bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of an Interspinous Device above the Level of Interbody Fusion: Does it Reduce the Worsening of Adjacent Segment Degeneration?
Authors: Sudarshan Pramod , Panda Aditya Prasad , Paramasivam Aghilavendan , Varma Vamsi Krishna , Hegde Sajan 
Published: April 2016

Introduction Lumbar fusion in degenerative conditions has universally provided good results. However, adjacent segment degeneration, either afresh or worsening of a low grade degeneration in the segment above has been indicated for the pain and low functional outcome on long term follow-ups. Interspinous implants have been used to off load the facets and prevent spinal canal narrowing in stenosis with good results. This paper analyses the novel idea of using an interspinous device above the level of fusion to decelerate the physiologic process and reduce the incidence of adjacent segment degeneration (ASD). Material and Methods 12 patients were analyzed in the study. The inclusion criteria for the study was degeneration of the disc above the level of intended fusion with no or less than 50% disc height reduction and no nerve root compression. Patients with more than 50% height reduction or severe arthritic facet joints underwent fusion at two levels and were excluded from the study. Patients with failed back syndrome and significant osteoporosis were also excluded from the study. Coflex (Paradigm) interspinous device was used in the level above the fusion in all cases. Clinical and radiographic criteria for ASD was assessed at the latest followup. VAS and ODI functional outcome was analyzed. Results 12 patients with mean age of 63 years who underwent surgery between September 2012 and March 2014 were analyzed in the study. Mean followup was 27 months (Range 18–36 months). Single level fusion was performed in 9 cases and Two level fusion in 3 cases. Coflex device was implanted at L3–4 in 8 cases and L4–5 in 4 cases. All 12 patients had a good fusion in the 6 months radiograph. Disc height improvement was seen in the level above, with no evidence of stenosis or listhesis at the latest followup. Worsening of already existant ASD in one patient was noticed but did not require surgical intervention. VAS and ODI showed significant ( p < 0.05) improvement postoperatively. No infection or reoperation was needed in any of the 12 patients. Conclusion ASD remains a significant reason causing failed back syndrome requiring reoperations in lumbar fusion. Use of interspinous device not only preserves a motion segment from fusion, but also shows promise in reducing the incidence of degeneration above the level of fusion. Further studies with larger sample size and long term followup is necessary to support the conclusion.
The Stand-Alone Cervical Cages with Integrated Screw Fixation: Results in 315 Consecutive Operated Levels
Authors: El-Maghraby Hussien , Joshi Shabin 
Published: April 2016

Introduction Background: Cervical disc disease at C2/3, C3/4 and C7/T1 is less common. Fusion with cages & plating is the standard treatment at these levels and in multi-level disc disease. This is not without significant risks related to the need of larger exposure and anterior muscular dissection. Stand-alone cages with integrated screw fixation obviate the need for plating and larger exposure. Material and Methods To assess the exposure / cage related morbidities and fusion rates in Stand-Alone cervical cages with Integrated Screw Fixation. Design: Retrospective chart review. Subjects: 315 levels were operated in 253 patients from February 2009 to February 2015. Single and Multilevel cages were performed in 201 and 52 patients respectively. 201 of the 253 patients underwent single level discectomy with Stand-Alone cervical cages with Integrated Screw Fixation at C3/4 and C7/T1 levels. 52 patients underwent 114 multi-level discectomies with Stand-Alone cervical cages with Integrated Screw Fixation Results Operative time was shorter. There was no reported permanent exposure/ cage related morbidities in all operated levels. 3 patients with traumatic disc disruption required further surgery for lateral mass fixation. 12 patients had mild dysphagia that resolved during follow up with no patient having complains of dysphagia at 3- months follow up. Fusion rates were 95% at single level and 90% at multi-level discectomies at the last follow up. No patient required cage related surgical revision. Conclusion The current results support the use of Stand-Alone cervical cages with Integrated Screw Fixation especially at difficult levels at C3/4 and C7/T1 and in multi-level discectomies as it obviate the need for plating and larger exposure with less reported dysphagia and implant related complications.
Prevalence and Significance of Vitamin D deficiency in Patients with Idiopathic Scoliosis Requiring Corrective Surgery
Authors: Michael Antony Louis Rex , Hampton Matthew James , Evans Owain , Breakwell Lee , Cole Ashley , Naylor Beverley 
Published: April 2016

Introduction Vitamin D deficiency may affect children in terms of growth disturbance, deformity and metabolic disease. The senior authors have felt significant difference in bone quality intra operatively and wondered if vitamin D status was relevant in this. The aim was to assess the prevalence of vitamin D deficiency in a cohort of patients undergoing scoliosis correction surgery for adolescent idiopathic scoliosis (AIS) and to assess if Vitamin D deficiency had any significance/correlation to the pre-operative cobb angle or pain scores. Material and Methods Any patient undergoing corrective surgery for AIS who had pre-operative Vitamin D sample taken. From January to December 2014 a total of 69 records were assessed yielding a cohort of 41 patients undergoing surgery for Adolescent Idiopathic Scoliosis (AIS) with a recorded pre-operative total 25-OH vitamin D level. Three tiers of Vitamin D level were assessed including normal > 50nmol/L, insufficiency < 50 but  > 25nmol/L and deficiency < 25nmol/L as per local guidelines for Vitamin D deficiency in children. Patients' age, sex, pre-operative vitamin D levels, Cobb angles at time of surgery, pre-operative back pain scores were recorded. Results 41 Children with a recorded Vitamin D level pre-operatively were analyzed. There were 4 male and 37 females. The average age at surgery was 15 years,(range 12 – 17). Of the 41 patients 9 (22%) were Vitamin D Deficient (range 10–25), 14 (34%) were insufficient (range 29.3–49.8) and 18 (44%) were above the treatment level (range 54.8 – 139.1). The average pre-operative Cobb angle for the deficient patients was 68 (range 50–89) compared with 64 (range 48 – 85) for the insufficient patients and 62 (range 44–76) for the patients with normal Vitamin D levels. The pain scores for each of the 3 groups revealed that the patients in each group complained of a similar (moderate) amount of back and rest pain pre-operatively. Conclusion Vitamin D deficiency in children leads to reduced calcium absorption from the bowel and may lead to skeletal deformity and rickets. The effect on bone healing of Vitamin D deficiency may have an affect on the quality of spinal fusion required as part of the surgical treatment for AIS and it is not known whether those patients undergoing surgery have adequate levels. This study reveals that 56% of patients had Vitamin D levels requiring supplementation. Further work is being undertaken to evaluate pain values, fusion time and deformity correction in those children with insufficient or deficient levels of vitamin D.post-op complications and hospitalisation
The Effect of Post-Operative Complications in Complex Adult Spinal Deformity Surgery on Surgical Outcomes: an International, Large-scale, Prospective Multi-center Study
Authors: Cheung Kenneth M. C. , Bow Cora , Samartzis Dino , Kwan Kenny , Dekutoski Mark , Schwab Frank , Boachie-adjei Oheneba , Kebaish Khaled , Christopher Ames , Yong Qiu , Matsuyama Yukihiro , Dahl Benny , Hossein Mehdian , Pellise Ferran , Carreon Leah Y. , Shaffrey Christopher , Fehlings Michael , Lenke Lawrence 
Published: April 2016

Introduction This large-scale study aimed to determine the effect of non-neurological complications in complex adult spine deformity surgery upon post-operative functional/disability profiles. Methods This is an international prospective multi-center study involving 15 sites from North America, Europe, and Asia. Adult patients with severe spinal deformity were assessed at 6 weeks and 6 months post-operatively. Non-neurological complications were recorded and grouped into intraoperative events, minor and major complications. Post-operative functional/disability outcomes were evaluated by Oswestry Disability Index (ODI) and SRS-22 pre-operatively and at each follow-up ( Fig. 1 ). Results 269 subjects were included (68% women and 32% men; mean age: 57.8 years). There were no significant differences in pre-operative ODI and SRS-22 scores between patients with and without major complication. At 6 weeks and 6 months after surgery, patients with major complications had significantly worse ODI and SRS-22 scores compared with patients without major complications ( p < 0.005). Both groups with and without major complications showed statistically significant functional improvement 6 months after surgery ( p < 0.0001). Improvement in functional scores were similar in patients with and without intra-operative events and/or minor complications (p > 0.05). Conclusion Based on the largest, multi-center study addressing complex adult spine deformity patients, worse post-operative functional/disability profiles were noted up until 6 months follow-up in patients who experienced major complications than those that did not. Similar functional/disability profiles were noted in patients who experienced intra-operative or minor complications. This study further broadens the understanding of postoperative surgical outcomes, risk profiles, and clinical/patient expectations following such deformity surgeries. [Figure: see text]
The Convex Manipulation: An Alternative Technique in Surgical Treatment of Adolescent Idiopathic Scoliosis
Authors: Oggiano Leonardo , La Rosa Guido 
Published: April 2016

Introduction Concave derotation is the traditional correction maneuver in adolescent idiopathic scoliosis surgery. However, the positioning of thoracic pedicle screws at concave side of the curve can be quite challenging, because of the small pedicle size and the wide variation in its morphological characteristics, due to the vertebral dystrophy observed in scoliotic patients. Then, to reduce risks of neural damages, and ensure the same strenght of derotation maneuver, a convex manipulation through an all-level pedicle screws convex instrumentation can be performed. We report perioperative and 2-year results in a consecutive series of patients treated by convex manipulation through an all-level pedicle screws convex instrumentation. Material and Methods From January 2013 to January 2015 we surgical treated 36 consecutive patients (28 F, 8 M, mean age 13 years) affected by thoracic adolescent idiopathic scoliosis (Lenke type 1, 27 patients, and Lenke type 2, 9 patients). Mean pre-operative Cobb angle was 56°±6° in Lenke type 1 group and 51°±4° plus 32°±3° in Lenke type 2 group. We performed a posterior access only in all patients using polyaxial pedicle screws at each level on the convex side of the curve. Derotation and manipulation maneuvers were performed on the convex prebent rod. In all cases motor-evoked potentials monitoring was used. Mean follow-up time was 27 months. Results The average percentage of coronal correction was 76 ± 5% (mean post-operative Cobb angle 15°±4°), with no neurological complications. Concerning the post-operative kyphosis, we observed a slight decrease of mean values compared with pre-operative measurements (mean reduction of thoracic kyphosis 5°±2°). At 2-year follow-up no changes in coronal nor in sagittal plane were observed. The mean operative time was 210 ± 30 minutes, with a mean blood loss of 500 ± 100 ml. Using the free-hand technique, the mean time of pedicle screws positioning in the thoracic area on the convex side was 2 ± 1 minutes from T6 to T12, and 4 ± 1 minutes from T3 to T5. Whenever included in the area of arthrodesis, T2 was usually instrumented with the Universal Clamps, to reduce the stiffness of the construct. Instead, T1 has never been included in the arthrodesis area. Conclusion This case-series study shows the effectiveness and the safety of convex manipulation in Lenke type 1 and type 2 scoliosis. The coronal correction obtained with this technique is comparable to that obtained with the traditional concave derotation. Other advantages are the short operative time, the low intra-operative blood loss and, mostly, a lower risk of neurological complications.
Can EOS 3D Morphological Analysis Better Correlate with Pain Patterns than the Lenke Classification
Authors: Simoes Leonardo , Ouellet Jean , Jiang Fan , Aldebeyan Sultan , Aoude Ahmed , Sun Jenny , Ferland Catherine , Saran Neil , Bote Sheila 
Published: April 2016

Introduction Adolescent Idiopathic Scoliosis (AIS) has been thought to be a relatively painless three dimensional (3D) deformity of the spine, but some studies has shown that the incidence of mild to moderate pain in AIS ranges from 25 to 50%. With the arrival of the new low dose radiation EOS technology, it is now possible to quantify intersegmental changes of the scoliotic spine in an upright position that could be related to pain. Hypothesis EOS 3D morphological analysis of AIS patients will better correlate with presence of pain than the Lenke classification. Methods Fifty-nine patients (7 male/52 female, mean age of 14.3 years old) who were scheduled for elective posterior spinal fusion with diagnosis of AIS. Preoperative clinical pain data recorded consisted of: 1) numerical visual analogue (VAS) pain scores quantifying patients average and worst pain over the preceding month; 2) SRS22 scores. Preoperative PA and lateral imaging were utilized to reconstruct and generate 3D models using the EOS software. Global and segmental intervertebral orientation in all three planes including the Da Vinci diagram identifying maximal deformity orientation were generated and correlated with patients' clinical presentation. In addition, standard curve magnitude, curve classification (Lenke) and pelvic parameters were also analyzed to observe their association to pain. Statistical analysis was performed with GraphPad Prism 6. Results Lenke classification and its subtypes did not correlate with pain, nor did any of the classic curve parameters, with the exception of the presence of hyper lumbar lordosis (>60 degrees) (r = 0.32, p = 0.06). Hyperlordotic patients reported greater pain intensity than normal lordotic patients (U = 81.50, p = 0.04). Additional new 3D parameters from both global and intersegmental vertebral orientations in space were investigated. With the exception of high intervertebral frontal, lateral tilt of L4 over L5, no 3D correlations with pain patterns were observed. Conclusion Despite the additional 3D morphological analysis generated by the EOS imaging, we were not able to identify anatomical characteristics associated to the pain experience reported by patients, with the exception of hyperlumbar lordosis.
Single Stage Hemivertebra Excision and Correction of Congenital Scoliosis
Authors: Elbanna Yasser 
Published: April 2016

Introduction Congenital scoliosis isa progressive three-dimensional deformity caused by congenital anomalies of vertebrae that result in an imbalance of the longitudinal growth of the spine. Failure of the vertebral formation if complete will produce hemivertebra with unilateral pedicle Material and Methods The study included 30 patients with thoracic (16)and lumbar (14) hemivertebra. Posterior only hemivertebra resection with correction by short segment fixation was done for all cases. Intr-operative monitoring was used in (11) cases. Results Full correction was achieved in all cases. Temporary neurological deficit occurred in only two cases. Conclusion Because of the development in anesthesia and post-operative care, today posterior hemivertebra resection has become the standard treatment method for the single hemivertebra of the thoracolumbar and lumbar region.
Should the Spinous Process be Harvested as Bone Graft in Idiopathic Scoliosis Surgery?
Authors: Lai Po-Liang , Yeh Yu-Cheng , Niu Chi-Chien , Chen Lih-Huei , Chen Wen-Jer 
Published: April 2016

Introduction The spinous process is commonly resected during posterior fusion of adolescent idiopathic scoliosis (AIS) to allow for a wider fusion bed and more local autologous bone graft. However, the spinous process is an important structure in the posterior ligament complex and anchors paraspinal muscles. With the development of pedicle screw instrumentation and the potential fusion ability in adolescents, the need for resecting the spinous process in this procedure should be further investigated. The purpose of this study is to compare the fusion rate, duration of surgery, blood loss, surgical outcomes and complications between harvesting and preserving the spinous process in posterior spinal fusion of AIS. Material and Methods From January 2003 to December 2008, 104 consecutive AIS patients who underwent primary posterior fusion with local autologous bone grafts and who were followed for a minimum of 24 months were reviewed. The patients were divided into a harvesting group ( n = 61) who had the spinous process harvested, and a preserving group ( n = 43) who had the spinous process preserved. Radiographic assessments of structural curves were reviewed pre-operatively, 3 days, and 3 and 6 months post-operatively, and then annually. Blood loss, duration of surgery, pseudoarthrosis, post-operative back pain and other complications were also recorded at these time points and compared between the two groups. Results There were no significant differences in the duration of surgery between the harvesting and preserving groups (216 ± 47 versus 224 ± 50 minutes, p = 0.40), however blood loss was significantly higher in the harvesting group was statistically higher (983 ± 446 ml) than in the preserving group (824 ± 361 ml; p = 0.048). The pre- and post-operative Cobb angles, correction rates, and loss of correction of the structure curves were similar in both groups. Based on radiographic evaluation, the incidence of pseudoarthrosis was similar in both groups (3/58 versus 2/41; p = 0.95). Post-operative back pain or soreness was significantly higher in the harvesting group (16/58 versus 4/43; p = 0.03). Conclusion The surgical outcomes and fusion rates between harvesting and preserving the spinous process were comparable, despite significantly lower blood loss and less back pain or soreness in the preserving group. Thus, resecting the spinous process as local autologous bone graft may not be necessary in posterior fusion for AIS patients.
Apical Vertebral Rotation Assessment in AIS: What is the Best Method Scoliometer, X-ray or MRI?
Authors: Cho Woojin 
Published: April 2016

Introduction There are many factors correlated to the vertebral rotation in AIS patients such as the distance between the apex of rib and vertebra (rib-vertebral distance: RVD) on lateral X-rays, MRI or the Scoliometer measurement. However, no study has shown the relationship between those factors and the apical vertebral rotation. Methods Out of 380 consecutive AIS patients who underwent corrective surgery, 22 patients who had preoperative MRI and complete radiographic images stored in PACS were identified. Various angles and distances including Main Thoracic curve (MT), T5–12 sagittal profile, Apical Vertebral Translation (AVT), Apical Vertebral Rotation (AVR), RVD, trunk depth, and axial rotation of apical vertebra on MRI (AVRMR) were measured. Scoliometer angles (SA) for these patients were found in the charts as well. Rib Trunk ratio (RTR) was calculated by RVD/trunk depth. Each paired value was compared with find any significant correlation. Results The radiographic measurement and correlation values are shown in the table. There was no significant correlation between thoracic and lumbar parameters while the larger curves had the greater rotation. RTR was correlated with MT, T5–12 and T-AVT, but not T-AVR. MRI and Scoliometer could not predict the T-AVR as well. Conclusion This study shows that we can predict the amount of coronal and saggital deformities from lateral X-rays, but not the axial rotational deformities. Supine MRIs cannot predict AVR and standing MRIs may be helpful. Scoliometer angles predict L-AVR, but not T-AVR probably due to the combination of rib cage deformity and vertebral rotation. During the corrective surgeries in AIS, deformity surgeons may still need to consider the deformity of rib cage itself, even with the direct derotation of vertebral column.
Augmented Reality Mobile Applications to Interactively Show Complex Spine Pathologies: First Version
Authors: Galvez Marcelo , Rojas Gonzalo , Fuentes Jorge , Asahi Takeshi , Montoya Carlos , Vidal Aarón , Currie Willam , Chahin Andrés 
Published: April 2016

Introduction Visualization of complex human body structures such as the spine and his malformations such as, foraminal stenosis, spine stenosis, and herniated disk is a challenge. Augmented Reality is the combination of a real scene supplemented, or augmented, by computer generated information, such as image, video or graphical animations. Android and iOS based mobile devices such as smartphones and tablets are being increasingly massive adoption and with higher performance characteristics. Material and Methods Sagittal 2D T2w TSE sequence MRI (TR 4420 milliseconds, TE 130 milliseconds, FoV 320x320, Matrix 448x448, Voxel Size 0.7x0.7x3 mm) and sagittal CT (kVp 140, 1 mm slice thickness, 0,30x0,30 mm pixel spacing, B31s kernel) images were scanned in a 57 years old male patient. Both images were co-registered using “Linear registration” algorithm of 3D Slicer v 3.6 software. CT image was segmented using threshold option (113–1303 Hounsfield units) of 3D Slicer and then L4-L5 vertebral bodies was extracted manually using ImageJ v1.49n version. The L4-L5 intervertebral disk was segmented using “simple region growing” algorithm of 3D Slicer, and then was cleaned manually using ImageJ software. Mesh of L4-L5 and intervertebral disk was generated using 3D Slicer “Model Maker” algorithm with default options, and HC Laplacian smoothing (MeshLab software). The iOS-Android application were created using C# language and software tools: Unity 4.5x (graphic engine; www.unity3d.com ), 3Ds Max ( www.autodesk.com ), Visual Studio 2013 ( www.microsoft.com ), and Qualcomm Vuforia for Unity Android & iOS (Augmented Reality, developer.vuforia.com). Results By focusing the printed target image using iOS-Android app,L4-L5 vertebral bodies and the intervertebral disk of the patient was shown in 3D. The user can rotate the spine with the two-finger twist gesture, by rotating the view angle over the target image, or rotating the target image itself. The size of the spine can be changed by modifying the distance between the mobile device and the target image, or by the pinch gesture. Augmented reality demonstrated new views from inside spine (using total immersion feature of augmented reality) and relationship of normal structures and different pathologies. Conclusion The application described here demonstrates the use of augmented reality technique with medical images of patients with spine pathologies. The application shows how to use ubiquitous mobile devices to display advanced medical information in a 3D interactive application. The application is useful to show, explain and describe in a 3D, interactive and immersive way the spine pathology that the patient has. More work must be done to create an automatic CT-MRI registration, segmentation, creation of mesh, smoothing and decimation of vertebral bodies and an intervertebral disk.