bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment of Degenerative Disc Disease of L5/S1 with ALIF only (Standalone) versus Posterior Approach Pedicle Fixation: Comparative Retrospective Study
Authors: Tejeda Martin 
Published: May 2015

Introduction In the surgical treatment of degenerative disc disease, specifically in L5/S1 segment have been proposed various treatment modalities, the most used is posterior arthrodesis considered nowadays as the current gold standard. Objective This study aims to compare the results of two groups of patients with degenerative disc disease in terms of improvement in pain, functional scale, functional recovery time, and radiological lumbar lordosis correction. Material and Methods Two groups of patients diagnosed with degenerative disc disease (adult patients, chronic low back pain of more than 6 months duration, with failed previous treatment without radicular component, decreased height of intervertebral space, studies were compared retrospectively with plain X-ray, CT and MRI), operated from April 2009 to April 2014, with a minimum follow-up of 6 months and maximum of 4 years. A group of 25 patients was treated with arthrodesis using a posterior approach with fixation with pedicle screws and bone graft posterolateral from bone bank, while the second group of 22 patients was treated with technique ALIF with PEEK cage via anterior approach (standalone), with fixing screws to the platforms and bone grafting from bone bank. Pain and Oswestry functional index plus functional recovery time and return to work, as well as changes in radiological lumbar lordosis were compared. Operative time, bleeding, and hospitalization time were also compared. Statistics included measures of central tendency, and standard deviation for continuous variables, and frequencies and proportions for categorical variables were used. Student t-test was used to compare both groups to perform simultaneous and multivariate analysis clinical measures. Results We found improvement on the pain intensity visual analog scale, at least 50% of the intensity of initial pain, and in regard to functional scale ( p > 0.01), it was possible to improve the overall height of the intervertebral space the anterior approach which was not achieved by the posterior route. Moreover, significant differences of less surgical time, less bleeding, shorter hospital stay, and were found by the anterior approach to the posterior approach. Conclusion In this study was found for degenerative disc disease of L5/S1, a better surgical outcome by the anterior approach than the posterior approach in terms of pain and functional recovery in an average follow-up of 2 years.
Lateral Lumbar Interbody Fusion for the Correction of Spondylolisthesis and Adult Degenerative Scoliosis in High-Risk Patients: Early Results and Complications
Authors: Waddell Bradford S. , Briski David C. , Zavatsky Joseph M. 
Published: May 2015

Introduction Lateral lumbar interbody fusion (LLIF) by a transpsoas approach can avoid complications seen in other techniques. Lateral cages offer a larger cage and may increase stability by spanning the ring apophysis. Patients with multiple comorbidities, including smoking, diabetes, and obesity, have been shown to have decreased fusion rates. This study used computerized tomography (CT) scans to assess interbody fusion utilizing the LLIF technique in patients at high risk for nonunion and pseudoarthrosis. Methods We performed a retrospective review of patients who underwent LLIF between January 2008 and December 2013. A total of 64 patients with 151 levels underwent nonstaged or staged LLIF with posterior correction and augmentation. Per protocol, patients received CT scans at their 1-year follow-up. Of the 64 patients, 32 patients with 86 levels met inclusion criteria. Two board-certified musculoskeletal radiologists and the senior surgeon (J. Z.) assessed fusion. Results We performed six revision surgeries (18.75%). Other comorbidities included osteopenia/osteoporosis (46.8%), diabetes (25%), obesity (25%), and active smoking (25%), among others. Postoperative complications occurred in 15 patients (46.8%). Anterior thigh pain and weakness occurred in five patients (15.6%), all of which resolved by 6 months. There were five cases of delirium/postoperative confusion (15.6%). There were three cases of proximal junctional kyphosis, each requiring revision and cranial extension. Two cases of abdominal atonia occurred, one of which resolved at 1 year and the other still symptomatic at 1 year and 1 month. There were no cases of infection, ileus, UTI, catastrophic subsidence, DVT or PE. By CT scan assessment, each radiologist found solid fusion, as demonstrated by strong bridging trabeculae, was achieved in 84 out of 86 levels (97.6%). This was in agreement with the senior surgeon (J. Z.). Conclusion Several studies have evaluated LLIF fusion and reported fusion rates between 88 and 96%. Our results demonstrate high fusion rates (97.6%) using this technique, despite multiple comorbidities. Since stability plays a vital role in successful fusion, spanning the ring apophysis with a larger cage, along with pedicle screw supplementation, appear to be key factors.
Effect of Incidental Durotomy on Cost and Length of Stay in Primary, Short, Posterior Lumbar Fusion for Lumbar Spinal Stenosis: An Analysis of 17,232 Cases
Authors: Yoon S. Tim , Buck Stewart 
Published: May 2015

Introduction The incidence of durotomy and its economic impact during primary short lumbar fusion is not well described. The purpose of this study was to determine the incidence of and factors associated with durotomy in primary one- or two-level lumbar fusions performed for lumbar spinal stenosis and its impact on cost and hospital resource utilization. Material and Methods The Nationwide Inpatient Sample (NIS), was queried using ICD-9 codes for all primary one- or two-level lumbar fusions performed in adults for lumbar spinal stenosis between 2009 and 2011; only elective cases without concurrent diagnoses of vertebral infection, fracture, or tumor were included. Chi-square and t-tests were used as appropriate to compare categorical and continuous variables, respectively. Multivariate regression analysis was performed to identify factors independently associated with incidental durotomy, as well as total hospital charges and costs, as well as length of stay (LOS). Results A total of 17,232 procedures performed were identified, of which 801 had an incidental durotomy (rate of 4.65%). The rate of dural tears in teaching hospitals (5.09%; 95% CI: 4.66–5.55) was significantly higher as compared with nonteaching hospitals (4.19%; 95% CI: 3.77–4.66) ( p = 0.006). Multivariate regression analysis revealed that the odds of experiencing a dural tear increased by 2% with each year of increasing age (unit odds 1.02; 95% CI: 1.01–1.03). Incidental durotomy was associated with a mean 1.40-day (95% CI: 1.22–1.59) increase in hospital stay, a mean $10,885 (95% CI: $6,592–$15,177) increase in total hospital charges, and a mean $3,873 (95% CI: $2,502–$5,242) increase in estimated total costs (all differ from no durotomy group with p < 0.0001). Conclusion In this large retrospective series, the rate of incidental durotomy during primary short lumbar fusion for LSS fell within the range of previously reported rates. We have identified increasing age and surgery in a teaching hospital as factors associated with higher rates of durotomy. These findings are important given the significant financial and health care resource costs associated with dural tears.
A Cluster-Based Method for the Preoperative Identification of Lumbar Degenerative Patients having Higher Risk for Poor Global Outcome
Authors: Lazary Aron , Bozsodi Arpad , Klemencsics Istvan , Eltes Peter Endre , Varga Peter 
Published: May 2015

Introduction Surgery for lumbar disc degeneration has been shown to yield poor results in 10 to 45% of the patients. Evidence-based clinical tools for preoperative risk estimation would be very important to identify the “at-risk” patients. Several factors referring on the patients' symptoms, psychosocial issues, and medical history were previously published as significant individual risk factors on outcome, but there is low number of reports on integrative models with advanced statistics. The aim of this study was to identify significant outcome predictors and clinically different subgroups in patients surgically treated because of lumbar degenerative disc disease. Patients and Methods A total of 750 consecutive patients indicated for one- or two-level lumbar decompression/microdiscectomy or fusion surgery (TLIF) were recruited into the study. Patients with previous lumbar surgery or nondisc degeneration-related phenotype were not included into the analysis. Patients completed a questionnaire booklet containing the Oswestry disability index (ODI), visual analogue scales on low back (LBP), and leg pain (LP), Zung depression scale (ZDS), and the Modified Somatic Perception Questionnaire (MSPQ) before the surgery and 2 years after the surgery. Five-point Likert scale on self-reported outcome of the surgery was classified into two categories (“good” and “poor” outcome) and effect of preoperative parameters on that was determined applying uni- and multivariate logistic regression models. Two-step agglomerative cluster analysis was used to determine the best fit cluster structure of the cohort entering the significant outcome predictors into the model. Multivariate analysis of variance (MANOVA) and Fischer test were used to analyze the clinical clusters and their canonical discriminant functions. Chi-square tests were applied to investigate the clinical outcome in the different clusters. Results Four different preoperative parameters; number of spinal levels treated, severity of low back pain, duration of pain, and distress (calculated from ZDS and MSPQ scores) were proved to be significant predictors on surgical outcome in the final multivariate regression model ( p < 0.001). The four parameters identified four different subgroups in patients with good cluster quality. Clinical outcome was significantly different in the four preoperative patient-clusters (poor outcome in 5.1, 12.4, 20.9, and 25.6% of subjects, chi-square = 29.3, df = 3, p < 0.001). Conclusion Preoperative parameters of the patients with lumbar disc degeneration have got significant influence on the midterm surgical outcome. Outcome predictors determine different patient clusters with different risk for poor outcome. Advanced statistical approaches are advised to use in the future for patient stratification and risk estimation.
Postoperative Pain Control with Epidural Catheter after Posterior Lumbar Spine Fusion
Authors: Toktas Zafer , Yilmaz Baran , Eksi Murat , Konakci Murat , Aksoy Tamer , Urgun Kamran , Konya Deniz , Kilic Turker 
Published: May 2015

Introduction Pain management after posterior spinal fusion surgeries is a challenging topic. Epidural analgesia (CEA) technique has been developed to resolve some deleterious effects related with conventional intravenous patient-controlled analgesia (IV-PCA) method. However, studies are scanty in adult lumbar deformity patients. We hypothesized that CEA would be beneficial in adult lumbar deformity patients and conducted a study to observe effectiveness and safety of the procedure with a special consideration of the catheter level. Patients and Methods Forty-six patients scheduled for elective posterior lumbar spine fusion, in one spine-center clinic, were enrolled into the study. Three patients' dataset about pain control and/or sedation status were inconclusive and they were excluded from the final analysis. Pain and sedation status were evaluated with VAS and Ramsay sedation scales, respectively. Epidural catheter was inserted under direct visualization intraoperatively. Results There were 43 patients in the final analysis. Twenty-one patients had epidural catheters at or below the L2 level, 22 patients had their catheters above the predefined level. There was significant difference between the groups only in the 24th hour VAS scores. Patients with catheters of higher level location in the spinal canal, had higher VAS scores at the immediate postoperative period, however VAS scores in this group lessened more than the lower level catheter group at the 24th hour. Ramsay sedation scale score was significantly slightly higher in the patients with lower level catheters than the other group at 0 and the 2nd hour. Conclusion Continuous epidural analgesia is an effective and safe method in controlling postoperative pain in adult lumbar deformity patients treated with PSF method. Higher placement of epidural catheter in the spinal canal causes more pain at the beginning; however, drug release at this level has more effect over pain than lower levels.
Long-Term Effect of Selective Nerve Root Block in patients with Lumbar Stenosis
Authors: Jimenez Kathryn Anne , Sison Gerardo Juan 
Published: May 2015

Introduction Low back pain with radiculopathy is a common problem encountered both by the young and the elderly. In the young, it may be caused by HNP and/or chemical irritation causing nerve impingement. In the elderly, it is usually caused by a degenerative process causing stenosis. One problem faced by the surgeon is when the patient has an equivocal presentation; wherein surgical outcome becomes unpredictable. The aim of our study was to show the long-term effect of selective nerve root block, using a combination of lidocaine and methylprednisolone, in patients suffering from low back pain with equivocal presentation caused by lumbar spinal stenosis. Materials and Method This has a prospective study design, SNRB was done in patients with equivocal symptoms. A total of 19 patients who satisfied the inclusion criteria were included in the study, informed consent was granted by all the participants. All the patients already underwent at least eight sessions of physical therapy and took oral analgesics with no relief of symptoms. SNRB was done in a sterile environment with the guidance of an image intensifier. A combination of 1 mL methylprednisolone and 1 mL of 2% lidocaine was injected after verification of the needle position in two planes was done. The procedure was completed with the patient awake to elicit sensory changes to confirm proper positioning of the needle. Close follow-up was done at 1 week, 3 weeks, 3 months, 6 months, 1 year, and 3 years post-SNRB. Results After 1 week, 17 patients reported resolution of symptoms. Immediate relief was observed in 15 patients after the injection. At 1 year, all 17 patients still reported no recurrence of pain. Three were lost to follow-up, failing to return for the 3rd year post-SNRB, decreasing the success rate at 3 years to 15 patients out of 19. The remaining two patients required repeat SNRB, with one of the two eventually requiring surgical decompression. Conclusion This study showed that the combination of methylprednisolone and lidocaine was able to provide pain relief in 89% of the participants at 1 year follow-up, and 74% at 3 years. SNRB may be used in treating patients with equivocal presentation, providing faster relief than other conservative management, and evading unnecessary surgery.
A Quantitative Study of the Effects of High-Dose Parathyroid Hormone (1–34) and Low-Dose rhBMP-2 on Posterolateral Lumbar Spine Fusion in a Rabbit Model
Authors: Holmes Christina , Lina Ioan , Liauw Jason , Lo Sheng-Fu Larry , Theodros Debebe , Mao Annie , Elder Benjamin , Witham Timothy 
Published: May 2015

Introduction Parathyroid hormone (1–34) (PTH), which is commonly used in the treatment of osteoporosis, has been shown to increase bone mass and reduce the risk of fracture. Previously, we demonstrated that, while intermittent low-dose (10 µg/kg) PTH (1–34) treatment resulted in increased fusion mass volume, it did not improve biomechanical stiffness over the use of autograft alone, and did not improve fusion when combined with BMP-2 treatment (Lina et al, Spine [Phila Pa 1976]. 2014; 39(5):347). However, studies in other rodent models have indicated that the effects of PTH (1–34) on spinal fusion may be dose-dependent (Ming et al, Spine [Phila. Pa. 1976]. 2012; 37(15): 1275; Abe et al, Bone. 2007; 41(5): 775). These rat and mouse studies used PTH (1–34) doses as high as 20 to 40 µg/kg compared with the 10 µg/kg used in our experiments. We thus aim to evaluate whether increasing the dose of PTH (1–34) administered increases both the volume and biomechanical stiffness of the resulting fusion masses and/or exhibits synergistic effects with low-dose BMP-2 treatment. Materials and Methods A total of 60 rabbits underwent posterolateral intertransverse process lumbar spinal fusion surgery, and were assigned to one of the six groups depending upon the fusion grafting group employed: iliac crest autograft alone ( n = 10), iliac crest autograft + 20 µg/kg PTH (1–34) ( n = 10), iliac crest autograft + 40 µg/kg PTH (1–34) ( n = 10), rhBMP-2 alone ( n = 10), rhBMP-2 + 20 µg/kg PTH (1–34) and, rhBMP-2 + 40 µg/kg PTH (1–34). Fusion mass and quality were assessed using manual palpation, CT analysis of fusion mass volume, and four-point nondestructive biomechanical testing. Results/Conclusions: Although manual palpation is used as the standard measure of fusion, we found that CT analysis proved more effective in differentiating fused masses based on bone formation, not fibrous tissue. Both the PTH (1–34) group and BMP-2 increased bone density and volume of the fusion masses. Biomechanical analysis of fusion mass strength is currently underway.
IPD Coupled Decompression of Degenerative Spinal Stenosis: Comparative Results with Traditional Methods
Authors: Fokter Samo , Mirnik Nino 
Published: May 2015

Introduction The goal of this study was to obtain the success rate of decompression with concomitant interspinous process distraction device (IPD) implantation for degenerative lumbar spinal stenosis (DLSS) and to compare the results to historical series treated with traditional decompression with or without posterolateral (PL) instrumented fusion. Material and Methods This study prospectively analyzed the success rates of 18 DLSS patients treated with decompressive surgery and implantation of soft IPD (DIAM) at one or two levels. We compared the results with a historic group of 20 patients which were treated with traditional surgical decompression with or without PL fusion at one or two levels. In the DIAM group, outcomes were measured with the Zurich Claudication Questionnaire (ZCQ) and the short form health survey 36 (SF-36), completed preoperatively and at 6, 12, 24, and 48 months postoperatively. In the historic group, outcomes were measured with the ZCQ preoperatively and at 20.5 ± 10.5 months. The groups were compared in ZCQ results at 24 months. In the DIAM group, postoperative X-rays taken at 4 years were examined for erosions or fractures of the spinous processes Results The operating time was 89 (± 29) minutes in the DIAM and 139 (± 40) minutes in historic group. The blood loss was 265 (± 308) mL in the DIAM and 913 (± 630) mL in the historic group. The hospital stay was 6.3 (±2.4) days in the DIAM and 9.6 (± 5.4) days in the historic group. The narcotic use was 2.3 (± 1.5) days in the DIAM and 4.6 (± 2.6) days in the historic group. Overall, 61.1% (11/18) in the DIAM and 70% (14/20) of the patients in the historic group were considered to be clinically successful. In the DIAM group, SF-36 results significantly improved on follow-up at 6 months and continued to improve to 4 years. No erosions or fractions of the spinous processes were found on the X-rays in the DIAM group at the latest follow-up at 48 months. Conclusion The adjunct of a soft IPD to the decompression has provided patients with comparative results to traditional surgical methods. The main advantages of decompression coupled with soft IPD implantation for DLSS are shorter operating time, less blood loss, less hospital stay, and less narcotic use. The main disadvantage is increased cost of surgery.
Supine Position after a Major Spine Surgery: A Bad Position
Authors: Costa Camelo Rafael , Valdeci Worm Paulo , Vincent Berthier Brasil Albert 
Published: May 2015

Introduction Patients undergoing spine surgery by the posterior approach are subjected to excessive and constant pressure on the operative site, because decubitus adopted (dorsal) in most procedures, including lying on his back on the injury held recently. The increased pressure on the wound after surgery may lead to tissue ischemia and this fact may explain why patients operated on by posterior approach have higher rates of pain and infection postoperatively. This prospective, controlled study was designed to demonstrate the excess pressure on the muscle of the wound in patients submitted to surgery in the spine by the posterior approach when they assume supine position. Patients and Methods A total of 22 patients undergoing major surgery in the thoracic and lumbar regions had a fiber optic catheter (Codman ICP Monitoring System, Jonhson and Jonhson) inserted in to the body (right or left) of the paraspinal muscles. The catheter was inserted 3 cm lateral to the incision and 5 cm deep. The pressure was measured and recorded hourly obeying the order of dorsal decubitus, right and left lateral decubitus for 24 hours postoperatively with the patient at bed rest. After this period the catheter was removed. Results Patients had a mean age of 55.9 ± 4.2 years (11 men and 11 women); height of 167.8 ± 2 cm; weight and BMI (body mass index) was 73.0 ± 2 (kg), and 25.3 ± 0.8, respectively. The average abdominal circumference was 93.7 ± 2.7 cm. ANOVA showed a significant difference in mean pressure (24 hours) from the supine position (24.7 ± 2.0 mm Hg) with left or right lateral decubitus (4.92 ± 2.3 mm Hg and 4.77 ± 2.83 mm Hg). There was no significant correlation between weights, sex, BMI, and waist circumference with the pressure of decubitus adopted by the patient, or with the side that the catheter was inserted. Conclusion The supine position adopted in the postoperative period of major spine surgery through the posterior approach can be a factor implicated in postoperative complications. The pressure difference is significant enough to exceed capillary pressure.