bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of Validated Computer-Based Preoperative Predictive Model for Proximal Junction Failure (PJF) or Clinically Significant PJK with 86% Accuracy based on 510 ASD Patients with 2-year Follow-up
Authors: Scheer Justin , Smith Justin , Schwab Frank , Lafage Virginie , Hart Robert , Bess R. Shay , Line Breton , Diebo Bassel , Protopsaltis Themistocles , Jain Amit , Ailon Tamir , Burton Douglas , Klineberg Eric , Ames Christopher ,   International Spine Study Group
Published: April 2016

Introduction Proximal Junction Failure (PJF) and Proximal Junction Kyphosis (PJK) are significant complications. It remains unclear what are the specific drivers behind the development of either. This study attempts to develop a preoperative predictive model to identify patients at risk to develop PJF or PJK. Material and Methods Inclusion criteria: age ≥18, adult spinal deformity (ASD), ≥4 levels fused. Variables included in the model were: demographics, primary/revision, use of 3-column osteotomy, UIV/LIV levels and anchor (screw, hooks), number of levels fused, and baseline sagittal radiographs (PT, PI, PI-LL, TK, and SVA). PJF was defined as requiring revision for PJK and PJK was defined as an increase from baseline of PJK > 20° and with deterioration by at least 1 SRS-Schwab sagittal modifier grade from 6wks postop. An ensemble of decision trees were constructed using the C5.0 algorithm with 5 different bootstrapped models, and internally validated via a 70:30 data split for training and testing. Accuracy and the area under a receiver operator characteristic curve (AUC) were calculated. Final model utilized 13 preoperative variables. Results 510 patients were included, with 357 for model training and 153 as testing targets (PJF: 37, PJK: 102). The overall model accuracy was 86.3% with an AUC of 0.89 indicating a good model fit. The 6 strongest (importance ≥0.95) predictors were (% target): age (>64yrs, 41.4%), PI-LL (>48.7deg, 35.6%), UIV (T10-L3, 35.1%), SVA (>13.5cm, 32.5%), LIV (sacroiliac, 31.6%), and UIV Type (screws, 29.8%). If a patient met these criteria, they had a 66.7% chance of developing PJF or PJK with deterioration of sagittal alignment. Conclusion A successful model (86% accuracy, 0.89 AUC) was built predicting either PJF or clinically significant PJK. This model can set the groundwork for preoperative point of care decision making, risk stratification, and need for prophylactic strategies for patients undergoing ASD surgery.
Long-term Results of Implant Related Complications after Lumbar Fusion Using a Non-rigid Transpedicular Pedicle Screw-Rod System
Authors: Bank Andras , Varga Péter Pál 
Published: April 2016

Introduction Transpedicular fixation is associated with the risk of hardware failure, such as screw/rod breakage and/or loosening at the screw-rod interface and difficulties in the system assembly, which remains a significant clinical problem. Removal or revision of the spinal implants is often required. This is a retrospective radiological study of the single- and two-level lumbar stabilization procedures (TLIF, PLIF or PLF) performed from January 2002 to December 2012 using a non-rigid transpedicular implant system. The purpose of this study was to retrospectively analyze the radiological outcome of 1280 patients focusing on implant related complications. Material and Methods 1280 patients were included into the study. The female/male ratio was 56%/44%, the mean age was 59 years (18–88), the mean FU time was 32 months. Indications for surgery were DDD, FBS and spondylolisthesis (DDD: 77%, FBS: 18%, spondylolisthesis: 5%). There were 727 single-level stabilizations and 553 two-level stabilizations in this cohort. The radiological status of the implants was assessed on lateral and AP X-rays and available CT scans by independent radiologists. We investigated the occurence of screw breakage, screw loosening and element rod breakage, rod slipping and movement. Results In the single-level group 8 screw breakage (1.1%), 27 screw loosening (3.7%), 9 element rod breakage (1.2%) and 47 element rod slippage or movement (6.5%) were detected. In the two-level group 9 screw breakage (1.6%), 30 screw loosening (5.4%), 14 element rod breakage (2.5%) and 37 element rod slippage or movement (6.7%) were present. Conclusion Comparing the result of this retrospective radiological study with the available literature data, we can state that the rate of implant related failures in case of the nonrigid transpedicular system is lower than in the previously published studies. Low implant complicationn rate can be associated with the effect of the non-rigid stabilization on bony remodelling at the surroundings of the transpedicular screws. The influence of non-union rate and sagittal alignment on the outcome needs further evaluations.
Mortality and Causes of Death in Patients Requiring VEPTR Surgery
Authors: Smith John , Heflin John , Vitale Michael , Samdani Amer , Morgan Jessica ,   Children's Spine Study Group
Published: April 2016

Introduction The VEPTR device is used to treat a heterogeneous population of children with EOS and TIS. Complications associated with this treatment are known to be high, but there is limited documentation regarding risk of mortality in this population while undergoing treatment. The objective of this study is to report the 14 year mortality and cause of death from 4 major centers treating patients with TIS. This is a retrospective review of patients treated at 4 institutions for EOS and TIS. All patients were treated or had planned treatment with VEPTR instrumentation. Methods 295 consecutive patients with EOS treated with VEPTR between 2000 and 2014 were reviewed. All patients were entered into a prospectively collected database. For the patients who died during or awaiting treatment, medical records were reviewed to determine the age and cause of death. Results 292 patients treated with VEPTR and 3 patients awaiting surgery were included. 17 patients died during the study period, for an overall mortality rate of 5.76%. The etiology was varied in the patients who died (congenital/structural-1; neuromuscular-8; syndromic-5; idiopathic-3). There were 1261 total VEPTR-related procedures completed. Causes of death included: respiratory failure-8; shunt complications-2; cardiac failure-4; and GI complications-3. Two children died of pulmonary and nutritional complications while awaiting surgery. One patient died of a cardiac arrhythmia in the operating room. Conclusion EOS occurs in a complex heterogeneous group of children and is associated with multiple co-morbidities. The 2010 combined mortality rate for children 1–19 years of age was 54.1/100,000 while the rate for this group was 823.2/100,000 suggesting the long term natural history of this condition is associated with significantly increased mortality. While the aggressive surgical management of EOS compared with the natural history is not debated, there is clearly a need for a better understanding of the mortality risk over time for this patient population.
Predictors of Neurological Motor Decline in Complex Adult Spinal Deformity Surgery: Results of the Prospective, International, Multicenter Scoli-RISK-1 Study
Authors: Fehlings Michael , Lenke Lawrence , Nakashima Hiroaki , Nagoshi Narihito , Shaffrey Christopher , Kopjar Branko , Cheung Kenneth M. C. , Carreon Leah Y. , Dekutoski Mark , Schwab Frank , Boachie-Adjei Oheneba , Kebaish Khaled , Ames Christopher , Qiu Yong , Matsuyama Yukihiro , Dahl Benny , Mehdian Hossein , Pellise Ferran , Lewis Stephen , Berven Sigurd 
Published: April 2016

Introduction Significant variability in neurologic outcomes following surgical correction for ASD has been reported. Risk factors for decline in neurologic motor outcomes are poorly understood. The objective of this prospective, multicenter, international cohort study in 15 sites is to evaluate the incidence and risk factors for postoperative neurological motor decline in patients undergoing surgery for complex adult spinal deformity (ASD). Material and Methods From September 2011 to October 2012, 273 consecutive patients were prospectively enrolled. One patient lacked baseline ASIA lower extremity motor score (LEMS), and one patient did not have follow-up LEMS leaving 271 (99.27%) subjects for analysis. Decline in neurologic motor outcomes was defined as deterioration in any of discharge or 6 weeks American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) compared with pre-operative status. To identify risk factors associated with decline in LEMS, two step statistical analysis was performed. First, 128 candidate variables consisting of demographics, comorbidities, treatment history, disease severity, radiologic parameters and surgical details were screened in bi-variate models. Then, 53 variables that had a p-value of 0.2 or less were included in a multivariate logistic stepwise model. Results 70 (25.93%) patients showed decline and 200 (74.07%) had no decline in LEMS. Of those with a decline, nine patients (overall rate of 3.33%) had a severe deterioration of > 10 points on LEMS scale. Key factors associated with postoperative neurological deterioration included older age, non East Asian ethnicity, cardiovascular disease, preoperative motor weakness, kyphosis on T12 – S1, focal severe deformity angle, pedicle subtraction osteotomy, thoracic level fusion and intraoperative motor evoked potential change. Conclusion Although complex ASD surgery can enhance the quality of life of adult patients with severe deformity, a significant portion of patients with ASD experience a postoperative decline in LEMS. The risk factors identified in this study are useful to help clinicians to anticipate and potentially develop strategies to reduce the risk of postoperative neurologic complications.
Recovery Pattern in Surgical Management of Late Onset Myelopathy Due to Spinal Deformity
Authors: Gujral Amandeep , Bapat Mihir , Naskar Susmit 
Published: April 2016

Introduction Late onset paraplegia due to spinal deformity heralds a progressive death of neurological function. Evidence suggests that decompression and deformity correction offers a promising result. Aims To analyze recovery patterns after surgery for late onset myelopathy. Methods 25 consecutive patients were reviewed. Average age was 17.84yrs and duration of pre-operative deficit was 4.6months. 18 patients had paraparesis and 7 quadriparesis. The average JOA score was 4.85/17 in quadriparetic and 5.33/11 in paraparetic patients. The average Nurick's grade was 2.7. The average spasticity was 2.2 (1- 4) as per Ashworth scale. 13 patients had bladder dysfunction. Deformity apex was cervical, cervico-dorsal, upper-dorsal and dorsal in 5, 4, 2 and 14 patients. 19 had kyphosis and 6 had multi-planar deformity. Vertebral resection osteotomy was performed in 13 and decompression alone in 12. Methodology: The records were obtained from software Horizon CSR used to register all patients form 2000–2009. The final follow-up was obtained by direct patient interview in 11, telephonic interview 5 and via email in 9. Results At 1year, significant improvement in JOA scores were seen recovery patters. Of the2 patients, 2 patients, 14 had immediate recovery (4 Weeks), delayed recovery (4 -12 Weeks) was seen in 9 patients and 2 patients developed deterioration after surgery. Out of the 13 patients with bladder dysfunction, 2 developed worsening post surgery. Average Nurick's grade improved from 2.7 to 2.3. Complications: Pulmonary complications developed in 5 patients, 4 patients had wound dehiscence, 2 patients showed Myelopathy progression, 1 patient developed Brachial plexus paresis and progression of deformity was observed in 6 patients. Conclusions (1) Severity and duration of pre operative deficit correlate with neurological outcome (correlation coefficient(r value) = 0.72). (2) Safe correction of deformity provides a better mechanical and physiological environment for lasting results.
Unilateral Approach for Bilateral Microsurgical Decompression of Lumbar Spinal Stenosis: Synopsis of 15 Years of Experience with this Surgical Method
Authors: Spetzger Uwe 
Published: April 2016

Introduction The surgical aim in the treatment of symptomatic lumbar spinal stenosis is the relief of the patient's complaints by an adequate neural decompression. In a preliminary cadaver study the unilateral laminotomy for bilateral access to the lumbar spinal canal was investigated, and the experiences were evaluated in a clinical study. Material and Methods Microsurgical decompression was performed by partial resection of the ipsilateral facet, the medial portion of the laminar arch, the contralateral facet and by complete removal of the ligamentum flavum bilaterally. Anatomical, radiological and morphometrical studies on 4 adult cadaver spine specimens have proved the feasibility of this unilateral approach. Complete bilateral flavectomy and partial bilateral facetectomy were the essential surgical steps for an adequate operative decompression. The clinical practicability in the treatment of lumbar spinal stenosis was initially confirmed in 254 patients. Results The postoperative morphometric evaluation in the cadaver study clearly demonstrates that bilateral ligamentectomy and recess decompression were adequately and successfully achieved via unilateral approach. The clinical evaluation of this technique was performed in 254 patients with symptomatic mono- or multisegmental lumbar stenosis. Postoperatively, 229 of the 254 patients with neurogenic claudication (90.2%) demonstrated a marked improvement of the walking distance. The follow-up of 249 patients (mean follow-up time was 37 months) demonstrated an excellent result without pain in 77 patients (30.9%); a good outcome with mild residual pain, but a normal working capacity in 130 patients (52.2%); and a fair outcome with unchanged postoperative low-back pain but markedly improved working capacity and walking distance in 41 patients (16.4%). There was only one patient with surgically induced, permanent neurological deterioration (0.5%). In nine patients, an inadvertent dural tear occurred, and due to unchanged symptoms three patients with a multisegmental stenosis had to be re-operated on at an additional level. During the past 15 years the author has experience with this method in over 1600 microsurgical decompression procedures. Conclusion Unilateral laminotomy and bilateral spinal canal decompression represents a safe, effective and minimally invasive surgical method and meanwhile is a routine microsurgical strategy for the treatment of patients with lumbar spinal stenosis.
Extreme Lateral Interbody Fusion Using Bone Marrow Aspirate Combined with a Porous Hydroxyapatite/Collagen Composite
Authors: Yoshida Makoto , Fujio Keiji 
Published: April 2016

Introduction Extreme lateral interbody fusion (XLIF) has been popular as a safe and reproducible method to obtain minimally invasive anterior spinal fusion. Autogenous bone, commonly from the iliac crest, constitutes ideal grafting. However, the amount of iliac crest bone available is limited and its harvesting is associated with significant donor site morbidity. Recently a porous hydroxyapatite/collagen (HAp /Col) composite has been developed as a substitute for conventional corticocancellous autografts. The aim of this study is to investigate the efficacy of a porous HAp /Col composite for XLIF. Material and Methods From November 2011, 15 consecutive patients (21 levels) underwent XLIF for lumbar degenerative diseases. In all cases, titanium cages filled with hybrid grafts using bone marrow aspirate (BMA) combined with a porous HAp/Co composite were inserted as intervertebral spacers and supplementary stabilization with posterior instrumentation were performed. In 4 cases (4 levels) pedicle screws (PS) were inserted unilaterally, and in 11 cases (17 levels) PS were inserted bilaterally. Fusion status was assessed using computed tomographic (CT) scans. A solid fusion was defined by the presence of bony bridging on 2 consecutive sections in at least 2 plains on CT imaging. Results At a follow up of 15.4months (minimum: 6 months), 66.7% of all patients (10 of 15) and 76.2% of all levels (16 of 21) were evaluated as solid fusion. In cases with bilateral PS, fusion rates were 81.8% of patients (9 of 11) and 88.2% of levels (15 of 17) respectively. Only one case with unilateral PS was evaluated nonunion due to PS loosening. No revision surgery for nonunion were requested. Conclusion Hybrid grafts using BMA combined with a porous HAp /Col composite were efficacious for XLIF as substitutes for conventional autografts. Rigid supplementary stabilization was considered necessary to obtain high fusion rates.
Multicolumn Spinal Cord Stimulation Surgical Lead Implantation Using an Optic Transligamentar Minimally Invasive Technique
Authors: Cam Philippe , Monlezun Olivier , Lorgeoux Bertille , Roulaud Manuel , Rigoard Philippe 
Published: April 2016

Introduction A new generation of neurostimulation surgical leads is used to increase the success of spinal cord stimulation (SCS) in difficult-to-treat indications such as Failed Back Surgery Syndrome (FBSS). This makes the implant procedure more invasive, which is likely to be a determinant factor in clinical and functional outcomes. Minimal access spinal technologies (MAST) have been previously used for surgical lead implantation. However, only a unilateral approach was described, causing some difficulties for median lead placement and not always preventing laminectomy. A recent MAST technique can be used to implant SCS leads without these limitations, which seems to be key in the positive outcomes experienced. The objective is to describe the original MAST technique used in the pilot study. Material and Methods Twenty-four consecutive patients were implanted with a multicolumn surgical lead for refractory chronic back and leg pain using the optic transligamentar MAST technique described extensively. Clinical outcomes, functional ability and adverse events (AEs), were recorded for up to 12 months after surgery. Results The MAST technique allowed median lead placement, facilitated visualization of the spine and permitted transligamentar insertion that minimized scarring and muscle damage, intraoperative blood loss and postoperative functional complications. Back pain decreased significantly at all follow-up, while functional status improved significantly at 1 year. No technique-related AEs were reported. Conclusion Use of MAST approach could be useful in safe implantation of multicolumn surgical leads and confer major advantages in difficult-to-treat refractory lower back pain conditions such as FBSS
Post Traumatic Stress Disorder Symptoms following Elective Spine Surgery. Is Surgery Really the Reason?
Authors: Shiban Ehab , Meyer Bernhard 
Published: April 2016

Introduction Recently, posttraumatic stress disorder symptoms (PTSD) were found in 20% of cases following elective spine surgery. PTSD was therefore attributed to surgery. Furthermore, PTSD symptoms were associated with reduced clinical benefit. However, PTSD is seen in up to 10% of the normal population. Aim of this study is to evaluate the incidence of PTSD before and after elective spine surgery and the influence of PTSD on clinical outcome. Methods A prospective study of patients undergoing elective spine surgery was performed. The patients were evaluated for PTSD using the PTSS score before surgery and 3 months postoperatively. In addition SF36 physical composite score (PCS), Oswestry Disability Index (ODI) and pain visual analog scale (VAS) were completed preoperatively and at 3 months postoperatively. Incidence and influence of PTSD symptoms on clinical outcome were examined. Results 144 patients met all inclusion criteria. 78 patients were male (54.2%); mean age was 59.49 years. PTSD symptoms were reported in 59 patients (41%) before surgery. However, only 32 patients (22.2%) still had abnormal PTSS scores at 3 months follow up. Only 6 patients (4,17%) developed PTSD symptoms following surgery. PTSD was associated with worse clinical outcome before surgery in the ODI score (ODI: 18.45 versus 43.16, p = 0.000). There were also statistically significant differences in mean SF36 PCS score ( p = 0.000) and pain VAS ( p = 0.000) between both groups. At three months follow up patients with PTSD showed worse clinical outcome in the ODI score and VAS pain (ODI: 10.89 vs 28.43, p = 0.000; VAS: 11 vs 4.26, p = 0.000) and also in the SF36 PCS score ( p = 0.000). Conclusions PTSD symptoms are associated with worse outcome following elective spine surgery. However, the vast majority of patients with PTSD symptoms exhibit symptoms before surgery and only a small minority develop PTSD symptoms after surgery.
Episacral Lipomata as a Cause of Lower Back Pain: Series of Cases Managed by Excision
Authors: Singh Avthar , Ramalingam Kuharajan , Kai Lim Kang , Jeremy Satish Vincent 
Published: April 2016

Introduction Episacral Lipomata or the “back mouse” is a tender, fibro-fatty subcutaneous nodule found in the thoracolumbar fascia area in up to 16% of people. The “back mouse” can be a cause of significant low back pain in patients with associated disc disease, nerve root compression and facet hypertrophy. This is due to the particularly dense innervation with substance P positive free nerve endings in the posterior layers of the fascia. Material and Methods We studied the outcome of removal of the ‘back mouse’ in nine patients with twelve lipoma's (three had bilateral lipoma's). The diagnosis was made by clinical examination and all of the excised nodules were confirmed to be episacral lipoma on histo pathological examination subsequently. The outcome was measured with Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scoring. The average VAS reduced from 7.8 pre operatively to 4.8 post operatively. Results Six patients had improvement in ODI from moderate to minimal disability, one patient had improvement from severe to moderate disability and the ODI in three patients were unchanged. Seventy percent of the patients were happy with the outcome as the symptoms had significantly reduced despite having some other underlying spinal pathology. Conclusion In our opinion, episacral lipoma may be an unrecognized entity by both specialists and generalists and can be a treatable cause of low back pain. The excision provided relief to the compressive effect it had on the middle and posteriro layers of the lumbar fascia and the muscles it encloses. Marginal excision of a painful episacral lipoma may provide pain relief and improved lower back function in patients who are carefully selected for this procedure,