwic Grzegorz , Marcol Wieslaw , Wysokinski Tomasz , Paruzel Krzysztof , Slosarek Zofia 
Published: April 2016

Introduction Lumbar fusion is a mainstay in the treatment of low back pain resulting from degenerative disc disease. Of the various fusion techniques available, anterior lumbar interbody fusion (ALIF) has become a good treatment technique to achieve this goal. Our aims were to describe our experience with lumbosacral ALIF performed in cooperation of neurosurgeons and vascular surgeons and analysis of improvement in function and a biometrical aspects. Material and Methods From 2011–14, 33 patients underwent ALIF, 45 were identified as having a single level procedure at L5-S1 from a mini-open retroperitoneal approach. The cases were reviewed to determine fusion status, incidence of complications and length of stay. Disc space heights were determined using a ratio of disc space height to superior end plate length. For each treatment group, anterior and posterior disc space measurements were collected on a lateral radiograph and averaged to obtain a measure for disc space height. Statistical analysis was performed using Statistica 8.0. Results The average length of hospitalization was 4 days. Most of patients had spinal cord stenosis. 3 patients had early complications like parestesis of lower limbs, but there were no major complications. Blood loss was less than 75 cc in all cases. The SynFix-LR implants were used for all - average size 12,31 mm and angle 11,61. The pre-op angle of lordosis was 12,3° and post-op +8,9° added. The average disc space before treatment was 10 mm and after +7,17mm added. Conclusion The mini-open ALIF approach for L5-S1 fusion is a reasonable alternative to the more extensive posterior approaches. Although no direct comparison with the more extensive approach has been performed, our initial experience suggests that this procedure may reduce pain, blood loss, complications and length of hospital stay. ALIF significantly restores the height of the intervertebral disc and provides stability. Based on these results, it would appear that in properly selected patients ALIF with neurosurgeon-vascular surgeon cooperation raises the standard of comparison for nonfusion methodologies with regards to short and long-term pain relief and functional recovery.
Incidence and Risk Factors for Adverse Outcomes after Open Surgery for Spinal Metastatic Fractures
Authors: Theiss Steven 
Published: April 2016

Introduction Several scoring systems have evolved to estimate life expectancy in the setting of spinal metastases. However, neither overall mortality rate nor risk factors for complications in open surgery for spinal metastatic fractures have been well defined. We hypothesize that the mortality risk for these patients is high, and that additional medical comorbidities add substantially to the risk of early postoperative death. Understanding these risks will help us to choose surgical candidates with more carefully. Methods A national database, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) files, from 2011–2013 were queried for patients who underwent open surgery for pathologic vertebral fracture in the setting of metastatic cancer. Patients were analyzed for rates of any adverse event (AAE), readmission, reoperation, and mortality. Bivariate and multivariate analyses were performed to determine independent risk factors for these events. Results Of the one hundred and fifty three patients identified, seventy-eight (51%) experienced AAE, fifteen (9.8%) required reoperation, thirty (19.6%) were readmitted, and nineteen (12.4%) died within 30 days. Risk factors for AAE included pulmonary comorbidity ( p = 0.049, OR=3.87) and chronic steroid use ( p = 0.045, OR=2.28). Reoperation risk factors included male gender ( p = 0.038, OR=4.00). No risk factors were identified for readmission. Regarding mortality, identified risk factors included dependent functional status ( p = 0.009, OR=5.75), diabetes ( p = 0.004, OR=5.55), and pulmonary comorbidity ( p = 0.041, OR=4.23). Conclusion Open surgery for spinal metastatic fractures carries significant morbidity and mortality. Greater than half of patients in this cohort experienced an adverse event, nearly 20% were readmitted, and greater than 10% died within 30 days. Patient factors, including pulmonary disease, diabetes, and dependent functional status, were identified as risk factors for poor outcomes. Thorough preoperative counseling should be performed for patients with our proposed risk factors, and the risk of mortality in surgery must be carefully weighed against life expectancy and neurological deficits.
Low Back Pain and Sciatica as the Prominent Clinical Manifestations of Pelvic Venous Congestion Syndrome. A Case Report
Authors: Delaportas Grigorios , Manolarakis Georgios 
Published: April 2016

Introduction Although back pain / sciatica are common conditions in the general population and their etiology is very well understood, there is a strong interest in non-musculoskeletal origins of pelvic pain masked by symptoms resembling radicular pain such as in the case of circulatory disorders in anatomic sites beyond the spine. This study presents a particular case of low back pain & sciatica as the main symptoms of pelvic venous congestion syndrome. Material and Methods A 25 year old female presented to the Spine Institute of New England complaining of 90% low back pain and 10% right lower extremity constant pain affecting the lateral aspect of her thigh and averaging around 6/10 with reported flare-ups up to 10/10 especially at the end of a long day full of activities and with prolonged standing. She has also been complaining of sleep disturbances over the last 6–9 months. She has tried land physiotherapies in the past unsuccessfully. She complained of mild dyspareunia as well. Clinical assessment suggested pain of discogenic and/or facetogenic nature, questionable meralgia paresthetica, and sciatica; however, plain radiographs were equivocal. One month prior to the patient's visit to our clinic, Gynecological laboratories ordered by primary care physician were unremarkable. The patient followed a conservative treatment plan consisted of simple analgesics, non-steroidal (Meloxicam), and steroidal (Methylprednisolone) anti-inflammatory medication, antidepressant (Fluoxetine) and antiepileptic drugs for neuropathic pain (Gabapentin). One month later, she reported no significant improvement especially on her right thigh stating that cortisone has helped initially; NSAID's were somehow helpful unlike Gabapentin, which did not help at all. The patient was followed up with MRI, which demonstrated a tubular fluid-filled structure in the region of the right adnexa in addition to mild effacement of the thecal sac at the L3-L4 level, not a strong evidence of discogenic/radicular pain. Subsequently, a transabdominal US revealed prominent pelvic veins bilaterally – more pronounced on the right side – reflecting the likelihood of pelvic venous congestion syndrome. EMG excluded nerve root compression at the spinal level, while a thorough gynecological clinical examination confirmed the aforementioned diagnosis at initial stage due to hormonal dysfunction. Results The patient has been placed on cortisone treatment for ovarian function suppression showing encouraging early outcomes. Conclusion Even though pelvic venous congestion syndrome is diagnosed via exclusion of other pathological conditions that most likely cause symptoms of low back pain and/or sciatica, this case report comes to highlight the importance of integrated initial systemic clinical assessment, particularly when more than one medical specialties are involved in the region of interest.
Influence of Psychiatric Comorbidities on Clinical Outcome Before and after Elective Spine Surgery. A Prospective Observational Study
Authors: Meyer Bernhard , Shiban Ehab , Shiban Youssef , Mühlberger Andreas 
Published: April 2016

Introduction It is widely accepted that psychiatric comorbidities have a negative influence on health-related quality of life and long-term outcomes following spine surgery. However, most published data are restricted to postoperative measurements and data from preoperative settings in lacking. Aim of this study was to assess the incidence and influence of psychiatric comorbidities on clinical outcome in patients undergoing elective spine surgery. Methods A prospective study of patients undergoing elective spine surgery was performed. Evaluation for depression (ADS-K score) and anxiety (STAI-S, STAI-T and ASI-3 scores) before surgery and at three months follow up were done. In addition SF36 physical composite score (PCS), Oswestry Disability Index (ODI) and pain visual analog scale (VAS) were completed preoperatively and 3 months postoperatively. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined. Results 144 patients met all inclusion criteria. 78 patients were male (54,2%); mean age was 59.49 years. Most patients were married or in a steady relationship (77,8%). Abnormal STAI-S, STAI-T and ASI-3 anxiety scores were encountered preoperatively in 51,4%, 39,6% and 11.8% of cases but resolved in 38,6%, 31,9% and 11,1% of cases at 3 months follow up. 17,36%, 11,11%, 5,55% reported abnormal STAI-S, STAI-T and ASI-3 anxiety scores only following surgery, respectively. Abnormal ADK-S score were seen in 25% of cases before surgery and resolved in 14,6% of cases at 3 months follow-up. 5.55% of patients showed abnormal ASD-K scores only following surgery. Patients with an anxiety disorders at follow up had a worse clinical outcome compared with there counterparts (ODI: 43.07 vs 35.67, p = 0,304; VAS pain: 43.07 vs 5.54, p = 0.000, PCS: 42.08 vs 41.83, p = 0.949). Pathologic depression scores also had a negative influence on most clinical outcome measurements (ODI: 10.44.3 vs 26.4, p = 0.000; VAS pain: 10.49 vs 3.97, p = 0.000, PCS: 10.03 versus 48.93, p = 0,000). Conclusions The incidence of depression and anxiety disorders in patients undergoing elective spine surgery is very high. This was also associated with unfavorable outcome. Most cases of depression and anxiety were present prior to surgery. More patients are needed to asses the possibly of preoperative screening for such comorbidities as many of the patients psychiatric problems resolved after surgery.
Diagnostical Challenges of Tumor-Like Conditions of Cervical Neural Arch in Childhood
Authors: Hoffer Zoltan , Lazary Aron , Varga Péter Pál 
Published: April 2016

Introduction Neck pain is a rare symptom in childhood. However, if exists permanently, require a thorough checkup, because very often some serious pathology it is in the background. We present two consecutive cases of young patients with neck pain, where the differential diagnosis was challenging, and has proved two different tumor-like pathologies. Material and Methods The first case concerns a 17 years old boy, who represents a pain localizing to the scruff region, mainly during night and to have a rest. MR imaging showed a high intensity changes on T2-weighted, and low intensity changes on T1-weighted pictures at the top of C.7. spinous process. According to SPECT/CT and bone scan an osteoid osteoma was suspected. The second case concerns a 7 years old boy, who had been complaining for few months a temporary, however a sharp pain also at the scruff region, consequently during extension of the neck. MR showed especially on STIR pictures edema at the region of C.4, 5. spinous process. Bone scan proved a slightly increased uptake, also with the suspicion of osteoid osteoma, however the CT scan was negative. Results In the first case, based on the results of the radiological examinations, we have decided on “en bloc” resection of the malformation. The histology revealed pigmented villonodular synovitis (PVNS), which is according to the literature a really rare finding in this region, and require surgical solution. After the surgery, the patient became complaint free, with full function of his neck. On one year follow up MRI was negative regarding recurrence. On the second case pediatricians have excluded any organic rheumatologic disease, and although the inflammatory laboratory tests (We, CRP) were negative, they reckon the malformation as a chronic osteomyelitis and administered a prolonged antibiotic course under strict control for ten weeks. Because of the continuous improvement of the young boy during this therapy, biopsy was not necessary. After three months the patient became also complaint free, and the one year follow up MRI also revealed a normal status. Conclusion In case of permanent neck pain in childhood it is mandatory to perform a thorough checkup to find the reason behind these complaints to be able to exclude any tumor, or tumor-like malformations. If there are any morphological changes on the radiological examinations, the differential diagnosis could be very challenging, requiring individual therapeutical plan. The first proposed examination should have to be MR imaging.
Thoracic Volume Progressively Decreases in a Virtual Osteoporotic Vertebral Wedging Model with Increasing Severity of Kyphotic Deformity
Authors: Lee Po-Chih , Ledonio Charles , Polly David W. , Jones Kristen E. , Erdman Arthur 
Published: April 2016

Introduction Osteoporotic vertebral fractures commonly result in increased kyphotic angle. Several studies have shown that compared with controls increasing severity of osteoporotic kyphosis significantly decreases volumetric parameters of pulmonary function such as vital capacity. However the effect on the thoracic volume has been less fully studied. With the ability to accurately model thoracic volumes, we are now capable of virtually modeling the effect of increasing kyphosis on thoracic volume through the computer graphical software, Blender. We hypothesize the computed thoracic volume measured from a 3D virtual model decreases with progression of kyphosis from 50 to 100 degrees and the wedging fracture vertebrae only occur in sagittal plane. Methods Free opensource Blender software was used to create threedimensional thorax models with normal coronal and sagittal balance. By virtually wedging the vertebral bodies, the virtual osteoporotic models were progressively deformed by 10 degrees from 50100 degrees of kyphosis. Thoracic volume was simulated and measured via shrinkwrap modifier (Blender built-in function) applied to a sphere-shaped object within the virtual thoracic cavity. Results Virtual wedging of vertebral bodies was necessary to achieve virtual progression of sagittal curve. As kyphotic angle increased, more vertebral segments had to be virtually wedged. Thoracic volume in the virtual adult thorax with a 50 degrees kyphosis was 3643cc. The thoracic volumes approximately decreased in a linear fashion by means of 6.4% for every 10 degrees more of kyphosis. The final thoracic volume was 2472cc at 100 degrees of kyphosis, which was a 32.2% decrease in volume from baseline. Conclusion As the deformity progresses from 50 to 100 degrees, there is an overall 32.2% decrease in thoracic volumes. The decrease appears approximately linear. Although there is not a direct relationship between thoracic volume and pulmonary functions, adequate thoracic volume is a necessary condition for adequate pulmonary function. This study helps establish the relative magnitude of thoracicvolume decrease based on the sagittal Cobb angle.
Proposal of a New Trajectory for Screws in the Lateral Mass of the Cervical Spine
Authors: Ulloa Máximo-Alberto Díez , Amhaz-Escanlar Samer , Jorge-Mora Alberto-Agustin 
Published: April 2016

There are several trajectories described for the insertion of screws in the lateral facets of the cervical spine (Magerl, An, Anderson, based on spinous processes,..), they all rely on milimeters and precise angles; but anatomical variety (osteophytes, mass anatomy, spinous process deformities...) might render them not fully reproducible. It is proposed to consider the lateral mass as an slanted cube rotated to present a crest stright posterior, and define a trajectory as close to the 3D diagonal as possible from inferomedial corner at dorsal-medial facet to the anterosuperior cornar of the antero-lateral facet of such a cube. Hypothesis That trajectory is free of biass and represents the longest posible one in a cubic body, so obtaining the strongest anchor possible. Material and Methods 10 cervical spines (dry bone) from thew Anatomy Department of Santiago de Compostela University were gathered and 4 different trajectories were developed in each lateral mass from C3 to C6 (both sides) so getting 320 different trajectories. A Kirschner Wire 0.9 mm in diameter with an “ad hoc” guide were used to avoid destruction of the specimen. Spines were fixed to a table by a sargent clamp with the dorsal surface upwards, resembling an OR situation. The 4 trajectories tested were after the techniques originally published by Magerl, An and Anderson, and then, the new one (N), based on the spatial isolation of the lateral mass for the 3D diagonal. Variables: a) the length of each trajectory, b) violations of facet joint, c) potential injuries to vertebral artery (defined by a 3 mm wire passed through the tranverse processes) and d) potential injuries to the root (defined by the same kind of wire set exiting through the foramen). Then the results in each variable was compared among all trajectories to define the longest one and the safest one. Statistics: Linear model of mixed effects, REML adjusted for “length” and adjusted to the major probability (Laplace) for all lesions. Results a) Length: N longer than any and against each one. 16 mm vs <15 mm ( p < 0.0001) at C6 the longest one with any trajectory ( p < 0.001). b) facet violations: none. c) potential vertebral artery injury: 8/320, all right sided. N technique: 0; An technique:0. d) potential root injury: N the safest nad against each one ( p < 0.02), followed by An technique right side had a higher risk p = 0.001. Conclusions A new technique (N) is presented that allows for a longer screw insertion. Besides being longer, N technique is safer than any other relating to potential root injuries and also safer than Magerl and Anderson for potential vertebral artery injury. Right side seems more prone to both potential vertebral artery and root injury