bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional and Vitamin D Status in a Brazilian Sample of Patients Undergoing Spinal Surgery
Authors: Neto Diego Benone Santos , Pratali Raphael , Martins Samuel Machado , Barsotti Carlos Eduardo Gonçales , Oliveira Carlos Eduardo 
Published: April 2016

Introduction Several systemic parameters can affect the rate of complications in spinal surgeries and then have influence in the clinical outcomes. Among these parameters the nutritional status, which may be detected by the serum albumin concentration, is primordial. The vitamin D is a fat-soluble steroid hormone with important function at the bone metabolism and homeostasis, also diminishing surgical complications as bone mineral density compromises fixation. The aim of the study was to evaluate the epidemiologic profile of a Brazilian population sample specifically undergoing spinal surgery about malnourishment, identified by hypoalbuminemia, and vitamin D. Material and Methods This is a prospective observational study including patients undergoing spinal surgery in an only spine center. There were no exclusion criteria. The patients had a preoperative serum albumin and vitamin D concentration analysis on the day before their surgical procedure. Demographic variables were extracted. The results of the preoperative analysis were correlated with the demographic variables using the ANOVA and T-student's test, with the threshold of significance was set at P < 0.05. Results A total of 75 patients were included, 47 women (62.7%) and 28 men (37.3%). 74 had albumin concentration analysis and 64 vitamin D. The mean of the serum albumin result was 3,76 g/dL (DP: 0,53 g/dL), with 70.3% of the patients considered normal and 29.7% presenting hypoalbuminemia. About vitamin D, the mean of the value was 16,64 ng/mL (DP: 7,43 ng/mL), with 64.1% of patients considered deficient, 32.8% inadequacy and only 3.1% considered normal. There was a significant difference in the albumin concentration related with age ( p = 0.007), with older age group presenting poorer albumin levels. The hypoabluminemia occurrence was significantly higher in patients with 60 years or older ( p < 0.001). There wasn't correlation between vitamin D and age ( p = 0.603). The correlation analysis between the exam results and the gender didn't show any significant difference in none parameter. Conclusion Our study presented data about the serum albumin and vitamin D status in a Brazilian population sample of patients undergoing spinal surgery, information still unpublished. There was correlation between hypoalbuminemia, representing malnourishment, with patient in higher age groups. Almost all the patients presented some degree of hypovitaminosis D, without correlation with age.
Complications with and without the Use of Computer-Assistance in Lumbar Fusion Surgery: Analysis of 15,222 Patients in ACS-NSQIP Database
Authors: Aoude Ahmed , Nooh Anas , Fortin Maryse , Aldebeyan Sultan , Jarzem Peter , Ouellet Jean , Weber Michael H. 
Published: April 2016

Introduction The objective of this paper is to demonstrate the difference in post-operative complication rates between Computer-assisted surgery (CAS) and conventional techniques in spine surgery. Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CAS. Yet, few studies have compared the incidence of post-operative complications between CAS and conventional techniques. Material and Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent posterior lumbar fusion from 2011 to 2013. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between CAS and conventional techniques in spine surgery. Results Out of 15,222 patients, 14,382 (95.1%) were operated with conventional techniques and 740 (4.90%) were operated with CAS. Multivariate analysis showed that patients in the CAS group had less odds to experience adverse events post-operatively (OR 0.57, p < 0.001). Minor adverse events occurred in 2905 (20.2%) patients in the conventional group and 98 (13.2%) patients in CAS group (OR=0.57, p < 0.001). Blood transfusion was present in 2488 (17.3%) of the patients in the conventional group compared with 98 of the patients in CAS group (10.95%)(OR=0.56, p < 0.001). The mean operative time in the conventional group was 205.2 ± 106.1 minutes, and 227.0 ± 111.9 minutes in the CAS group. This difference was statistically significant (r=20.14, p < 0.001). Conclusion This paper examined the complications in lumbar spinal surgery with or without the use of CAS. These results suggest that CAS may provide a safer technique for implant placement in lumbar fusion surgeries.
Intramedullary Lesion Length has a Negative Effect on Neurological Recovery in Cervical Spinal Cord Injury Patients with AIS Grades A-C
Authors: Aarabi Bizhan , Sansur Charles , Ibrahimi David , Hersh David , Le Elizabeth , Akhtar-Danesh Noori , Diaz Cara , Massetti Jennifer 
Published: April 2016

Introduction Experimental spinal cord injury and clinical studies indicate a relationship between MRI lesion length and outcome. In patients with AIS grades A-B, IMLL expands at a rate of 900 µm/hour, culminating in an intramedullary lesion (IML) which measures ~50 mm at 3 days post-injury. We performed a retrospective analysis to measure the effect of IML length on long-term neurological recovery and to determine the significance of intramedullary lesion length (IMLL) in long-term AIS grade conversion in traumatic cervical spine injury (TCSI). Methods Ninety-five adult patients who underwent decompressive surgery for cervical TSCI were included. Post-decompression IML length was measured and long-term AIS grades were recorded. A regression analysis was performed. Results AIS grade was A in 51, B in 26, and C in 18 patients. Mean IML length on postoperative MRI imaging was 72.6 mm. AIS grade conversion was noted in 46 (48.4%) patients. Conversion was noted in 27.5% of AIS grade A, 65.4% of AIS grade B and 83.3% of AIS grade C patients. Timing of decompression (18.2 hours) had no effect on AIS grade conversion, but conversion was significant in older patients, those with higher ASIA motor score, lower injury severity score, shorter IML length and better evidence of decompression on postoperative MRI. Regression analysis indicated a significant relationship between AIS grade conversion and IML length on postoperative MRI (OR 0.953, 95% CI  = 0.9313–0.9761, p = 0.001). Conclusions In AIS grades A-C cervical TSCI, post-decompression rostrocaudal IML length was significant predictor of AIS grade conversion and neurological recovery. The timing of decompression did not correlate with recovery of function.
The Sympathetic Nervous System Mediates Functional and Robust Respiratory Recovery following Acute Cervical Spinal Cord Injury
Authors: Awad Basem 
Published: April 2016

Introduction The organization of the respiratory network has traditionally been described through descending medullary tracks. The diaphragm is innervated by the phrenic nucleus (C4-C6). However, the intercostal muscles are innervated by the intercostal motor nucleus (T1-T11) located at the thoracic spinal cord segments. Therefore, cervical spinal cord injury (SCI) can typically cause respiratory motor system dysfunction. From the literature, ventilation failure within the human lower cervical SCI population typically occurs 4.5 ± 1.2 days after injury, affecting 26.6% of patients. Also, the risk of apnea following low cervical SCI is increased during sleep. However, while intercostal muscles contribute to respiratory recovery post injury the pathways mediating this effect have never been fully elucidated. Methods Following complete C7 spinal cord transection in rats, we demonstrated the presence of intercostal-EMG activity synchronized to the inspiratory bursts of the diaphragm. We explored the anatomical, and latent, pathway that enables synchronized activation of the intercostal muscles after complete cord transection. Experimental work, in the form of bilateral dorsal/ventral rhizotomies, unilateral transection of the phrenic nerve and sympathetic chain ganglia and systemic application of salubutamol, suggested that intercostal activities is mediated through the sympathetic chain ganglion by means of connection to the ipsilateral phrenic nerve. Results In anesitised and unventilated rats, rhythmic inspiratory activity was present in the intercostal muscles following acute C7 transection and bilateral dorsal/ventral rhizotomies. This activity persisted up to five days following the initial trauma. Unilateral transection of the phrenic nerve and sympathetic chain ganglia eliminated ipsilateral intercostal motor activity. Systemic application of salubutamol (β2-agonist), not only increase intercostal activity but also restored it in transected rats which had not retained this activity following transection. Conclusions These data provide the first evidence of sympathetic nerve activity mediating synchronized and robust intercostal inspiratory muscle activity following severe, lower cervical transection. This activity occurs up to 5 days following trauma, an effect which correlates with the induction of ventilation failure and respiratory dysfunction in human patients with SCI. The clinical implications of this finding are provocative. 60% of patients undergo some degree of respiratory distress following acute C5–8 injuries. Using this pathway, it may be possible to modestly stimulate or activate sympathetic activity to further aid intercostal muscle activity and respiratory function following acute SCI. This thus represents a novel target for the treatment of respiratory dysfunction following spinal trauma. [Figure: see text]
A Systematic Review of the Measurement Properties of Patient-Reported Outcome Measures in Spinal Cord Injury
Authors: Abedi Aidin , Seyedpour Simin , Mokkink Lidwine B. , Shokraneh Farhad , Rahimi-Movaghar Vafa 
Published: April 2016

Introduction Over the past decades, a large number of patient-reported outcome measures (PROMs) have been developed for use in spinal cord injury (SCI) research and practice, which evaluate the patient's own perceptions and opinions. However, little is known about the measurement properties of the PROMs used in this population. The objectives of this systematic review were to appraise the methodological quality of the studies on reliability, validity, responsiveness and interpretability of the patient-reported SCI outcome measures and to evaluate and summarize the quality of the measurement instruments. Material and Methods A systematic search of literature in EMBASE, MEDLINE, PsycINFO and CINAHL was performed. Articles were included when they concerned the development of PROMs or the evaluation of their measurement properties in SCI population. Methodological quality of the studies was evaluated using the four-point rating system of the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. The overall quality of the measurement instruments was rated using a pre-defined criteria. The selection process, data extraction and quality assessment were performed by two independent reviewers and disagreements were resolved by consensus. In case of remaining controversy, a third reviewer made the final decisions. Results A total of 9337 articles were screened for eligibility. A wide variety of PROMs measuring different constructs, including quality of life, participation, physical activity, rehabilitation needs, pain, and spasticity were identified. Reliability was the most frequently evaluated measurement property. There was a paucity of literature addressing the responsiveness, measurement error, content and cross-cultural validity of the PROMs. The methodological quality of a majority of the studies was fair to poor and small sample size was a common drawback among the low quality studies. There were many validity studies with indeterminate results due to lack of pre-defined hypotheses. Conclusion There is an urgent need for high quality studies on measurement properties of PROMs in SCI population. Considering the importance of scientifically sound measurements, cautious use of the PROMs is advised until further evidence is available.
Diagnostic Work-Up and Treatment of Traumatic Spondylolisthesis of the Axis: Case Series and Literature Review
Authors: Yurac Ratko , Zamorano Juán José , Valencia Manuel , Marré Bartolomé , Izquierdo Guillermo , Illanes Juan Cristobal 
Published: April 2016

Introduction Traumatic spondylolisthesis of the axis represents a spectrum of injuries affecting the C2-C3 level, secondary to bilateral fracture of the pars of C2 due to extension and/or compression forces. The integrity of the C2-C3 disc and the posterior longitudinal ligament are key elements for segmental stability and should be thoroughly assessed before deciding the treatment modality. The aim of this study is to describe the diagnostic work-up and treatment decision in a case series of patients with traumatic spondylolisthesis of the axis. We also present a review of the available literature about this type of injuries. Material and Methods We reviewed the medical records and images of patients with a traumatic spondylolisthesis of the axis treated in two centers between January 2008 and March 2015. Details regarding demographics, injury mechanism, type of lesion (using the Levine & Edwards classification) and treatment modality (surgical or non-surgical and its justification) were analyzed. We also performed a literature review, focusing on the diagnosis and treatment of these injuries. Results Case series including 7 patients (4 males, mean age at the time of the injury of 37.9 years [23–55]). Six patients (85.7%) were injured in a motor vehicle accident and 28.6% (2/7) presented other spine fractures. All of the patients were neurologically intact. Five cases (71.4%) had a type I injury. Magnetic resonance imaging was obtained as part of the initial assessment in 5 patients (71.4%), none of these patients were considered to have a disrupted posterior longitudinal ligament, while 2 (28.6%) presented hyper intensity at the C2-C3 disc on T2-weigthed images. Surgery was promptly indicated only in one case (type III lesion with a disrupted C2-C3 disc on magnetic resonance imaging, in which an instrumented posterior C2-C3 fusion was performed). The remaining 6 patients (85.7%) were originally treated non-surgically with a hard collar, but 2 of them (both with type I injuries) had surgery one week after the accident (one anterior and one posterior instrumented C2-C3 fusion) due to progressive listhesis and angulation at the C2-C3 level. No treatment-related complications were identified in both surgically and non-surgically treated patients. The available literature emphasizes the importance of the assessment of the C2-C3 disc and the posterior longitudinal ligament via magnetic resonance imaging before deciding the treatment modality in these patients. Conclusion Initial imaging work-up, particularly regarding the C2-C3 disc and posterior longitudinal ligament's integrity on magnetic resonance imaging, together with close radiological follow-up are key elements to consider in the treatment of traumatic spondylolisthesis of the axis.
Single-Level, Multi-Level (Two, Three and Four Levels) and Hybrid Cervical Disc Arthroplasty: Age and Sex-Weighted Linear Regression Analysis, Results from a Single Centre
Authors: Rajesh Mangattil , Khan Shoaib , Friesem Shabtai , Bhatia Chandra , Berg Andrew , Reddy Guru 
Published: April 2016

Introduction The clinical outcomes of single, multi-level and Hybrid cervical disc arthroplasty are reported in the literature. However, there is less detail on the outcome results related to age and sex on these groups. We reviewed 405 patients who had single level, multi-level (two, three & four) and Hybrid cervical disc arthroplasty at our center. Methods The study involved a retrospective review of prospectively collected data on single level, multi-level (two, three & four) and Hybrid cervical disc arthroplasty patients with an average age of 54.64 (range: 34–80). 405 patients were followed up for 2 to 8 years based on clinical outcomes scores. These included NDI (Neck Disability Index), Visual Analogue score for Neck (VAS Neck), and Visual Analogue score for Arm (VAS Arm). Scores were collected pre-operatively and at each follow up at 3 months, 6 months, 1st and yearly afterwards. Linear Regression Analysis was performed to look at the impact of age and Two sample T-Test was used to look at the difference between males and females. Results The study consisted of 215 females and 190 males. The duration of symptoms was on an average 60 months. The indication for surgery was radiculopathy and a combination of radiculopathy and myelopathy. Linear Regression Analysis for NDI and age showed a Pearson correlation r of 0.002; P Value: 0.968; for sex difference - P value of 0.730 showed no statistically significant differences between male and female groups. For VAS Neck, the Pearson correlation was r = 0.008; P Value: 0.873; for sex difference – P value of 0.178 showed no statistically significant differences between male and female groups. For VAS Arm, the Pearson correlation was r = 0.064; P Value: 0.198; for sex difference – P value of 0.953 showed no statistically significant differences between male and females. Conclusion Our results suggest that there is no correlation between age of the patient and their NDI, VAS Neck and VAS Arm scores for all groups of Cervical Disc Arthroplasty. Similarly, there were no statistically significant differences in the outcomes between males and females.
Reduced Rate of Proximal Junctional Fractures above Long-Segment Instrumented Constructs Utilizing a Tapered Dose of Bone Cement for Prophylactic Vertebroplasty, A Biomechanical Investigation
Authors: Zavatsky Joseph , Shah Anoli , McGuire Robert , Serhan Hassan , Kelkar Amey , Kodigudla Manoj , Agarwal Aakash , Briski David , Goel Vijay 
Published: April 2016

Introduction PJK is a well-described post-operative complication associated with long instrumented fusion constructs. The surgical creation of a stiff upper segment along with patient osteoporosis has been suggested as etiologies. Materials and Methods Fifteen fresh-frozen ligamentous T6 - pelvis specimens were divided equally into three Groups: Group 1 - Bilateral pedicle screw and rod instrumentation from T10 to S1, no cement; Group 2 - Instrumentation + 4cc of cement injected into T10 (UIV) and 4cc into T9 (UIV + 1), 2cc of cement injected through each pedicle; & Group 3 - Instrumentation + 4cc of cement in T10 (UIV), 3cc total in T9 (UIV + 1), and 2cc total in T8 (UIV + 2). The pelvis and T6 vertebra were potted. Eccentric axial compression was applied 10mm anterior to the center of T6 using an MTS actuator. Maximum load to failure was measured in newtons (N). The spines were evaluated using fluoroscopy and CT. Results There was a significant reduction in the number of fractures in Group 3 versus Groups 2 and 1 ( p = 0.0019). There was only one fracture in Group 3, which occurred at T8 (UIV + 2); all five specimens suffered a fracture in Group 2; and five in Group 1. Posterior ligamentous rupture occurred in four specimens in Group 3; three in Group 2; and only one in Group 1. The mean peak load-to-failure values showed an increasing trend from Groups 1 to 3 ( p = 0.38). There was no difference in specimen DEXA values ( p = 0.71). There was no hardware failure in any Group. FEA mirrored the cadaveric data and the maximum load to failure increased from Group 1 to 3. Endplate stresses were reduced in Group 3 versus Groups 1 and 2. Conclusions In both cadaveric and FEA models, this novel technique of tapering the dose of prophylactic vertebroplasty cement in the UIV, UIV + 1, UIV + 2 decreased the endplate stresses, increased the load required for failure, and significantly reduced the incidence of VCFs above long-segment instrumented constructs. Clinically, this technique may reduce the risk of PJK, PJF, and revision surgery.
Impact of the Intraoperative Neurophysiologic Monitoring in Idiopathic Scoliosis Surgery
Authors: Rech Paulo Renato , Lanna Raquel , Menezes Cristiano Magalhães , Sakamoto Roberto , Dias Anderson , Vargas Rogerio de Almeida 
Published: April 2016

Objective The aim of this study is to analyze the use of intraoperative neurophysiological monitoring (MNIO) in idiopathic scoliosis correction surgery. Methods Retrospective study of 80 patients undergoing idiopathic scoliosis correction surgery between December 2008 and January 2015 using the MNIO. Among the patients, 85% were female ( n = 68) and 15% males ( n = 12), the average age on the day of surgery was 17 years and the prevalent type of scoliosis curve classification was Lenke 1-A-N (37.5%/ n = 30). We reviewed the significant changes in MNIO, duration of surgery, number of pedicle screws needed to correct deformities, screw time, onset of neurological deficits, Coob angle and effectiveness of MNIO. Results There were significant changes or loss of the MNIO data in 15 patients (18.75%). Complete recovery after intervention was seen in 12 patients (80%). Three patients (20%) had some neurological deficit in the immediate postoperative period. The mean duration of surgery was 320.76 minutes and were used on average 18.84 screws to correct deformities, with an average time of 8.27 minutes for the passage of each pedicle screw. The thoracic curves averaged 52.80 degrees and 47.40 degrees for lumbar curves. Conclusion Long constructions, osteotomies and more severe curves are related to most of the changes found in evoked potentials. The joint use of somatosensory evoked potentials and motor allows a direct evaluation of sensory and motor functions of the spinal cord and dramatically increased the sensitivity and specificity in the detection of neurophysiological changes, helping in decision making during surgery. The interpretation in real time by neurophysiologist possible interruption of operations by temporarily verge of nerve injury with immediate change of the surgical strategy.