bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiological Outcome in Adolescent Idiopathic Scoliosis Patients 20 Years after Treatment
Authors: Simony Ane , Christensen Steen Bach , Andersen Mikkel O. 
Published: May 2015

Introduction The purpose of this study was to evaluate the long-term radiological outcome, curve progression, and adjacent level degeneration 20 years after idiopathic scoliosis treatment with Boston brace or Harrington rods. Materials and Methods A total of 219 patients treated with Boston brace or posterior spinal fusion a.m. Harrington were invited to participate in a long-term evaluation with clinical examination and X-ray evaluation. The old medical charts and X-ray descriptions were available. Standing X-ray was examined, the Cobb angle measured and compared with the patient's previous X-ray and the adjacent levels were evaluated for any signs of adjacent level disease or local kyphosis. Results A total of 159 patients (78%) participated. Of them, 66 patients were treated with Boston brace and 92 patients were treated with posterior spinal fusion a.m. Harrington. In the brace group, the Cobb angle before treatment was 37.5 degrees (35.1–40.0 degrees) and after treatment was 34.7 degrees (31.9–37.5 degrees). Cobb angle after 20 years was 40.2 degrees (36.7–43.6 degrees). In the surgical group, the Cobb angle before treatment was 54.5 degrees (50.4–58.8 degrees), 1-year postoperatively was 29.5 degrees (25.7–33.9 degrees). Cobb angle after 20 years was 32.35 degrees (27.9–39.5 degrees). A total of 26 patients had distal segment degeneration in X-ray (16.5%), 4 patients were treated with brace and 22 patients with posterior spinal fusion. A total of 8 patients had proximal segment degeneration (5%), 2 patients were treated with brace and 6 patients with posterior spinal fusion. A total of 4 patients were treated with posterior fusion of the distal adjacent segment (2.6%), 1 was treated with brace and 3 were treated with posterior spinal fusion. Conclusion The average follow-up was 24.5 years (range, 15–35 years). The brace group had a small reduction in the spinal deformity during the treatment period, and X-rays show a small progression of the deformity, with the Cobb angle increasing by 5.5 degrees within 20 years. The surgically treated patients had a large correction during surgery and there is no statistical significant progression or loss of correction over a 20-year period. Only 4 patients in the brace group have distal segment degeneration and only 1 patient was treated with a one-level spinal fusion. The surgically treated groups had a significant deformity correction during surgery and have maintained the correction after 20 years. A total of 22 patients have distal degeneration and 3 patients were treated with distal adding on surgery.
The Fate of L5–S1 with Low Dose BMP-2 and Pelvic Fixation in Adult Deformity Surgery
Authors: Annis Prokopis , Spiker Ryan , Lawrence Brandon D. , Daubs Michael D. , Brodke Darrel S. 
Published: May 2015

Introduction Pseudarthrosis at L5–S1 is one of the most common complications of long fusions to the sacrum in adult deformity surgery. Strategies for decreasing pseudarthrosis include interbody fusion, use of BMP-2 at the lumbosacral junction, and the use of sacropelvic fixation, individually or in combination. High-dose BMP-2 (20–40 mg) placed posterolaterally has shown comparable fusion rates to interbody fusion. The purpose of this study was to evaluate L5–S1 fusion rates when lower dose BMP-2 (average 3.2 mg) and pelvic fixation were used, with or without interbody fusion. Materials and Methods This is a retrospective review of 61 consecutive patients with a minimum follow-up of 2 years at a single institution. All patients had an isolated posterior approach, ≥ 5 levels fused including L5–S1, use of pelvic fixation, and no previous L5–S1 procedures. The patients were divided into two groups for comparison based on the use of an interbody cage/fusion at the L5–S1 level. Radiographic union was assessed by three independent reviewers using Bridwell criteria. Revision rates and implant-related complications were also reported. Results The fusion rate at L5–S1 was 97% (59/61) with no difference between the interbody and no interbody fusion groups (97 vs. 96%, p = 1.0). The overall revision rate for L5–S1 nonunion was 1.6%. The mean amount of BMP-2 used in the interbody group was 4.1 mg (2–10), 2.5 mg (0–8) in the disc space, and 1.6 mg (0–4) in the interbody cage, while there was no difference in the amount of rhBMP-2 placed posterolaterally between the two groups (IF = 1.6 vs. NIF = 2.0 mg, p = 0.08) along with autograft and allograft. There were no significant differences in the radiographic parameters or deformity correction between the groups. Conclusion The use of low dose of BMP-2 at the L5–S1 level in combination with sacropelvic fixation achieved satisfactory outcomes in adult deformity surgery. No additional radiologic or clinical benefit was realized with the addition of an interbody fusion at the L5–S1 level.
Assessment of Impact of Long-Cassette Standing X-rays on Surgical Planning for Lumbar Pathology: An International Survey of Spine Surgeons
Authors: Smith Justin , Shaffrey Christopher , Lafage Virginie , Schwab Frank , Protopsaltis Themistocles , Klineberg Eric , Scheer Justin , Deviren Vedat , Hart Robert , Bess Shay , Arnold Paul , Chapman Jens , Fehlings Michael , Ames Christopher 
Published: May 2015

Introduction Surgical planning to address significant lumbar spine pathology, performed without appreciation of global spinal alignment, may have negative consequences. Our objective was to assess whether the extent of recommended surgery for lumbar pathology would significantly change with the addition of long-cassette standing X-rays. Materials and Methods This was an international online survey of spine surgeons. A series of 15 cases of lumbar spine pathology was presented with a brief clinical vignette and lumbar imaging (X-rays and MRI/CT). Surgeons were asked to select the most appropriate surgical plan, with five choices, ranging from least aggressive (decompression alone; 1 point) to the most aggressive (upper thoracic to sacrum/ilium fusion ± osteotomies/decompression/interbodies; 5 points). Cases were then reordered and presented with long-cassette standing X-rays and the same surgical planning question. Results were compared based on lumbar imaging only versus addition of long-cassette X-rays. Five cases (control group) had normal global alignment and 10 cases (study group) had global malalignment. Results A total of 316 surgeons completed the survey, predominantly (63%) from North America and Europe. Specialties included orthopedic surgery (65%) and neurosurgery (34%), 68% completed spine fellowship, and responders had a mean 13.4 years in practice that was a mean of 76% spine and included a mean of 123 fusions per year. For study cases, extent of recommended surgery increased significantly with the addition of long-cassette X-rays versus lumbar imaging only ( p = 0.002). For control cases with normal global alignment, no significant changes in surgery plans were identified with the addition of long-cassette X-rays ( p = 0.280). Conclusion Long-cassette standing X-rays can have a significant impact on surgical planning for lumbar pathology. Surgeons should maintain a relatively low threshold for obtaining long-cassette standing X-rays when contemplating surgical treatment for significant lumbar spine pathology.
Skeletal Muscle Mass is a Prognostic Marker at Diagnosis in Patients with Metastatic Spinal Cord Compression
Authors: Gakhar Harinder , Dhillon Amritpaul , Blackwell James , Hussain Kesar , Bommireddy Rajendra , Klezl Zdenek , Williams John 
Published: May 2015

Introduction Age-related loss of functional muscle mass is associated with reduced functional ability and life expectancy. In disseminated cancer, age-related muscle loss may be exacerbated by cachexia and poor nutritional intake, increasing functional decline, morbidity, and accelerate death. Patients with spinal metastases frequently present for decompressive surgery with decision to operate based upon functional assessment. A subjective assessment of physical performance has, however, been shown to be a poor indicator of life expectancy in these patients. We aimed to develop an objective measure based upon lean muscle mass to aid decision-making, in these individuals, by investigating the association between muscle mass and 1-year survival. Materials and Methods Muscle mass was calculated as total psoas area (TPA)/vertebral body area (VBA), by two independent blinded doctors from CT images, acquired within 7 days of spinal metastases diagnosis, at the L3 level. Outcome at 1 year following surgery was recorded from a prospectively updated metastatic spinal cord compression database. Results A total of 86 patients were followed for 1 year, with overall mortality at 39.5%. There was no gender difference although those alive at 1 year were of a significantly younger age. Alive at 1 year mean age was 62 years (IQR 53–71.75) versus dead at 1 year mean age was 68 years (IQR 61.75–76.25); ( p = 0.04). Significantly more patients in the lowest quartile of muscle mass died within 1 year, compared with the highest quartile (57.1 vs. 23.8%, p = 0.02). Individuals who died within a year had significantly lower lean muscle mass on initial CT compared with those alive at the end of 1 year ( p = 0.05). Patients with lung and gastrointestinal primary malignancies were more likely to die at 1 year, with both groups having 1-year survival rates less than 50%. Of the malignancies recorded, lung primary patients had a significantly lower muscle mass on CT than breast and lymphoma patients ( p < 0.01). Conclusion Death within 1 year in individuals with spinal metastases is related to lean muscle mass at presentation. Assessment of lean muscle mass may influence decision to operate patients with spinal metastases.
Intradural Extramedullary Spinal Cord Tumors: A Series of 72 Cases
Authors: Pothiraj Raju Rajkumar 
Published: May 2015

Introduction To analyze and present intradural extramedullary spinal cord tumors and the prognostic factors affecting their neurological outcome. Materials and Methods From June 2002 to June 2014, we had 72 cases of such tumors. Among them, 14 at cervical, 6 at cervicodorsal junction, and 52 at dorsal and dorsolumbar region. All of them presented with neurological symptoms and deficits. Microsurgical excision of the tumor was done in all cases. Histopathology showed schwannoma in 42 cases, meningioma in 28 cases, malignant schwannoma in 1 case, and dermoid cyst in 1 case. Results Except for the malignant schwannoma case, all patients had improvement in the neurological deficits. Follow-up period ranged from 2 months to 12 years. Postoperative CSF leak occurred in three patients, one at cervical region and two at dorsal region. CSF leak stopped with duraplasty and revision of the wound. Conclusion Size and location of the tumor, severity of neurological deficit at the time of presentation, degree of cord retraction and vascular insult during excision of tumor, and completeness of the removal are the prognostic factors in the postoperative neurological outcome of the patients with these tumors.
Biomodeling in Complex Revision Deformity Spine Surgery: Experience with Two Cases
Authors: Ramos Javier , Dittmar Michael , de Haro Jorge , Cruz Francisco 
Published: May 2015

Introduction The distortion of the anatomy in some spine pathologies such as severe scoliosis and tumors, make the surgery a complex event, and the planning plays an important role. The image study interpretation in this kind of cases is difficult. Methods Biomodelism provides a better understanding of the anatomy and the surgical plan. Two models performed before the surgery of a complex spine deformity, we obtain DICOM images with a CT scan with reconstruction of 64 slides, 1 mm of thickness, and an interval of 1 mm and a reconstruction was done, the data were transferred to a stereolithographic format to print the model. The model was used to plan the surgery, check the trajectory of the pedicular screw, the approach, and the education of the family. The model was sterilized before and used as a tactile guide in the surgery. Results Before the surgery, the family and the patients understand the surgical procedure, the surgical team could evaluate the anatomy to understand the pathology. During the surgery, the model serves as a guide to realize the approach and the screw placement in a simple and systematized manner according to the surgery plan, and helps to evaluate the event after the surgery. Discussion D'Urso et al got a huge experience with biomodelism, we believe that the result in they work like in our work bring satisfactory results before, in the surgery and after the surgery, in the planning and the development of the procedure, as well as the postoperative evaluation with the use on the plastic model. Conclusion The use of biomodeling should be a frequent tool in spine complex cases where the anatomy could be affected.
Pathologic Axis Fracture Secondary to Solitary Bone Plasmacytoma: A Case Report and Literature Review
Authors: Yurac Ratko , Delgado Matias , Marré Bartolomé , Ballesteros Vicente 
Published: May 2015

Introduction Solitary bone plasmocytoma (SBP) is an uncommon entity. It represents 5 to 10% of all plasmatic cell neoplasms. Usually, it affects axial skeleton and rarely cervical spine. Patient and Methods: A case report of a 73-year-old woman with 1.5 month of progressive neck pain with limitation of cervical mobility is presented. A nonsystematic literature review about cervical spine SBP was conducted. Results Cervical X-ray study showed a lytic lesion in C2 vertebral body with anterolisthesis of the atlas over the axis. Computed tomography scan confirmed complete destruction of C2 vertebral body with partial occupation of the spinal canal seen in the magnetic resonance imaging. The systemic tumor spread was discarded. The patient went for surgery with the diagnosis of a vertebral tumor lesion of C2. Posterior occipitocervical fixation of C0 to C5 with iliac crest autogenous bone graft and complementary fixation of the posterior arc of C1 to the placed rods with titanium cables was performed. Bone tumor biopsy using a posterior approach through the pedicle was done. Histological and immunohistochemical study resulted concordant with an SBP. Immediate postoperative was satisfactory, with disappearance of neck pain and with no neurological deficit. Six weeks after surgery, radiotherapy was conducted completing a total of 25 sessions with complete remission of SBP. Three years' follow-up, the patient presented no neck pain and no recurrence of disease. Seven years postoperative CT scan showed no signs of cervical SBP. Conclusion Spine SBP is a rare entity. It has a good prognosis depending on the correct and early diagnostic approach, which will offer the highest probability of therapeutic success. The main pillars of treatment are as follows: (1) spine stabilization surgery, complemented in some cases if necessary with decompression on neural elements and (2) radiotherapy.
Methods of Invasive Surgery Treatment in Patients with Lumbar Failed of Etiology Degenerative
Authors: Dimumbrun González R. , Alvarado E. , Cova Wilmer J. , Coello Miguel 
Published: May 2015

Introduction It is necessary to expose the transcendental forms of invasive treatment for failed back surgery studied in 4 years of follow-up for the benefit of quality of life from patients with chronic spinal pain and functional limitation, and promote replication strategies in community spinal surgeons. Patients and Methods A prospective, descriptive, comparative, randomized study of 48 patients with degenerative lumbar disc disease diagnosis of failed back surgery, from any health center in the country with one or more surgical procedures performed in the anatomic area was conducted lumbar region, related to moderate-to-severe low back pain, with or without, radiculopathy tested before and after the invasive modality with the EVA scale of nociceptive pain, neuropathic pain DN4 scale and the scale of oswestry functional disability. Patients with a history of previous surgery were included in this investigation degenerative disease with intractable pain, to alleviate or relieve pain, with less previous evolution of the 6 months in cases of severe pain, and with persistence or increased symptoms before surgery. Some images evidence reflecting the failure or implant surgical techniques. All patients without previous surgery were excluded and also those with percutaneous interventional approaches of chronic spinal pain, as the only tool treatment lumbar radicular pain, failed back surgery patients with traumatic, tumoral, and infectious origin where by all the patients with established diagnosis of failed back surgery degenerative etiology. Results The analysis included an interpretation of medical records and surgical event clinical evaluation of 48 patients attending consultations and team column in the University Hospital Dr. “Manuel Nunez Tovar” in the city of Maturin, Monagas State, Venezuela. From January 2010 to June 2014, the majority of patients were males 60.42% and females 39.58%, aged 32 to 68 years. It was fulfilled in the total of 48 patients studied, 66 invasive modalities, discriminated into three groups as follows: revision surgery, 13 patients; approach percutaneous interventional analgesic and anesthetic spine chronic pain as Cosman technique, 19 patients; and mixed mode, 16 patients. Repeat percutaneous interventional total in 18 patients. Conclusion The procedures were performed by the same surgical team, using a surgical procedure according to the analysis of symptomatic interpretation of pain, upgrade of the images, affected lumbar level, and characteristic of previous surgery and experience of the team treating surgeons followed by more than 6 months with good and excellent, measurable, and clinically beneficial results.
Diastematomielia Case Report
Authors: Giménez Carlos , Rivas Marcelino , Marin Elio 
Published: May 2015

Introduction The diastematomielia is a form of occult spinal dysraphism, which can be observed between 5 and 10% of the population, and once these 80% of which had lumbar location. The term diastematomyelia is because of Olliver in 1837 and is derived from the Greek “diastema” meaning cleft and “mielia” which refers to the spinal cord. Before 1950, this rare lesion was little known and few reported cases diagnosed postmortem. In the Mayo Clinic, 1935 to 1967, only 10 cases diagnosed during life and treated surgically were presented. After the 1950s, the prognosis of these patients improved significantly with the advent of new diagnostic techniques such as myelography, computed tomography [CT], magnetic resonance imaging (MRI), ultrasound (US), electromyography (EMG), and evoked potentials somatosensory (SSEP), treatment (surgical microscope and bipolar electrocautery), and rehabilitation of motor and sphincter. The diastematomielia is three times more common in women and occurs in any period of life, with peak incidence between 4 and 6 years old. At present, most authors deny the hereditary nature and diagnosis is often performed incidentally. Clinically, the disease presents with the following three pillars: skin disorders, orthopedic deformities, or signs and symptoms of neurological dysfunction. Patient and Methods: This is a case report of a 24-year-old girl with the following diagnosis: diastematomielia, thoracolumbar scoliosis, tethered cord (2 years' post-op). The girl consulted for thoracolumbar scoliosis and low back pain. At the physical examination, we saw thoracolumbar scoliosis, middle line scar (tethered cord post-op), skin stigmatas, and nonmotor deficit. On CT scan, we could observe a bone spur dividing the spinal canal at D9 level. On MRI, we could observe that the spinal cord was divided in two at the same level. In surgery, we found the bone spur at the center of the spinal canal splitting the spinal cord in two. We drilled the bone spur from the top to the base. We had to gently separate the two halves of the spinal cord from the bone spur to reduce the possibilities of damage. The two halves of the spinal cord were covered by dura mater. The surgery concluded with minimal bleeding, no dura mater injuries, and the patient had no deficit after the surgery. Results The patient had good postoperative evolution and went home for days after surgery with no deficits. Conclusion This is the first case of diastematomielia in 15 years. The diastematomyelia is a rare dysraphism condition. We must think of every child with peripheral stigmata of skin, tiredness when walking, orthopedic deformities, urologic symptoms, and so on. Urodynamic studies should be performed even when there are no symptoms because there may be a subclinical damage. Surgery should be performed early after the diagnosis is made.
A Clinical Prediction Rule to Major Spine Trauma
Authors: Sánchez-Bringas Guadalupe , Cruz-Arenas Esteban , Reyes-Sánchez Alejandro , Obil Chavaria Claudia 
Published: May 2015

Introduction Spinal trauma can be devastating and the ultimate solution is the prevention of delayed or missed diagnosis and treatment. Our purpose was to develop a reliable prediction rule to assess a patient's identify risk factors for spinal injuries that could guide trauma patient's screening for timely spinal fracture diagnosis and treatment. Patients and Methods Retrospective study from January 2005 to March 2014 of patients with trauma-associated spinal fractures who were admitted into the spinal surgery service of a referral institute. Two clinical prediction rules based on a set of demographic and clinical variables (injury mechanism, accident site, occupation, toxic substances intake, and presence of other fractures) were developed with a multivariate logistic regression model. AO type A spinal fracture and thoracolumbar spinal segment were the outcomes involved. Model performances were quantified with respect to discrimination area under receiver-operating-characteristics curve (AUROC). Results In a total of 209 patients, 78.5% were males, median age 36.7 ± 13.9 years and the most affected age group was that of patients aged 20 to 49 years (43.9%). The fracture distribution for axial compression with intact posterior ligamentous complex type A corresponded to 56.5% of the cases; the thoracolumbar junction was the most affected one (44.5%) at one level and 5.3% at two levels, mainly L1 (19.1%). A combination of fall from 1 to 5 m (OR = 3.9, p = 0.000), domestic occupation (OR = 3.1, p = 0.026), recreational place (OR = 5.02, p = 0.000), and toxic substances intake (OR =1.95, p = 0.035), altogether as a prediction rule, showed excellent discrimination in diagnosing AO type A spinal fracture (AUROC = 0.75) with 59% of sensitivity and 77% specificity. In the second model, a combination of falls from 1 to 5 m (OR = 5.8, p = 0.000) and presence of other fractures (pelvic, head, lower, and upper limb fractures) (OR = 5.1, p = 0.006); showed excellent discrimination in diagnosing a spinal fracture at the thoracolumbar junction (AUROC = 0.72) with sensitivity 70% and specificity 74%. Conclusion Our prediction rules, including a set of demographic and clinical variables at hand in the emergency room can guide trauma patient's screening for timely spinal fracture diagnosis and treatment. Our models, although stable and with acceptable discrimination should be validated and put to test in other populations.