bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Radiographical Feature of Osteoporotic Verbal Fracture Nonunion in Extended CT Reconstruction Images
Authors: Jiang Xiaobing , Ye Linqiang , Zhang Shuncong , Liang De , Mo Ling 
Published: May 2015

Introduction This study is to summarize the main radiographical feature of osteoporotic vertebral fracture nonunion (VFNU) in extended CT reconstruction images, and to evaluate reducibility and stability of the vertebrae. Patients and Methods All of the senior patients suffered from thoracolumbar spine fracture (December 2009 to March 2013) were retrospectively reviewed, 36 cases of VFNU with 39 level of vertebrae were included in this study according to inclusion criteria. The main radiographical features of 39 level of VFNU vertebrae were analyzed, including the specific segment, the type of substance in the intravertebral cleft, the starting points and terminals of intervertebral cleft, to explore the different radiographic feature of various type of VFNU. Results According to the over extension CT, new classification criteria are reported in the literature, all of VFNU patients were divided into the following three subgroups: reducible type (type A), unstable but can be reset type (type B), and loss of reducibility type (type C). Overall, 39 level of VFNU vertebrae in 36 patients were located in the region of T9 to L4, in which the thoracolumbar segments were compromised frequently, and 16 level of VFNU existed in L1. According to extended CT reconstruction images, 25 level of type A, 7 level of type B, and 7 level of type C VFNU were identified with the radiographic analysis, the starting points of intervertebral cleft located in the anterior edge of vertebral body (18 levels) or disc plate (21 levels), the terminals of cleft located in the intersecting point of pedicle and posterior–inferior edge of vertebral body (18 level) or superior disc plate (14 levels), the fracture line could be displayed clearly in the all coronal CT reconstruction images, however, terminals of intravertebral cleft in type C VFNU located in the trabecular bone region in the middle one-third part of vertebral body(4 level), and the middle one-third part of superior disc plate, even though there were significant collapse or intracranial retropulsion of posterior one-third part of vertebral body, fracture line could rarely be shown except for one patient, the fracture lines lateral cortex united in three patients, or just be shown in anterior–middle part of vertebral body in three patients according to the coronal CT reconstruction images. Conclusion Thoracolumbar segments are the most common region compromised by VFNU. There is a difference between the terminals of intravertebral cleft of types A, B, and C VFNU, and existence of fracture lines from the anterior edge to the posterior cortex might explain the mechanism of reducibility of types A and B.
Radiation Exposure during Fluoroscopic Assistance for Pedicle Screw Insertion during Instrumented Spine Surgery
Authors: Ballesteros Plaza José Vicente , Yurac Barrientos Ratko Jovan , Viveros Pereira Enrique Andrés 
Published: May 2015

Introduction The purpose of this study is to quantify the radiation exposure of the operating room personnel in fluoroscopy-assisted pedicle screw insertion during instrumented spine surgery, and to determine the protective effect of using a lead apron and increasing the distance between the subject and the X-ray source. Material and Methods We conducted a qualitative and quantitative analysis of personal dosimetry among the different members of the operating room personnel during 35 instrumented spine surgeries, using a pseudo experimental model (input–output) to determine the effect of protective measures (lead apron and distance from the radiation source). Statistical analysis was performed using a Student t test and one-way ANOVA. Results The mean radiation rate per procedure was 43.97 mGy (range, 12.3–137 mGy; SD = 30.9 mGy), with a mean exposure duration of 3 minutes and 6 seconds (1′14″–8′57″; SD = 2′02″). The use of a lead apron decreased the dose equivalent by 72.64% ( p = < 0.00001). A distance of 70 cm from the fluoroscopy beam was associated with a 50.14% ( p = 0.0089) dose equivalent reduction, while at 1 meter a 60.56% ( p = 0.0013) reduction was observed. Finally, a distance of 1.5 m showed a reduction of 50.61% ( p = 0.023). No statistically significant associations between exposure reduction and distance from the radiation source were detected (difference: 0.0005, p = 0.714). Conclusion Our study confirms the effectiveness of the use of a lead apron and highlights the importance of its proper use for reducing radiation exposure during instrumented spine surgery. It also confirms the benefit of increasing the distance from the radiation source for reducing the equivalent dose received by the operating room personnel. However, we did not identify a proportional association between dose reduction and greater distance from the X-ray beam.
How Can We Teach Them about Neurotrauma Prevention? Prospective and Randomized “Pense Bem—Caxias do Sul” Study with Multiple Interventions in Preteens and Adolescent
Authors: Falavigna S. Asdrubal , Medeiros Gregory , Canabarro Carolina , Bossardi Julia Bertholdo , Teles Alisson Roberto , da Silva Pedro Guarise 
Published: May 2015

Introduction A previous study published by the authors showed that a single intervention could not change the base line attitudes toward neurotrauma prevention. The present study was designed to evaluate the effectiveness of multiple interventions in modifying knowledge and attitudes for the prevention of neurotrauma in Brazilian preteens and adolescents. Materials and Methods In a randomized controlled trial, fifth-year primary school (PS) and second-year high school (HS) students were divided into a control and two intervention (single/multiple) groups. The study was conducted in the following eight stages: T1, questionnaire to measure baseline characteristics; T2, lecture on trauma prevention; T3, reapplying the questionnaire used in T1; T4, Traffic Department intervention; T5, a play about trauma and its consequences; T6, Fire Department intervention; T7, Emergency Medical Service intervention; and T8, reapplying the questionnaire used in T1 and T3. Positive answers were considered those stating that safety devices were used “always or sometimes” and negative as “never” using safety devices. Results The sample consisted of 535 students. Regarding attitudes, students in all the groups at any stage of measurement showed protective behavior more than 95% of the time about seat belt use. There were only differences between attitudes in PS and HS students on T8 assessment concerning the use of safety equipment on bikes in the multiple intervention group and concerning the use of safety equipment on skateboards and rollerblades in single- and multiple-intervention groups. These differences were caused mainly by the reduction in positive answers by the HS group, rather than by the increase in positive or protective answers by the PS group. However, there was no difference when the control and intervention groups were compared, independent of the attitudes or the student groups studied. The most important reason for not using protective devices was the belief that they would not get hurt. Conclusion Multiple and different types of educational interventions, such as lectures, scenes from plays about trauma and its consequences, traffic and fire department intervention, and medical emergency intervention directed to preteens and adolescents from public and private schools did not modify most students' attitudes toward injury prevention. Clinical trial registration no was U1111–1121–0192 (National System of Ethics and Research in Brazil).
Motor Outcome and Histological Findings in a Clipping Model of Spinal Cord Injury: Comparison between Posterior and Lateral Clip Placement
Authors: Falavigna Asdrubal , Finger Guilherme , Sebben Cesar , da Silva Pedro Guarise , Conzatti Lucas Piccoli , Peletti-Figueró Manuela 
Published: May 2015

Introduction Different types of spinal cord injury models in rats were described in the literature, including spinal cord clip compression. This type of procedure can be performed by placing the clip in two directions in relation to the spinal cord: lateral or posterior. Studies published in the literature usually do not describe the direction of the clip placement. It is assumed that the severity of neurological symptoms and the histological lesion are different from each other in these two models. The objective is to evaluate the locomotor and the histological impact on the spinal cord comparing lateral and posterior clip placement. Materials and Methods This study is a randomized experimental trial. A total of 20 female Wistar rats, ranging from 250 to 300 g, aged 12 to 14 weeks, were randomized in two groups by the direction of clip placement: lateral group ( n = 10) and posterior group ( n = 10). After exposing the thoracic segment of spine (T8–T10), a laminectomy was performed at the T9 level under microscope view. The spinal cord injury was made using a 5 mm long aneurismal clip with a closing pressure of 50 g. Locomotor behavior was evaluated by the Basso, Beattie, and Bresnahan scale at the 1st, 7th, 14th, 21st, and 28th day after surgery and the histological analysis of the injury area by computer software. Results The histological evaluation showed a greater lesion area in the lateral group, mean 2.3 ± 2 mm2, when compared with the posterior group, mean 4.8 ± 1 mm2 ( p = 0.03). There was no overall difference between lateral and posterior locomotor scores from day 1 to 28 ( p = 0.361). Conclusion The lesion area observed in the spinal cord histology after the lateral placement of a clip was significantly greater than in the posterior direction of the clip. There was no overall motor performance difference between lateral and posterior BBB scores.
Evaluation of Protocols for Use of Hyperbaric Therapy for Functional Recovery in Rats with Spinal Cord Injury
Authors: Falavigna Asdrubal , da Silva Pedro Guarise , Conzatti Lucas Piccoli , Rizkalla Elisa Braun , Peletti-Figueró Manuela 
Published: May 2015

Introduction Currently, the recovery of neurological functions after spinal cord injury (SCI) still relies on the host's neural plasticity and compensatory mechanisms. Unfortunately, many of these patients are permanently paralyzed. The objective of this study is to analyze the efficacy of hyperbaric therapy (HT) on the motor recovery process and define the best protocol of treatment. Materials and Methods Experimental study with 48 Wistar that was performed following the University standards advocated by the Ethics Committee. The SCI was simulated by performing a laminectomy at the T8–T10 level using a surgical microscope (DF Vasconcelos, RJ, Brazil) and subsequent SCI by a falling object weighing 5 g, controlled by the IMPACTOR equipment (MASCIS Impactor, New Jersey, United States). The drop height was 12.5 mm (mild) ( n = 8) or 25 mm (moderate) ( n = 8) as they were the models most used in the literature. Motor recovery was assessed by the scale of Basso, Beattie, and Bresnahan (BBB) on days 1, 3, 7, 14, 21, and 28 postoperative (PO). The first phase of the study was the comparison between the two models of SCI. In the second step, 32 rats were subjected to SCI, and were divided into five protocols using HT with a hyperbaric oxygen chamber held at a pressure of 2.5 atmospheres for 1 hour: Control (SCI only), 12H (SCI 12 hours PO in a single session), 12H7D (SCI 12 hours and PO once daily for 7 days), 30 MIN (SCI 30 minutes PO in a single session), 30MIN7D (SCI 30 minutes and PO once daily for 7 days). The comparison between the scores of the BBB test was performed using the one way ANOVA + Tukey HSD. Significance was p < 0.05. Results By comparing the curves of motor recovery between rats with mild and moderate SCI, the average BBB in mild SCI was higher than in the moderate group only on days 3 and 7 PO. There was no statistically significant difference between the models in relation to the final motor outcome. The HBT group had a BBB significantly higher than the control group ( p = 0.001) on days 1, 3, 14, and 28 PO. The best HT protocol was the 30MIN7D p = 0.03 when compared with control on day 28. Conclusion There is no difference in the final outcome after 28 days PO between the light and moderate SCI in rats. Using HT accelerates motor recovery and improves motor outcome of rats. The best HT protocol is 30 minutes and after PO daily for 7 days.
Posterior and Anterolateral Surgical Approach for C2 Dumpbell-Shaped Cervical Neurinomas
Authors: Falavigna Asdrubal , Righesso Orlando , Volquind Daniel 
Published: May 2015

Introduction The treatment of hourglass-shaped neurinomas of the C2 root is surgical, using various approaches such as the posterior, posterolateral, anterior, or combined ones. There are controversies in the literature regarding the choice of the best surgical access aiming to remove the tumor completely and safely and maintaining the stability of the spine. This study reports the authors' experience with 14 hourglass-shaped neurinomas of the C2 root, comparing the posterior and anterolateral approaches. Patients and Methods A total of 14 patients with hourglass-shaped neurinoma of the cervical root of C2 were surgically treated. The analysis involved symptoms, radiological diagnosis, information about surgery, and postoperative outcome. The posterior approach was used to remove the tumors in nine patients, and the anterolateral one in five patients. The 10 steps and tips/tricks for safe surgical removal are identified and reported. Results Females predominated in this sample ( n = 8) and the mean age was 52 ± 4.16 years. The time from onset of the symptoms to diagnosis was 17.8 months ( ± 7.8 months). The mean surgical time was 180 minutes ( ± 39.15 minutes) in the posterior approach and 192 minutes ( ± 22.17 minutes) in the anterolateral approach ( p = 0.52). There was no statistically significant difference in the volume of intrasurgical bleeding among the groups (posterior approach: 70.71 ± 16.93; anterolateral approach: 65.00 ± 24.15; p = 0.64). The tumor was completely resected in all the patients. A complication occurred with the posterior access, which was the presence of a cerebrospinal fluid fistula, and it was necessary to reoperate, reconstructing the duramater with fascia lata. Conclusion The tumor was completely resected with both surgical approaches, but the posterior approach has the advantage of being more familiar to the surgeon.
Concomitant Dermoid Cysts of Conus Medullaris and Cauda Equina
Authors: Falavigna Asdrubal , Righesso Orlando , Hauschild Luis , Scatola Fernanda 
Published: May 2015

Introduction Spinal dermoid cysts are benign tumors that results from congenital or acquired ectodermal inclusion. These tumors account for 0.8 to 1.1% of all primary spinal tumors with the majority occurring in the extramedullary area mainly in the pediatric population. We present a rare case of an adult woman with two separate dermoid cysts in the cauda equina and conus medullaris. The literature concerning dermoids is also reviewed focusing on tumor etiopathogenesis. Patient and Methods: We report a case of 35-year-old woman who presented with chronic low back pain and left ciatalgia. She had a history of two abdominal surgeries to treat chronic constipation with an intraoperative diagnosis of intestinal adhesions. No history of spinal trauma, surgery, or lumbar puncture was reported. Neurological examination revealed hypoesthesia in the lateral surface of the left leg, weakness on dorsiflexion of the left foot, and Lasègue sign on the left leg. The magnetic resonance imaging evidenced a large mass located at the cauda equina and a smaller mass located at the conus medullaris. The literature was reviewed in PubMed. Surgical resection was accomplished through a posterior midline incision exposing L2 to S2. The histological examination of the tumors in cauda equina and conus yielded a diagnosis of dermoid cysts. Postoperatively, the patient had urinary retention which reverted in 2 months. Follow-up at 4 years showed complete resolution of preoperative symptoms. Results Our case is interesting because the adult patient with chronic low back and leg pain and intestinal dysfunction presented with two distinct dermoids located in the lumbosacral region. The patient had no history of spinal manipulation or trauma or any sign of dysraphism on physical and image examinations. Although the most common spinal localization is in the lumbosacral region, a concomitance of two separate tumors had never been reported in the literature to the best of our knowledge. Conclusion Spinal dermoid cysts are rare tumors that results from congenital or acquired implantation of embryogenic cells in the spinal canal. We do not know the origin of the two tumors in the presented case, they may have developed from two different embryogenic cells during fetal development or may have been secondary to a possible past cyst rupture whose contents spread to the conus medullaris. Total tumor removal should be the goal for preventing cystic recurrence and future malignization.
A New Entry Point and Trajectory for Iliac Bolt Fixation in Patients Undergoing Long Fusion to the Sacrum
Authors: Enercan Meric , Kahraman Sinan , Gokcen Bahadir , Sanli Tunay , Ozturk Cagatay , Alanay Ahmet , Alanay Azmi 
Published: May 2015

Introduction Osteotomy of the posterior superior iliac spine for preparation of traditional iliac screw entry point exposes the cancellous bone of the inner ilium and causes loss of circumferential cortical starting point which may compromise biomechanical stability. For this reason, traditional iliac screws may not provide the desired primary stability especially in osteopenic and osteoporotic patients. We describe a new free-hand technique with a starting point located at the posterior inferior iliac spine (PIIS), which does not require any decortication for entry and courses very close to the rigid subcortical bone over sciatic notch while providing a low profile fixation and easier connection with S1 screw. The aim of this study is to evaluate the result of this new iliac bolt fixation technique. Patients and Methods A total of 26 patients (21 F and 5 M) having lumbopelvic fixation with the new technique were reviewed. The new entry point is located at the midpoint of PIIS. Lateral cortex of distal iliac wing is exposed subperiosteally and sciatic notch was palpated for safe trajectory. Screw trajectory is intended to be parallel to the outer cortex of ilium, passing 1 to 1.5 cm above the sciatic notch. PIIS provides a rigid circumferential cortical starting point for entrance and trajectory through thick cortical iliac bone over sciatic notch which provides very strong screw purchase even in osteopenic and osteoporotic spine. New entry point also enables easier connection to S1 screw. Free-hand technique eliminates radiation exposure. Pre-op, post-op, and follow-up X-rays were reviewed for the radiological data. Results Mean age was 63.6 years (range, 19–84 years) and mean follow-up was 14 months (range, 12–18 months). Mean screw length was 93.46 mm (range, 80–110 mm). Screw diameters were 8.5 mm in 22 patients and 7.5 mm in 4 patients. Lumbosacral fusion was achieved in all the cases. There were no neurovascular injuries related to the sciatic nerve and gluteal artery during screw placement. There were no implant failures or screw breakage at end of final follow-up. Conclusion This new technique seems to be a viable option in patients undergoing fusion to the sacrum for iliac bolt fixation. PIIS provides a circumferential cortical starting point and low profile fixation with stronger screw purchase especially in osteoporotic patients.
Is Dynesys a Good Device for Motion Preservation and Prevention of Idiopathic Unstable after Decompression Surgery
Authors: Chang Chih-Ju 
Published: May 2015

Introduction The Dynesys dynamic stabilization system was first implanted in patients in 1994 in an attempt to overcome the drawbacks of fusion. It is supposed to preserve motion at the treat levels, while avoiding hypermobility and thus spondylosis at the adjacent levels. The aim of this retrospective study is to investigate the clinical outcome and the effect of preservation of ROM and developed instability after decompression surgery. Patients and Methods A total of 30 patients were treated with Dynesys between August 2008 to March 2014. The diagnosis included degenerative spinal stenosis, severe spinal stenosis with HIVD, huge intervertebral herniated disc, or recurrent HIVD. Back pain and leg pain were evaluated using visual analog scale (VAS). The Oswestry Disability Index (ODI) was used to evaluate the patient's function. The range of motion at the operative level and whole lumbar spine were measured on preoperative and postoperative radiographs. Results All the patients were followed up for 3 to 96 months (mean, 26.33 ± 25.3 months). Overall, 87 segments were applied in 30 patients. The mean age of the patients was 49.5 ± 10.4 years (range, 22–67 years). There were 19 male and 11 female patients, with slightly male predominant. VAS of leg pain, lower back pain, and the ODI were significantly improved postoperatively. There was a significant difference in the range of motion at the operative levels and the whole spine. The mean range of motion of whole spine was 28.89 ± 15.3 degrees preoperatively and 16.29 ± 8.39 degrees postoperatively, with 43.61% loss. The range of motion of operative levels were 12.01 ± 7.73 degrees preoperatively and 4.03 ± 3.19 degrees postoperatively, with 66.44% loss. There were four broken screws and no screws loosening were noted. No developed unstable conditions occurred and no cases need revision surgery in our study. Conclusion The preliminary results of Dynesys for lumbar degenerative stenosis with/without HIVD in our series are similar to the published results of the previous literature. It can significantly improve the clinic symptoms and signs. And the Dynesys device is a semirigid fixation system for the stabilization of lumbar degenerative disease. We think the role of Dynesys is a device to delay the nature decade of lumbar spine and prevent the possibility of idiopathic unstable after decompression surgery. So, the indication of the Dynesys should seriously restriction of the age. It should be used in the patients with no or mild unstable condition, and it is better in the younger patients. But the true effect should depend on longer follow-up.