bluuebunny/crossref_metadata_2025_split huggingface dataset:
Responsiveness of Different Validated Patient Reported Outcome Measurements in Cervical Spine Care
Authors: Klemencsics Istvan , Lazary Aron , Bozsodi Arpad , Szollosi Balazs , Varga Peter 
Published: May 2015

Introduction The importance of use of patient-reported outcome measurements (PROMs) in spine care has been previously widely reported, especially for lumbar conditions. One of the main clinicometric properties of a PROM is the responsiveness showing its discriminative ability between good and poor global treatment outcomes. Very limited data about the responsiveness of different cervical PROMs have been published so far. The aim of the study was to analyze the responsiveness of three validated cervical PROMs on a prospective clinical cohort. Material and Methods A total of 100 patients with degenerative cervical spinal disorders were recruited into the study. The patients filled out the cross-culturally adapted Hungarian versions of the Neck Disability Index (NDI), the Neck Pain and Disability Scale (NPAD), and the Core Outcome Measures Index for neck (COMI). Test–retest method was applied to assess the validity and reliability dimensions of the questionnaires. Patients completed the questionnaires 3 months after the surgical or nonsurgical treatment. Two different five-point Likert scales on global treatment outcome were used to determine the “good” and “poor” results. The receiver operating characteristics (ROC) method was used to evaluate the discriminative ability of the given change score relative to the outcome (c-index). SPSS 20.0 statistical program package was used for the analyses where p < 0.05 was considered significant. Results Correlation of the PROMs with pain was very good (r = 0.65, 0.73, and 0.79 for NDI, NPAD, and COMI, respectively). Intraclass correlation coefficient for the reliability measurement was high for all the three PROMs (ICC = 0.90, 0.85, and 0.89 for NDI, NPAD, and COMI, respectively) and the other clinicometric parameters showed good reliability and validity of the three PROMs in the test–retest phase of the study. For the question about the success of the applied treatment, the c-index was 0.66, 0.76, and 0.65 for NDI, NPAD, and COMI, respectively. When patients replied about the health of their cervical spine, the c-index proved to be 0.74, 0.85, and 0.68 for NDI, NPAD, and COMI, respectively. Conclusion Hungarian versions of NDI, NPAD, and COMI proved to be valid and reliable condition-specific measurements. The discriminative ability between “good” and “poor” global treatment outcome of the three PROMs was good, especially for the NPAD which performed significantly better in the responsiveness dimension than the other two PROMs. Based on our results, we can conclude that the use of condition-specific PROMs in cervical spine care is desirable but the performance of the PROMs can be different in certain clinicometric dimensions. Nevertheless, further studies considering the potential differences in different conditions and treatments are needed.
Role of MRI Features as a Prognostic Index in Cervical Spondilogenetic Myelopathy
Authors: Iodice Savino , Zelletta Nicola , Cecchini Giulio , Di Benedetto Mariagrazia , Cirrottola Giovanni , De Tommasi Antonio 
Published: May 2015

Introduction The importance of a correct preoperative radiological diagnosis in patients with cervical myelopathy has been widely demonstrated. Indeed, few studies still exist about the correlation between postoperative radiographic and clinical modifications. Materials and Methods The authors present a prospective study of 54 patients with cervical spondilogenetic myelopathy, who underwent surgery for corpectomy and anterior fusion with mesh in a period between January 2005 and August 2013. Images of cervical RMN were studied pre-and postoperatively and attention has been focused on alterations of intramedullary signal on T1- and T2-weighted sequences. Pre-and postoperative changes were correlated with clinical data (obtained by means of a Nurick scales and JOA classification—modified by Benzel). In relation to cervical RM-based studies, patients were divided into 3 groups: (A) no intramedullary signal alteration; (B) alterations in T2-weighted sequences; (C) alterations of the signal in both T1- and T2-weighted sequences. Results In all patients, decompression of the cervical spinal cord has been demonstrated by extension of the anteroposterior diameter of the spinal canal and by increase in the thickness of the subarachnoid space. In group A patients, no intramedullary signal changes were highlighted postoperatively. Patients in group B showed improvement on the base of hyperintensity disappearance on T2-weighted MRI, correlating with an improvement in the clinical quadro. Patients of group C have not been showing changes in the intramedullary MRI signal despite spinal cord decompression. Conclusions Signal alterations in T1 are an unfavorable prognostic index and proved to be irreversible. They correlate with a lack of clinical improvement of the patient. Patients in group B are those with the greatest clinical benefit after surgery and in whom clinical improvement correlates clearly with the radiological outcome.
Severity of Dysphagia after Anterior Cervical Surgery
Authors: Zaater Ahmed 
Published: May 2015

Introduction Several studies show a relatively high incidence of dysphagia following anterior cervical decompression and fusion (ACDF). Most of these studies are retrospective and lack a control group. This is a prospective study to show the incidence and severity of dysphagia after ACDF using lumbar decompression patients as a control group, and to show factors associated with increased postoperative dysphagia. Materials and Methods We prospectively followed patients undergoing ACDF single or double level ( n = 43) and posterior lumbar decompression ( n = 58) (control group). Patient data were recorded. We assess dysphagia using special questionnaire preoperatively and during the 2-week, 6-week, and 12-week postoperative visits. We found no significant differences between the patients who had cervical and lumbar surgery with regard to patient age, body mass index, or the preoperative incidence and severity of dysphagia. Results Postoperative dysphagia was reported in 75% of the patients having cervical spine surgery at 2-week follow-up. This incidence decreased to 10% at 12-week follow-up. The cervical group has higher incidence and severity of dysphagia at 2- and 6-week follow-up with a trend toward greater dysphagia at 12-week follow-up. The risk of developing dysphagia was not related to the body mass index, sex, location of surgery, or the number of surgical levels. We observed that operative time was correlated with the severity of postoperative dysphagia. Conclusion Dysphagia after anterior cervical spine surgery is a common early finding. However, dysphagia decreases over time, it decreases significantly by 12 weeks.
Subsequent Cervical Disc Herniation following Single-Level ACDF
Authors: Jeon Ikchan , Cho Yongeun , Chin Dongkyu 
Published: May 2015

Introduction Subsequent herniated cervical disc (HCD) and revision anterior cervical discectomy and fusion (ACDF) is not an uncommon disease and procedure. And we, as a spinal surgeon, have some difficulties in decision-making, because of the airway, esophagus, and vocal cord problems. Adjacent segment disease is well known as the pathologic process, in which the changes in the other segment may occur at the cranial or caudal segment. In this study, we discuss about the subsequent HCD which requires surgical treatment following single-level ACDF. Materials and Methods From 2006 to 2012, 27 Korean patients, who were operated for subsequent HCD following previous ACDF, were enrolled. The subsequent HCD was detected not only in adjacent segments just around fused spine but also in the skipped segments. A total of 23 patients were approached anteriorly (22 revision ACDF and 1 anterior foraminotomy) and 4 patients were approached posteriorly for posterior keyhole surgery. All 23 patients with anterior approach were evaluated for vocal cord palsy before anterior revision surgery. We retrospectively reviewed and analyzed the pre- and postoperative data. Results The subsequent HCD significantly occurred on the caudal segment in patients with C3–4 and C4–5 fused patients and on the cranial segment in C6–7 and C7–T1 fused patients ( p = 0.045). In C5–6 fused patients, the subsequent HCD occurred similarly, both caudally and cranially (5 cranially, 6 caudally). The use of plate in primary ACDF has no significant effect on either the caudal or the cranial segment ( p = 0.168). The direction of approach in primary ACDF (right vs. left) was mainly on contralateral side to the patient's symptom ( p = 0.007), whereas there was no laterality of approach in the revision ACDF according to the symptom and previous ACDF ( p = 0.767). Vocal cord palsy developed only in one patient with anterior keyhole surgery, who had been approached right in primary ACDF and left in revision surgery and there was right-sided vocal cord damage. Conclusion Revision ACDF was the major surgical method for subsequent HCD. There was no relationship between the laterality of the approach according to the previous operation and development of vocal cord palsy. The vocal cord palsy was detected in a significantly lower incidence (4.3%, 1/23) compared with the results of other studies. The subsequent HCD had a tendency of developing in the caudal segments in C3–4, 4–5 fused patients and in cranial segment in C6–7, C7–T1 fused patients. In C5–6 fused patients, the subsequent HCD occurred both caudally and cranially.
Changes in Lumbosacral Radiographic Parameters after Minimally Invasive Lumbar Interbody Fusion
Authors: Vialle Emiliano , Vialle Luiz Roberto , Carneiro Abel , Colina Orlando 
Published: May 2015

Introduction Modern techniques have allowed for less aggressive surgeries and faster postoperative recovery. This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent or rectangular shape) would influence the results. Method This is a retrospective analysis of 70 patients who underwent one or two-level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (3–6 months postoperatively) radiographs were used for measuring lumbar lordosis (LL), segmental lordosis at the level of interbody fusion (SL), and sacral slope (SS). Further analyses divided the patients into Roussouly lumbar subgroups. Results LL was significantly reduced after surgery (59:39 degrees, p = 0.001) as well as the SS (33.8:31.2 degrees, p = 0.05). SL did not change significantly (11.4:11.06, p = 0.85). There were no significant differences when comparing patients who received crescent-shaped cage ( n = 27) and rectangular-shaped cage ( n = 43). Hypolordotic patients (Roussouly types 1 and 2) had radiographic improvement in comparison to normo and hyperlordotic groups (types 3 and 4). Conclusion Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Hypolordotic patients showed improvement in radiographic measurements, in comparison to normo and hyperlordotic ones.
Transpedicular Biopsy versus Bone Densitometry in Diagnostic Process for Osteoporosis
Authors: Tellez Duarte Agustin 
Published: May 2015

Introduction Osteoporosis is a pandemic disease that affects women and men worldwide, being the principal cause for bone fractures after the age of 75 years, making a gigantic cost in health for families, institutions, and countries. There is a need for a simple, sensible, and specific system of detection and diagnosis for this disease. It is also needed for it to be identified as a disease apart from other vertebral and bone destruction processes. Bone densitometry does give us a good sensitivity 95% but less than 45% of specificity, so many times other bone diseases get diagnosed wrongly as osteoporosis and mistreated and vice versa. Because of this situation, our study proposes the use of a transpedicular biopsy be added as part of the osteoporosis diagnostic schedule. We also took the advantage of our study for doing optic and electronic microscopic analysis of each sample to see the microarchitecture of the trabecular and transpedicular bone searching and describing specific disease patterns in osteoporotic bone. Materials and Methods Overall, 30 human vertebral body specimens, OSAT questionnaires, bone densitometer, Trans Quirurgical Jamshidi trocar, pathologic specimen analysis equipment for optic and electronic microscopy, and SPSS data analysis software. During the spine surgery consultation processes, all the patients older than 45 years were given OSAT questionnaires to answer. Patients who came out positive were subject for a bone densitometry. From this list of patient, those attending for a spine surgical procedure were under previous authorization summited to a transpedicular vertebral body biopsy. Each specimen was processed for optic and electronic microscopy then they were analyzed for the following microstructural characteristics: trabecular alignment and density, collagen fibers and their bonds, cell number, and collagen chain alignment. Three different observers analyzed all data and a Kappa analysis was determined, together with a Pearson correlation. Results This protocol is still in process and the results will be ready for February 25, 2015. Conclusion This protocol is still in process. Conclusion of the study will be ready for February 25, 2015.
Comparative Study of the Results and Complications of the Growing Rod System versus VEPTR System for the Treatment of Early Onset Scoliosis
Authors: Montero Carlos , Meneses David , Alvarado Fernando , Godoy Wilmer , Zuluaga Julian , Mendez Ricardo 
Published: May 2015

Introduction Congenital and neuromuscular scoliosis occurring in children younger than 5 years have a high likelihood of progressing and end in severe curves. The concepts of treatment have changed with the emergence of distraction systems as VEPTR (vertical expandable prosthetic titanium rib) and growing rods. The aim of this study is to compare the clinical outcomes and complications that occur with the two systems used in the Instituto de Ortopedia Infantil Roosevelt. Methods An observational study of the transversal, comparative cut was designed by evaluating spinal surgeries performed between 2008 and 2012 at the Instituto de Ortopedia Infantil Roosevelt, including patients in whom implantation of an elongation system was performed and then underwent a program of periodic lengthening with VEPTR technique or growing rods. The number of elongations performed analyzed the surgical time, postoperative Cobb angle, bleeding, and complications. For quantitative variables, measures of central tendency and dispersion measures and confidence intervals were obtained; for those qualitative variables, ratios and confidence intervals at 95% were obtained. Statistical differences between groups were evaluated using the Student t test, Mann–Whitney U, Pearson chi-square, and Fisher exact tests depending on the nature of the variable. Analyses were performed using SPSS statistical software Statistics Version 21. Results A total of 40 patients met the selection criteria, 17 patients with growing rods and 23 patients with VEPTR system. The composition of the two groups had similar clinical characteristics. No significant differences in mean elongations number, bleeding, and implantation time were observed; however, the average correction of the deformity with the growing rods system (50.89 degrees) was 15.89 degrees higher than with the VEPTR (30.0 degrees) system. The complications were more frequent with VEPTR system: for the growing rod system six patients (35%) had complications, while for the VEPTR system was 10 patients (43%). However, complications because of the failures in the implanted materials were more frequent in patients with rods 35.3%, compared with 4.3% in the VEPTR, and clinical complications were more frequent in the VEPTR 43%, compared with 11.8% in growing rods. Conclusion When comparing different elongation systems of the spine, used to treat the congenital and neuromuscular scoliosis in children younger than 5 years, we conclude from this study that the correction of the scoliotic curve is higher with the growing rods system, but with more complications related with implant failures and minor clinical complications compared with VEPTR; these results are similar to those found in the literature.
Preservation Technique of Autologous Bone in Scoliosis Surgery
Authors: Godoy Miguel Angel , Tello Carlos A. , Francheri Ida Alejandra , Noel Mariano A. , Galaretto Eduardo , Remondino Rodrigo G. , Bersusky Ernesto 
Published: May 2015

Study Design This is a retrospective study. Objective This study aims to describe surgical technique of locally wound autologous bone conservation when primary surgery becomes mandatory to be staged, described as well the evolution and technique complications. Introduction One of the goals of scoliosis surgery is to halt the progression of curves achieving solid fusion. The contribution of additional bone graft in particular cases is critical. There are different types of bone grafts or bone substitutes, with different costs, and technical complications; it has become increasingly important the way to obtain and preserve a good amount of autologous bone. Patients and Methods A total of 12 patients, who required two-staged surgical procedures, were operated from June 2012 to April 2014 in our Spine Department. A subfascial pocket was performed in paraspinal muscles at the distal end of the surgical field where we added 1 g of vancomycin every 50 mL of bone graft. Surgical procedure, surgical correction, and complications with a full detailed analysis of infectious complications were assessed and recorded. Results Overall, 12 patients were operated in our hospital Spine Department with a two-staged surgical procedure plan. Patients mean age at surgery was 14 years. The etiology of deformity consisted in five idiopathic scoliosis, three congenital scoliosis, one associated with high-grade spondylolisthesis, two neuropathic scoliosis, and one myopathic scoliosis. In five cases (41.6%), surgery was initially staged in two different surgical days according to surgeon criteria and spinal severity deformity, in the other seven cases (58.4 degrees), the surgeon in charge, resolved to reschedule the surgical procedure in two different stages because of some intraoperative urgent event. The mean preoperative scoliosis angular value was 92.8 degrees. The mean postoperative scoliosis angular value was 42.4 degrees. We found that every patient in this study group required three surgical procedures to solved spinal deformity. Five patients developed superficial or deep infection (41.6%). Conclusion The local conservation of autologous bone graft in severe scoliosis surgery that has to be rescheduled or was already staged in 2 different days can be performed by storing the local bone graft in a subaponeurotic or subfascial pocket, with proper bone fusion imaging recordings, without incurring in an increasing risk of infection diminishing health costs.
Evaluation of the VEPTR (Vertical Expandable Prosthetic Titanium Rib) Device in the Treatment of Patients with Congenital and Neuromuscular Spinal Deformities
Authors: Montero Carlos , Meneses David , Godoy Wilmer , Alvarado Fernando , Acosta Margarita 
Published: May 2015

Introduction Multiple methods are included in the management of congenital, neuromuscular, or idiopathic scoliosis in younger patients. The traditional surgical treatments, such as, in situ fusion and hemiepiphysiodesis have not addressed the thoracic deformity in three dimensions, and the results are usually insufficient and unpredictable. The objective of the VEPTR management is focused on the chest wall extensions, to provide more space for the developing lungs, and prevents progression of the scoliotic deformity. From results of studies on the effectiveness of patients with VEPTR within early onset scoliosis, we designed a retrospective case series study for clinical and radiological outcomes of VEPTR system in the management of patients with spinal deformities in congenital and neuromuscular scoliosis. Patients and Methods This is a retrospective case series study. A total of 23 patients, 15 women and 8 men, with congenital and neuromuscular scoliosis, treated with VEPTR implantation, from January 2008 to May 2014 were included. The average age for the initial insertion of VEPTR was 5 years (range, 8 months–12 years), with an average follow-up time of 26 months. Specific data for the construction of the implant were collected; the pre- and postoperative X-rays were measured by the Cobb method to evaluate the magnitude of the curve, and the total length of the system in the coronal plane before insertion of the VEPTR device, and after each elongation were measured. In addition, complications such as infection, failure of material, pressure zones, synostosis, and hemothorax were evaluated. Results Our results demonstrated that there was an improvement in the postoperative Cobb angle measurement in the coronal plane. In children with congenital scoliosis, the average correction was 13% ( p < 0.001) and in neuromuscular scoliosis was an average correction of 22% ( p < 0.001). Likewise, there was an increase of the thoracic length measured through the VEPTR device, developing an average elongation of 9% of the column in children with congenital scoliosis and 18% in children with neuromuscular scoliosis. In this study, complications such as device migration, costal synostosis, pressure injuries, rib fractures, hemothorax, and deep infection were identified. Conclusion The data analysis shows that the natural history of progressive spinal deformities in children with congenital and neuromuscular scoliosis was satisfactorily controlled by using the VEPTR device. This allows us to recommend the use of this implant and continue using it in the treatment of patients with these deformities.