bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrathecal Baclofen Pumps do not Accelerate Progression of Scoliosis in Quadriplegic Spastic Cerebral Plasy
Authors: Rushton Paul , Nasto Luigi , Aujla Ranjit , Vloeberghs Michael , Grevitt Michael 
Published: April 2016

Introduction Intrathecal baclofen pumps are an effective treatment for spasticity in patients with cerebral palsy. Recently, concerns have been raised regarding the potential for intrathecal baclofen pumps to accelerate scoliosis progression and increase the need for spinal fusion surgery. To date the literature remains unclear, with studies often failing to account for the natural history of scoliosis progression in this population when assessing the influence of baclofen pumps. We aim to clarify matters by comparing progression of scoliosis in quadriplegic spastic cerebral palsy with and without intrathecal baclofen pumps. Material and Methods: Design: Retrospective matched cohort . Patients: Inclusion criteria: Quadripegic spastic cerebral palsy, GMFCS level 5, follow up > 1 year, adequate radiographic/clinical data . Methods: Suitable patients who underwent intrathecal baclofen pump insertion were matched to cases with the same diagnosis and function level with comparable age and baseline Cobb angle but without intrathecal baclofen pumps. Outcomes: Primary: Sequential radiographs measured to assess annual coronal curve progression and peak curve progression . Secondary: Need for spinal fusion for curve progression . Analysis: Between group comparisons made with paired t-tests and chi square tests. Results Baclofen group: 17 patients (7 female), mean age at insertion of pump 9.4 (3.6), 10 cases with a scoliosis > 10° at baseline. Initial Cobb angle 21° (21) and Risser grade 0.8. Twelve cases had hip subluxation/dislocation at baseline. Mean follow up 4.7 (1.3–8.8) years. Mean Cobb angle at final follow up was 77° (27). Non-baclofen group: 17 patients (10 female), mean age at baseline 9.5 (3.7), 12 cases with a scoliosis at baseline. Initial Cobb angle 25° (20) and Risser grade 0.9. Three cases had hip subluxation/dislocation at baseline. Mean follow up 3.6 (1–7.5) years. Mean Cobb angle at final follow up was 67° (30). The two groups were statistically similar in terms of age, initial Cobb angle, Risser grade and presence/absence of scoliosis at baseline. The baclofen group had a higher proportion of hip subluxation/dislocation at baseline ( p = 0.006). Mean annual curve progression was 13.4° (7.2) for the baclofen group vs 13.6° (9.1) for the non-baclofen group ( p = 0.8). Mean peak curve progression was 31.7 (34) for the baclofen group and 27.1 (18) for the non-baclofen group ( p = 0.95). 4 patients with baclofen pumps and 5 without required spinal fusion for curve progression during follow up. All patients, aside one non-baclofen case, had developed a scoliosis by follow up; mainly thoracolumbar/lumbar collapsing C curves. Conclusion Patients with quadriplegic spastic cerebral palsy with and without baclofen pumps showed significant curve progression over time. Intrathecal baclofen pumps do not appear to alter the natural history of curve progression in this population.
Three Dimensional Correction of Severe Rigid Neurofibromatosis Scoliosis
Authors: Koptan Wael , El-Sharkawi Mohammad , ElMiligui Yasser 
Published: April 2016

Introduction The surgical management of severe rigid dystrophic neurofibromatosis curves is a demanding procedure with uncertain results. Several difficulties are present in such patients including a poor bone stock, sharp angulation of these curves and the delicate nature of the dural sac. The aim of this work is to review the clinical and radiographic outcome of three-dimensional correction of severe rigid neurofibromatosis curves analyzing its efficacy, safety and possible complications. Materials and Methods The results of 32 patients with severe rigid neurofibromatosis deformities were retrospectively reviewed. Patients were followed-up for a minimum of 3 years; an average of 6.5y (range 3 – 9y). The average age was 14 years (range 11 – 19y). All patients had typical dystrophic curves and the apex of the deformity was dorsal (13 patients); dorsolumbar (14 patients) and lumbar (5 patients). All patients had a two staged procedure; an anterior release followed by posterior instrumentation augmented by sublaminar wires. The wires were placed immediately below the proximal anchor and several sublaminar wires at the apex of the deformity. There were a total of 142 wires with an average of 6.5 wires/ patient (range 5 – 8 wires). Results The mean Cobb angle of the main curve was 102° before surgery corrected to an average of 39° and the loss of correction had an average of 4°. Sagittal alignment improved from an average of 12° to an average of 47° and rotation was corrected by an average of 34%. There were no dural tears during passage of the sublaminar wires and no neurological or implant related complications. Conclusions The use of extensive and vigorous anterior release with posterior hybrid instrumentation has proved useful and effective in the treatment of these difficult cases; sublaminar wires allow safe gradual correction and even distribution of forces over multiple anchor points improving the correction achieved and decreasing implant related complications.
The Impact of Low Back and Neck Pain on Dentistry Students in Northern Greece
Authors: Stavridis Stavros I. , Samoladas Efthimios , Tsitas Konstantinos , Xanthopoulou Kassiani , Apostolidou Kleri , Hatzokos Ippokratis 
Published: April 2016

Introduction Dentistry students and dentists comprise a unique group of professionals, whose everyday professional activity requires long hours of standing and working in position considered “unhealthy” for low-bask and neck. The aim of this cross-sectional study was to explore the factors involved in the appearance of low-back and neck pain in dentistry students, as well as the impact of the pain on the students' professional and everyday activities. Materials and Methods A questionnaire was sent via e-mail to all dentistry students of the 7th, 8th, 9thand 10th semesters (years of clinical practice) of our university. The questionnaire included 43 questions regarding demographical data, history (spinal injury, other comorbidities), daily activities (exercise, smoking, alcohol and caffeine consumption, use of cell phone, etc), professional activities (length and type of dental work), pattern and intensity of pain and personal pain evaluation. A statistical analysis of the gathered data was performed. Results All students having suffered a spinal trauma or indicating any other comorbidities that could cause severe pain of the spine were excluded from the study. 55 students (21 male, 34 female) were included in the study. Our data showed that increased alcohol consumption and prolonged use of cell phone were connected to increased levels of pain. The students reported that the most frequent onset of pain was one hour after starting to work in standing position, while the majority believed that their working habits were involved in the appearance and the intensity of neck and low-back pain. Conclusions Our findings indicate that among dentists and dentistry students there appears to be a causative relation between their professional activities and the experienced spinal pain. These findings may be useful in a possible future restructuring of the educational program in dental schools, as well as in improving the ergonomics of dentistry working units.
Length of Stay and Post-operative Complications and Their Relation with the Glucose Level Preoperatively in Diabetic and Non-diabetic Patients Undergoing Spinal Surgeries
Authors: Almana Yousef , AlHammad Nouf , Almutair Abdulaziz , Awwad Waleed 
Published: April 2016

Introduction Hyperglycemia in diabetic patients is a well-known risk factor for many perioperative morbidity and mortality, as it alters the normal physiology of the patients responding to many stressors like surgery, it therefore tends to increase the patients’ costs and length of stay in the hospital. Other studies have showed the relation between glycemic instability with the adverse events following spinal surgeries, showing as high as 19% non-diabetic patients, had hyperglycemia and considering it as a risk factor for many adverse events like surgical site infections and sub-optimal wound healing and for the increasing rates of surgical revision, matching our hypothesis of the positive correlation between glycemic instability and the rate of adverse events. The purpose of this study was to expose the effect of glucose level preoperatively on the patient complications and length of stay in the hospital, and to compare between diabetics and non-diabetics with hyperglycemia preoperatively regarding complications and length of stay. Material and Methods Of the 129 patients who underwent spinal surgeries at King Saud University Medical City, Riyadh SA, during two years period (2013–2015) exclusion and inclusion criteria were applied including only the patients whom their preoperative glucose level was documented and a total number of 106 patients were enrolled in a retrospective analysis study design. Each of the patients' records underwent a comprehensive and complete review. Results 34 (32.1%) of our patients were diabetic, 13 (12.2%) of all patients had hyperglycemia, 6 (46.2%) of the hyperglycemic patients had at least one post-operative complication, compared with 9 (10.5%) among the euglycemics ( P value 0.004), having most commonly infections and suboptimal wound healing (23.1%, n 3, P value 0.094, 0.192, respectively), with an increase in length of stay by an average of 4.37 days ( P value 0.256) and the incidence of complications among the hyperglucemic ptients seen in 5 (55.6%) of the diabetics and in 1 (25.0%) of the non-diabetics( P value 0.343). Conclusion Pre-operative hyperglycemia is associated with more adverse events post operatively (seen more in diabetics in this study), hence, along with other factors, increasing patients' length of stay in the hospital which adds to the financial costs as well as predisposing to more infections. However, the number of diabetic patients examined in this study was limited, demanding for more extensive researches addressing the same topic.
Differences between Manufacturers of CT-based Computer Assisted Surgery Systems Do Exist: A Systematic Literature Review
Authors: Nooh Anas , Lubov Joushua , Aoude Ahmed , Aldebeyan Sultan , Jarzem Peter , Ouellet Jean , Weber Michael H. 
Published: April 2016

Summary of Background Data Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CT-based navigation systems. Yet, there has been no systematic review directly comparing accuracy of pedicle screw placement between different CT-based navigation systems. The aim of this study was to review the results presented in the literature and compare CT-based navigation systems relative to screw placement accuracy. Methods A systematic review of the literature was preformed using CENTRAL, Medline, PubMed and Embase databases. Studies included were randomized clinical trials, case series, and case control reporting the accuracy of pedicle screws placement using CT-based navigation. Two independent reviewers extracted the data from the selected studies that met our inclusion criteria. Papers were grouped based on the CT-based navigation system used for pedicle screws placement. Results 33 Papers met all of our inclusion criteria and were included in the final analysis, which showed a significant statistical difference ( P < 0.0001) in accuracy of pedicle screws placement between three different CT-based navigation systems. The mean (weighted) accuracy of pedicle screws placement based on the CT-based navigation system was found to be 96.8% ± 3.8% in StealthStation, 96.07% ± 3.8% in VectorVision and 97.7% ± 1.7% in SurgiGate. Post hoc analysis showed a significant statistical difference between StealthStation vs VictorVision ( p < 0.0001) and StealthStation vs SurgiGate ( p < 0.0001) as well. Conclusion This paper summarizes results presented in the literature and compares screw placement accuracy using different CT-based navigation systems. The differences in accuracy demonstrated in this review should be considered by spine surgeons, and need to be validated for effects on patients' outcome. Level of Evidence Level I.
Pedicular Screw Placement Accuracy with O-Arm Based Navigation in Patients with Scoliosis
Authors: Urbanski Wiktor , Jurasz Wojciech , Wolanczyk Michal , Dragan Szymon 
Published: April 2016

Introduction Application of transpedicular screws to obtain posterior spinal fusion in thoraco-lumbar spine has become standard in spinal surgery. However technique of screws insertion is demanding and not free of complications. Positioning is particularly challenging in pediatric patients with spinal deformity. Navigation systems based on intraoperatively obtained 3D image seem to be very promising solution to prevent or at least minimize screw misplacements. Although still lack of data confirming superiority of navigation above other techniques. The study was designed to assess the accuracy of transpedicular screws placement with O-arm and navigation in patients who underwent surgery for idiopathic scoliosis. Material and Methods 451 screws in 27 patients were evaluated. All the screws were positioned by two surgeons (WU, WJ) with aid of navigation (Stealth Station, Medtronic) based on 3D image obtained during surgery (O-ARM, Medtronic). The accuracy was described separately for each screw based on postoperatively obtained CT scans. The assessment was made according to widely accepted grading system: grade 0 – no pedicle wall violation, grade 1 =< 2 mm perforation, grade 2 – wall perforation with half of the diameter of the screw outside of the pedicle (=< 4 mm), grade 3 complete perforation of the pedicle (>5 mm). The comparison of accuracy was made between adults (13 patients) and adolescents (14 patients). Results In the study authors reported overall accuracy of 96% correctly positioned pedicle screws (83% grade 0 and 13% grade 1). No grade 3 screws were reported. Statistical analysis confirmed decreased accuracy in upper thoracic level (82% of grade 0 and 1). No statistically significant differences in implant accuracy were observed between adults (96.2% of grade 0 and 1) and adolescents (95.3% of grade 0 and 1). Conclusion The application of navigation system is a safe method of pedicle screws introduction either in adults or adolescents. However the technique does not eliminate misplacement. Significant misplacement rate is still observed in upper thoracic spine.
Study of Functional Outcome of Anterior Cervical Decompression and Fusion Using Tricortical Iliac Bone Graft for Degenerative Cervical Spondylotic Myelopathy with Modified Japanese Orthopedic Association Score
Authors: Sharma Ayush , Singh Vijay 
Published: April 2016

Objective To determine functional outcome of anterior cervical decompression and fusion using tricortical iliac bone graft (ACDF) for degenerative cervical spondylotic myelopathy with modified Japanese orthopedic association score (MJOA). Materials and Methods 60 diagnosed cases of one and two levels cervical myelopathy were prospectively analyzed preoperatively and at 3 months, 6 months, 1 year using MJOA. Results 46 patients underwent Single level ACDF with C5-C6 the commonest level to be affected. The correlation between Duration of Symptoms to Preoperative and postoperative MJOA was statistically significant. We noted statistically significant improvement in symptoms of axial neck pain, radicular arm pain, clumsy hand, and gait disturbances post operatively at one year. Statically significant difference was noted while comparison MJOA of Pre-operative to 6 months and 1 year, and 3 months to 6 months and 1 year. Statistically significant difference in blood loss and anesthesia time for one level fusion compared with two level fusions was also noted. The fusion rate for single level ACDF was 95.65% compared 71.42% for two levels. Conclusion Functional outcomes in operated patients at 1-year follow up are better if ACDF surgery is done early. Symptoms of axial neck pain; radicular arm pain, clumsy hand and gait disturbances show significant improvement at one year follow up. While bladder and bowel involvement showed the least recovery. Significant improvement in function occurs postoperatively between 3 and 6 months, and then it plateaus from 6 months to 1 year. Fusion rates for single level ACDF are better than two levels ACDF.
Transpedicular Wedge Opening (TWO) Osteotomy for Post-Traumatic Kyphosis (PTK): Own Technique and Preliminary Results
Authors: El-Meshtawy Mohamed 
Published: April 2016

Introduction Management for symptomatic post-traumatic kyphosis always has presented a challenge to orthopedic surgeons. The management for post-traumatic kyphosis remains controversial: Anterior, posterior, or combined anterior and posterior procedures have been advocated by different authors and show various degrees of success. All of these techniques end in abnormal morphology of the affected vertebra, so in this technique we try to restore the normal sagittal balance by restoring the normal morphology of the affected vertebra (natural kyphoplasty). Material and Methods Between May 2010 and Jun 2014 30 patients with symptomatic kyphotic deformity were treated with TWO osteotomy. Twenty-two are males and eight are females. The mean age of patients was 37 years (range 18- 62 years). All patients had history of old trauma with time lag till surgerical interferance was 10 months in average (3m- 12y.). They underwent TWO osteotomy of the wedged VB bisegmental TPSF through posterior-alone approach The clinical evaluation throughout the study entailed visual analogue scale (VAS) and Oswestry disability index. The local kyphotic angel (LKA), sagittal balance (SB) and sagittal index (SI) were measured preoperatively, postoperatively and during the follow up visits. Radiographic bony healing of the v-shaped VB defect which left after the TWO osteotomy is confirmed by MSCT. Results The mean follow up period was 26.5 months (range12- 48 m.). TWO osteotomy was done for wedged VB between D10 and L2. The mean operative time was 110 minutes (range 70- 180 minute.) and the mean intraoperative blood loss was 625 cc (range 400- 1700 cc). The mean preoperative LKA was 28.7° (range 20- 56°) that had been improved to -2° (range 8°- (−10°)) postoperatively. Lordotic correction of 30.8° (range 22–48°) was achieved with minimum loss of correction (range 0- 8°) through the period of follow up. The mean period required for radiographic bony healing of the osteotomy was 7 months (range 3–15m.). The VAS &ODI had been improved significantly (p.005) in comparison to preoperative values. Excellent clinical and radiographic outcomes were achieved in 92% of cases with no major complications. Conclusion Spontaneous bony healing after TWO of wedged VB occurs without doubt. This study evoked the concept of “Natural Kyphoplasty” for treatment of certain cases of PTK. Although it is a newly described technique, it was proved to be safe and effective method for treatment of symptomatic thoracolumbar PTK.
Interbody Fusion in Low Grade Lumbar Spondylolsithesis: Clinical Outcome Do Not Correalte with Slip Reduction and Neural Foraminal Dimension
Authors: Debnath Ujjwal K. , McConnell Jeffrey R. , Goel Vivek 
Published: April 2016

Introduction There is no consensus in literature whether a beneficial effect of reduction on outcome can be expected following reduction and surgical fusion for low grade lumbar spondylolisthesis. This prospective study was designed to find a possible correlation between the clinical outcome and extent of lumbar spondylolisthesis reduction. Material and Methods 52 patients (age 17–48 years) with isthmic spondylolisthesis underwent interbody fusion with cages with posterior instrumentation (TLIF or PLIF). Clinical outcome was measured using Visual Analogue Scores (VAS) and Oswestry Disability Index (ODI). Foraminal dimensions and disc heights were measured in standard digital radiographs. These were analyzed at baseline and at 1 year after surgery and changes were compared. Radiographic fusion judged with CT scans at 1 year. Results 90 percent of the patients in the study had good or very good clinical results with fusion and instrumentation. The baseline and at one year postoperative, the mean VAS scores were 6.39 (range 5–8) and 0.81 (range 0–3) respectively ( p = 0.004). The baseline and at one year postoperative, the mean ODI scores were 48 (range 34–58) and 9.8 (range 4–22) respectively ( p < 0.001). A mean spondylolisthesis slip of 33.2% was reduced to 6.7% at 1 year. Average anterior disc height, posterior disc height, C distance, F diameter improved from 9.4mm to 11.7mm ( p = 0.005),from 4.3mm to 5.8mm( p = 0.004),from11.2mm to 12.0mm( p = 0.002), from 18.5mm to 19.4mm respectively( p < 0.001). The fusion rate was 66% with PLIF and 75% with TLIF. There is no significant correlation between the improvements of ODI scores and the extent of slip reduction. Conclusion Neural decompression and interbody fusion significantly improved pain and disability but the clinical outcome does not correlate with radiological improvement in neural foraminal dimension.
Comparison of NPY Y1 Receptors in the Spines of Ovariectomized and Ovary Intact Rats
Authors: McGuire Robert , Tucci Michelle , Benghuzzi Hamed 
Published: April 2016

Introduction Neuropeptide Y (NPY) is a 36-amino acid neuropeptide that acts as a neurotransmitter in the brain and in the autonomic nervous system of humans. In the autonomic system it is produced mainly by neurons of the sympathetic nervous system and serves as a strong vasoconstrictor. Recently, NPY has been shown to increase during stress and in patients with chronic back pain. NPY has the potential to innervate 5 subtypes of receptors Y1-Y5. The Y1 receptor has been shown to play a role in cell survival and contribute to pain hypersensitivity. In addition, Y1 receptors are also thought to contribute to bone loss leading to disc degeneration in osteoporosis. The goal of our study was identify the location of the Y1 receptor in the disc of osteoporotic animals and to compare those to ovary intact control. Methods Eight OVX animals and eight ovary intact control animals were followed weekly for 8 weeks. Four animals in each group were sacrificed at 4 and 8 weeks and blood and spines were harvested. Spines were decalcified and processed for histological analysis. Routine hematoxylin and eosin staining along with immunhistochemical analysis of the spine Y1 receptors. Results The results showed the intervertebral discs in the control group appeared normal. The nucleus pulposus contained abundant notochordal cells, surrounded by large zones of extracellular matrix, and the cartilage endplates were hyaline cartilage composed of chondrocytes. In the OVX animals, the discs showed degenerative changes, where the nucleus pulposus appeared reduced in size and comprised relatively few, chondrocyte-like cells. Mucoid degeneration could also be seen. An increased number of small chondrocytes appeared in the inner layer of the annulus. Bony tissues that contained bone marrow, hematopoietic lineage cells and mineralized bone, became more obvious in the deep zone of middle cartilage endplate. Immunohistochemical analysis for Y1 receptors showed positive staining in the outer annulus in the control with defined staining of chondrocyte cells. Y1 receptor staining was diminished in the OVX animals. Higher levels of circulating NPY was found in the plasma of OVX animals and may contribute to internalization of the Y1 receptor as a compensatory mechanism. Conclusions Y1 receptors are located in the outer portion of the annulus of rats. The portion of cellular staining differed between the OVX and intact ovary control animals. More experiments are needed to clarify the role of NPY in the normal and osteoporotic spine.