bluuebunny/crossref_metadata_2025_split huggingface dataset:
Locomotor Improvement after Spinal Cord Injury by Multiple Injections of Bone Marrow Mononuclear Cells without Local Inflammatory Modulation
Authors: Bonatto Francine , Falavigna Asdrubal , DaCosta Jaderson 
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 the study was to compare the results of treatment groups with 3 and 5 applications of bone marrow mononuclear cells (BMMC) in the subarachnoid space through a lumbar puncture in a rat SCI model. Subsequently, the motor function and inflammatory rate at the site of injury were analyzed. Materials and Methods The study design was an experimental animal study of SCI, using a stem cell (SC) delivery system. The experiment was done using an animal model of thoracic SCI with aneurysm clip compression. Afterwards, these animals were treated with 3 (BMMC3) or 5 (BMMC5) applications of BMMC directly into the subarachnoid space using a lumbar puncture. The control group received saline solution (SS) that was injected at the same time and frequency (SS3 and SS5) used for BMMC delivery. The animals were sequentially evaluated for motor function using the BBB scale for the presence of BMMC in the lesion by PCR, and the local inflammatory rate through interleukin (IL-1β) and tumor necrosis factor α (TNF-α), which were analyzed by immunohistochemistry. Results The BMMC5 group showed significant differences in motor scores over the entire study when compared with their SS5 control group. At the end of the treatment, there was a similar motor performance when both treatment groups (CMM3 vs. BMMC5) were analyzed. In both treatment groups and their control there was no difference in the inflammatory rate. The PCR could not detect the presence of BMMC at the injury site. Conclusion Multiple administration of BMMC in the subarachnoid space through lumbar puncture improves locomotion without showing local inflammatory modification.
The Influence of Spinal Deformity on Acetabular Orientation in Total Hip Arthroplasty
Authors: Phan Duy , Bederman Samuel S. , Schwarzkopf Ran 
Published: May 2015

Introduction The interaction between the lumbosacral spine and the pelvis is complex. This interface is further complicated by preexisting pathology and by positional change. Our study examines the influence of spinal deformity on positioning of total hip arthroplasty (THA). A guideline is provided to assist in preoperative planning and improved communication between hip and spine subspecialists. Materials and Methods A comprehensive literature review was conducted investigating the relationship at the spinopelvic junction. Specific topics examined included methodology to measure acetabular and spinal orientation, acetabular anteversion (AA) with spinal imbalance and rigidity, hip functional range of motion with positional change, and hip functional range of motion after THA. Information and results that were consistently sourced were used to create specific recommendations for the hip and spine subspecialists. Both schematic and visual representations of the different recommendations were constructed. Results There is a predictable change in sagittal acetabular orientation that is influenced by lumbosacral balance and flexibility as well as by positional change. Preoperatively, patients in need of THA can be screened with sitting and standing lumbar radiographs into four categories based on flexibility and sagittal balance of the spine: flexible/balanced, flexible/unbalanced, rigid/balanced, and rigid/unbalanced. Patients in the flexible/balanced category should have AA during THA in the standard safe zone of 5 to 25 degrees. Patients with spinal rigidity will require adjustment of AA to limit impingement and dislocation. Patients with spinal imbalance, whether rigid or flexible, will be best addressed by spinal realignment or alternatively may require adjustment of AA to accommodate for compensatory pelvic retroversion. Conclusion Sagittal imbalance of the lumbar spine, combined with spinal fusion or ankylosis from degenerative changes, influences AA during THA. Patients can be preoperatively screened into four different categories based on lumbosacral balance and flexibility. Acetabular cup placement can be optimized based on the type and significance of coexisting spinal deformity to increase hip functional range of motion. Spinal realignment should be considered primarily for unbalanced patients before THA to ensure ideal placement of the acetabular cup.
The Efficacy and Accuracy of Cone Beam CT (O-Arm) Navigation (StealthStation) on Screw Position in Adult Scoliosis Surgery
Authors: Strelzow Jason , Mendelsohn Danny , Dea Nicolas , Fisher Charles , Dvorak Marcel , Street John 
Published: May 2015

Introduction Intraoperative CT and navigation systems may provide an opportunity to improve precision and accuracy of pedicle screw placement, and in so doing, improve patient outcomes. Adult spinal deformity provides unique anatomical challenges potentially amenable to spinal navigation. Our study aimed to examine the efficacy and safety of intraoperative cone beam CT navigation for pedicle screw placement in complex spinal deformity cases. Material and Methods We identified all patients treated at our institution with spinal fusion for the primary diagnosis of major adult deformity between January 2008 and December 2012 in whom O-arm and StealthStation navigation was used (NAV). A historic control cohort (non-NAV) was matched based on age, number of levels, curve type and size, and previous fusion. The number and timing (intraoperative, early symptomatic postoperative, late symptomatic postoperative, and incidental) of screw malposition and the need for revision screw placement were recorded. All patients had a minimum follow-up of 1 year. Any screw with pedicle breach greater than 0 mm was recorded as misplaced. The direction and anatomical level of misplaced screws were also determined. Quantitative statistical analysis compared screw placement between NAV and non-NAV cases. Results A total of 56 patients met the inclusion criteria in both cohorts (112 patients). The mean number of screws placed in each group was not significantly different (17.29 in NAV and 17.71 in non-NAV, p = 0.75). Thirty-eight (34%) patients in the non-NAV group had misplaced screws compared with 21 (19%) in the NAV group ( p = 0.002). The detection of incidental screw malposition was significantly higher in the non-NAV cases (44.6 vs. 23.2%, p < 0.05) and the need for intraoperative screw revision favored navigation ( p < 0.03). Six cervical screws, 16 cervicothoracic, 90 thoracic, and 112 lumbar screws were placed. Early postoperative screw revision rates approached significance ( p < 0.06) favoring navigation. The number of adverse events and length of stay (mean 17 vs. 20.4 days in NAV and non-NAV groups, respectively) were not significantly different. The mean number of postoperative CT scans was significantly fewer in the NAV group (9 vs. 22 in non-NAV group, p = 0.004), while mean OR time was statistically different between groups (492 minutes in the NAV group vs. 408 minutes in the non-NAV, p = 0.002). Conclusion Our results demonstrate that intraoperative CT-guided navigation provides an equally safe and more accurate and precise tool for pedicle screw placement than traditional techniques in adult spinal deformity surgery. There were more intraoperative screws adjusted and fewer postoperative screws revised with NAV. Far fewer patients required postoperative CT examination with the use of NAV.
Laser Modified PEEK Implants as an Adjunct to Interbody Fusion: A Sheep Model
Authors: Briski David C. , Zavatsky Joseph M. , Cook Brandon W. , Ganey Timothy 
Published: May 2015

Introduction Advances in laser technology have been used to imprint mimetic surface patterns on PEEK implants that mirror isotropic bone in an attempt to enhance fusion. In vitro cell culture analysis suggests that laser surface etching enhances the deposition of matrix and preferentially encourages the attachment of bone. We evaluated the effect of mimetic patterning on PEEK cages on fusion in a sheep model. The aim of the study is to evaluate mimetic patterning on a polyether ether ketone (PEEK) cage as an innovative and alternative method to achieve solid interbody fusion in a sheep model. Methods PEEK implants were developed using advanced laser technology to produce a surface mimetic that was analogous to isotropic bone. Following IACUC approval, identical implants were placed in 20 sheep using an anterior approach to C3–4 with supplemental plating. Sheep were divided into four groups: Group 1, mimetic patterning without autograft; Group 2, mimetic with autograft; Group 3, no mimetic patterning with autograft; Group 4, no patterning without autograft. Sheep were analyzed at 3 and 6 months by radiography, CT, MRI, and histopathology. Nine sheep were sacrificed at 3 months for micro-CT and histological analysis. At 6 months, the remaining 11 sheep were analyzed. Results Radiographs and viable CT scans of all 20 sheep at 3 months demonstrated the greatest radiographic evidence of fusion in Group 1 (mimetic without autograft). Micro-CT and histological data were available in the nine sheep that were sacrificed at 3 months. Group 1 demonstrated more abundant mineralized matrix and bony attachments at the implant's mimetic surface interface consonant with fusion. The 11 sheep available for analysis at 6 months sustained evidence of lamellar bone formation adjacent to the implant, reduction in fibrosis, and a more cellular and highly vascularized bone. Conclusion Surface modification of PEEK spinal implants with a pattern and topography that mirrored isotropic bone enhanced fusion in a large animal model. In vitro cell culture analysis had suggested that laser surface etching boosted the deposition of mineralized matrix and preferentially encourages the attachment of bone cells. Three-month micro-CT and histological data, extended to additional corroboration at 6 months by both radiography and histology, confirmed these findings in the sheep model. Abundant mineralized matrix and bony attachment were found at the mimetic surface interface of the implant suggesting fusion in Group 1 in this sheep model.
The Specific Features of Logistic Regression Curves That Can be Used for Classification of Cases and Decision-Making
Authors: Bokov Andrey 
Published: May 2015

Introduction Logistic regression analysis is frequently used to estimate the relationships between dichotomized dependent variable and continuous independent variable; however, even an evidence of highly significant relationship could be insufficient for the decision-making. Thorough analysis of event probability growth patterns could be helpful to classify cases and to determine cut-off criterions that could be based on critical points of the graph corresponding to the changes in the velocity of event probability growth per unit of predictive variable. The objective is to study the specific features of logistic regression curves to evaluate those critical points. Materials and Methods A total of 15 logistic regression functions estimated during scientific studies were analyzed. Points in the graph that correspond to the changes in velocity of probability growth per unit of predictive variable were estimated using second, third, and fourth derivatives of estimated logistic regression functions. The calculated values were then used for predictive variables corresponding to zero points of derivatives to calculate the respective probability values applying estimated previous logistic regression function. Finally, the structure of logistic regression graphs was analyzed and divided into several parts as shown in Fig. 1. Results Typical logistic regression curve is shown in Fig. 1. It was revealed that logistic regression function graphs have the same structure. Point A corresponds to zero point of second derivative, the value of corresponding probability is 0.5. B and B1 points correspond to zero values of third derivative, the values of probability are 0, 21132 and 0, 0.788675, respectively. C and C1 correspond to zero points of fourth derivative and the corresponding probability values are 0.091751 and 0.90824, respectively. Up to point C, there is a baseline of the event with a minor velocity of probability growth. Part of the graph (from point B to C) represents the initial increase in velocity of probability growth, while the one from B to B1 represents maximal velocity of probability growth per unit of predictive variable. Conclusions This type of analysis can be applied to decision-making, while it is possible to reveal borders for part of the graph that is indicated as B–C part in Fig. 1. This part of the graph corresponds to the initial acceleration in probability of event growth per unit of predictive variable (e.g., the onset of the disease); consequently, those patients should be put under observation. Further shifts of predictive variable value to the B–B1 part of the graph should be taken under consideration and appropriate treatment should be applied as the velocity of probability growth becomes maximal. The example for this analysis application could be a relationship between low energy vertebra fractures rate and bone density.
Radiographic and Functional Evaluation of the Iliac Bone Graft in the Treatment of Adolescent Idiopathic Scoliosis
Authors: Fernando Franzin , Gotfryd Alberto , Neto Nicola , Poletto Patricia , Milani Carlo , Mattar Thiago , Rodrigues Luciano 
Published: May 2015

Introduction This study aimed to assess the impact of the use of an additional iliac bone graft on functional and radiographic results after thoracic spine arthrodesis with pedicle screws in patients with adolescent idiopathic scoliosis. Patients and Methods Participants were divided into two groups: a control group that received only local bone (CG; n = 19) and a second group that, in addition to this procedure, received an iliac graft (IG; n = 22). The evaluations were performed on preoperative, immediate postoperative, and last follow-up (mean 29.7 months; minimum 12 months). Radiographic evaluations included the loss of correction and the presence of nonunion. The functional outcome was evaluated using the Scoliosis Research Society-30 questionnaire. Surgical complications and the presence of iliac donor site pain were also described. Results There were no significant differences between groups in the pseudoarthrosis rate, loss of correction over time, and quality of life. The loss of correction was 5.9% in IG and 7.5% in CG ( p = 0.504). There was one case of pseudoarthrosis on IC and consolidation rate was 95.4% in IG and 100% in the CG ( p = 0.537). Functional evaluation, using the SRS-30 questionnaire, showed no differences between groups. At the end of follow-up, all the patients of both groups presented good scores regarding satisfaction with the treatment. Conclusion We concluded that the addition of bone graft from the iliac yielded no benefit in terms of the fusion rate and functional outcomes. The appropriate facetectomy, bed preparation, and filling with a local bone graft must be adequate to achieve an adequate fusion on surgical treatment of adolescent idiopathic scoliosis.
Determinants of Lumbar Curve Behavior in Lenke Type IA and B Thoracic Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Fusion
Authors: Elmalky Mahmoud , Arealis George , Grevitt Michael 
Published: May 2015

Introduction Study design: prospective. Objectives To assess lumbar curve behavior in Lenke IA and B curves treated by selective thoracic posterior fusion. Test hypotheses were that spontaneous lumbar curve correction (SLCC) would be better with smaller initial deformities, in more flexible curves, and of greater magnitude with higher metal density. Summary of Background Data There are different and often conflicting recommendations regarding selection of lowest instrumented vertebra and best approach which provides the greatest SLCC. All-pedicle-screw constructs and increasing metal density are recent trends. However, few reported the fate of the residual unfused lumbar curve. Material and Methods Thirty-three patients with AIS Lenke 1A/B (single surgeon) were included with a minimum follow-up of 2 years. Mean age was 14.2 years (9–19 years). All had all-pedicle-screw constructs with mean metal density of 58% (36–75%). The mean fused level was 10.3. Results The mean thoracic Cobb angle for preoperative, immediate postoperative, at 1-year, and final follow-ups were 60.6, 15.5, 15.9, and 17.2 degrees, respectively (mean flexibility 49.4% [10–96%]). Lumbar curve preoperative mean Cobb angle was 29.6 degrees (14–53 degrees) (mean curve flexibility 79% [40–96%]). Cobb angle at immediate postoperative, 1-year, and 2-year follow-ups were 9.2, 8.9, and 9.4 degrees, respectively. The mean lumbar lordosis angle preoperatively and at final follow-up was 57.3 and 55.9 degrees. Maximum SLCC was achieved within 6 weeks and maintained throughout. No lumbar decompensation was noted. There was significant correlation between the percentage correction of the thoracic curve and SLCC percentage ( p = 0.027). There was no significant correlation between SLCC and the preoperative thoracic curve magnitude ( p = 0.16). Similarly, there was no correlation between metal density and SLCC ( p = 0.62). The patients were divided into two groups according to the flexibility (< 40 and ≥ 40%). There was no correlation between the SLCC and curve flexibility. Conclusion Our results demonstrate that in Lenke IA and B curves treated with selective pedicle-only posterior fusion, there were no decompensation, lumbar curve was corrected significantly, and SLCC was completed within 6 weeks and maintained. Lumbar lordosis remained normal. The percentage of lumbar curve correction was neither associated with its initial Cobb angle magnitude nor flexibility. Finally, magnitude of preoperative thoracic curve, latter curve percentage correction, and metal density did not affect SLCC.
Efficacy of Electromyography in Identification of Pedicle Screw Position in Adolescent Idiopathic Scoliosis
Authors: Pratali Raphael , Barsotti Carlos Eduardo , Gavassi Bruno , Ferreira Ricardo , Oliveira Carlos Eduardo 
Published: May 2015

Introduction Pedicular screw has become the most popular device in spine surgeries, especially in the treatment of adolescent idiopathic scoliosis (AIS). They lead to better curve correction in coronal, sagittal, and rotational planes, shorter constructions, and better pulmonary function compared with other devices. Despite those advantages, this technique is potentially dangerous. Intraoperative neuromonitoring is frequently used to detect the misplacement of screw and reverse possible neurological complications. The aim of this study is to analyze the relation between electromyographic records of the inserted screws and their position by postoperative CT scan. Materials and Methods This is an observational prospective study which includes 16 patients undergoing AIS surgical correction between March and December 2013 at one institution. All procedures were monitored with electromyography (EMG) of the inserted screws and the stimulation threshold of each screw was recorded. Those values were compared with the position of the screws, based on the postoperative CT scan, according to the classification proposed by Abul-Kasim et al. Results Included were 16 patients with 281 pedicles instrumented (17.5 per patient). No patient presented with any neurological deficit or complaints after surgery. In the axial plane, 195 screws were ideally inserted in the pedicles (69.4%) and in the sagittal plane, 226 screws were ideally inserted in the pedicles (80.4%). Considering both the axial and sagittal planes, 166 (59.1%) did not breach any pedicular cortical wall. No statistical correlation was observed between EMG threshold and screw position in the axial CT-scan position, as in the medial or lateral misplacement ( p = 0.425), but statistical significant correlation was observed between EMG threshold and screw position in the sagittal CT-scan position, with smaller results when the screws were misplaced inferiorly, closer to the foraminal roots ( p = 0.017). Conclusion Pedicular screws were safe in this AIS surgery series, even with misplaced position. EMG monitoring has shown to be efficient in identifying misplacement of pedicle screws in the sagittal plane (inferior foraminal perforation) but not so much in identifying the axial plane misplacement (lateral or medial).
Treatment of Pediatric Scoliosis with Daytona Instrumentation Using the Cluster Technique
Authors: Ling Tah , Cardoso Pedro , Alves Cristina , Balaco Ines , Matos Gabriel 
Published: May 2015

Introduction The authors show their experience with the use of Daytona instrumentation in the treatment of pediatric spine deformities. In the correction maneuvers it is important to build up clusters that are groups of pedicle screws joined together for stability in the derotation and provide greater force in the correction and also to prevent the hypokyphosis effect of all screw construct in the scoliosis correction. Materials and Methods Our department used the Daytona system in 81 patients with pediatric scoliosis since March 2011. The Daytona instrumentation is a novel instrumentation that uses pedicle screws with long tulips in their basic construction. The screws are uniplanar or polyaxial and the tulips are 30 mm long, which makes it much easier to put the rod in the construction without the need of a persuader and helps in the initial correction maneuver. The caps are specially designed to embrace the rod and prevent splaying of the screw during the tightening and untightening. The scoliosis correction maneuver that we used were rod derotation, derotation of the spine with groups of screws (cluster), “in situ” bending, compression and distraction, and segmental derotation. Using the clusters, there are less chances of screw pullout and splaying. Generous Ponte osteotomies are important for spine flexibility and better correction. We use Lenke's classification for the classification of scoliosis. We analyze the follow-up time, curve angles, flexibility, and the Cincinnati index. For patients with idiopathic scoliosis, we use the SRS 22r outcomes questionnaire. Results Retrospectively, we analyze 81 patients with scoliosis, 64 female and 17 male, with a mean age of 13.96 years (10–17 years). A total of 88% of the patients had idiopathic scoliosis. Others are neuromuscular and syndromic patients. Preoperatively, the mean angle was 78.09 degrees (38–120 degrees) and the mean flexibility index was 30.7%. Postoperatively, the mean angle was 23.6 degrees (5–62 degrees). Correction percentage was 68.1% and the Cincinnati index was 3.33%. The mean follow-up time was 16.9 months, at last follow-up the mean curve angle was 24.7 degrees, representing a loss to the postoperative period of 5% of loss of correction. The most frequent complications that we encounter were temporary loss of MEP and screw breakage. Comparing with the literature, the Daytona system is as effective as other systems in the market. Conclusion The Daytona instrumentation is a very good system for the treatment of adolescent idiopathic scoliosis; it is as effective as other systems with the added advantage of being much easier to place in the patient, and with the cluster technique we can save money with fewer screws and the derotation maneuver with clusters is a powerful correction technique.