bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Sagittal Balance of Cervical Spine after Posterior Open-Door Laminoplasty: Comparison between the Modification by Preserving Unilateral Musculoligament Complex and Anchor Method
Authors: Feifei Z. , Sun Y. 
Published: May 2014

Introduction A balanced sagittal alignment of the spine has been shown to strongly correlate with less pain, less disability, and greater health status scores. The profile of sagittal balance after posterior laminoplasty of cervical spine has not been evaluated extensively. The aim of this study is to investigate parameters of cervical spine sagittal balance after posterior open-door laminoplasty and compare the difference between modified surgery with preservation of unilateral musculo-ligament complex (PUMLC) and anchor method (AM) operation. Materials and Methods A retrospective review of 96 patient records from January 2008 to July 2011 was performed. All patients were diagnosed cervical spondylotic myelopathy (CSM) and underwent C3-7 posterior open-door laminoplasty with preservation of unilateral musculo-ligament complex (5 cases) and anchor method (40 cases). Cervical digital radiographs showed all the important skeletal landmarks necessary for accurate measurement. The radiographs were measured using standard techniques to obtain the following parameters both pre- and postoperation: C2-C7 sagittal vertical axis (C2-C7 SVA), C0-2 lordosis (Cobb angle formed between Occiput-C2), C2-7 lordosis (Cobb angle formed between C2-C7), T1 slope (angle between a horizontal line and the superior end plate of T1), range of motion from C2-C7 (C2-C7 ROM). The status of neurologic function was evaluated by modified JOA score (mJOA). Comparisons of these radiological and neurological assessments before and after surgery and difference between two surgical manipulations were under analysis. Results With an average follow-up period of 16.7 months, there was a significant increase ( p < 0.05) in C2-C7SVA (22.99 ± 1.23 mm), C0-2 lordosis (22.89 ± 0.75 degrees), and T1 slope (25.13 ± 0.67 degrees) postoperatively compared with preoperation (C2-C7SVA 20.82 ± 1.05 mm, C0-2 lordosis 19.56 ± 0.78 degrees, T1 slope 26.22 ± 0.71 degrees). The alignment of lower cervical spine (C2-7 lordosis) did not change significantly after the surgery ( p = 0.09). Both C0-2 lordosis and T1 slope positively correlated with increased C2-C7SVA ( r = 0.44, p < 0.001, and r = 0.27, p < 0.05). All patients experienced an improvement of mJOA (12.23 ± 0.31) compared with pre-op (14.56 ± 0.21). PUMLC had a smaller loss of C2-7 lordosis and C2-7 ROM than AM, but parameters of sagittal balance (C2-C7SVA, C0-2 lordosis, and T1 slope) did not show any statistical significant difference. Conclusion There was a positive sagittal malalignment trend after posterior open-door laminoplasty expressed by enlargement of T1 slope and compensated by increased C0-2 lordosis. Two surgical methods, PUMLC and AM, did not show any statistical significant difference of sagittal balance parameters, but PUMLC had the advantage of maintaining the alignment and range of motion of lower cervical spine. Disclosure of Interest None declared
C1, 2 Pedicle Screw Fixation in Treating Atlantoaxial Instability Guided by Surgical CT Navigation
Authors: Jiang T. , Ren X. , Wang J. , Chu T. , Zhang Z. , Wang W. 
Published: May 2014

Introduction To evaluate the accurate rate of insertion and the short-term curative effect of C1, 2 pedicle screw internal fixation for atlanto-axial instability guided by surgical CT navigation. Materials and Methods Seven patients with atlanto-axial instability were treated by C1, 2 pedicle screw internal fixation and bone graft fusion, guided by surgical CT navigation, including three cases of congenital dysplasia of odontoid process, three cases of atlantoaxial instability, and one case of old odontoid process fracture. Results There was no vascular or neural injury found. The patients were followed up for 3 to 15 months. The clinical symptom was improved in some extent after operation. No looseness or breakage of screw occurred and bony fusion was achieved in all cases. Conclusion C1, 2 pedicle screw fixation is a reliable method for atlanto-axial instability. Accurate rate of insertion can be improved by surgical CT navigation. Disclosure of Interest None declared
Interspinous Dynamic Stabilization with DIAM (Silicone) or InSWing (PEEK) Interspinous Implants
Authors: Berg A. James , Tankel J. A. , Hernandez M. , Jensen C. D. , Purushothaman B. , Reddy G. Raj , Friesem T. 
Published: May 2014

Introduction Foraminal and spinal canal stenosis causes neurogenic claudication. Interspinous devices provide an indirect decompression by distracting the involved vertebrae, thereby tightening the buckled flavum and opening the foramina and attempting to restore normal loading patterns in the lumbar spine which have altered due to disc degeneration. When used for indirect decompression alone, they avoid scar tissue formation in the canal. The DIAM (Medtronic, United States) is made of silicone and therefore conforms more to the interspinous space. The InSWing (Orthofix, United States) is made of PEEK (polyether ether ketone) and is noncompressible. We report the outcomes between these devices and between direct and indirect decompressions. Materials and Methods Retrospective analysis performed for surgery in July 2009 to 2011. Paired and unpaired t-test used to assess statistical significance ( p < 0.05). Results A total of 60 patients were included (22 females, 38 males), age 46 (21-78) years. Preoperative duration of symptoms was 65 (4-420) months. The numbers in each implant/decompression group and follow-up are shown in Table 1. Statistically significant improvement observed in all outcome measures in direct and InSWing groups and all outcomes except MCS in DIAM group. Indirect group improved in all outcomes, but these were significant only in VAS Back/Leg. InSWing and direct group scores improved more than the DIAM and indirect groups, respectively, but these differences were only significant in Oswestry in the decompression group. All five patients requiring revision surgery were in the DIAM group. Conclusion Statistically significant improvement was seen in all outcome measures in patients undergoing direct decompressions or implantation with InSWing implants. Improvement in scores was greater in these groups compared with the indirect decompression or DIAM groups. Disclosure of Interest A. Berg: None declared J. Tankel: None declared M. Hernandez: None declared C. Jensen: None declared B. Purushothaman: None declared G. Reddy: None declared T. Friesem: Conflict with RTI Surgical, Globus Medical
Direct Repair for Treatment of Lumbar Symptomatic Spondylolysis without Spondylolisthesis in Young Patients Using Gillet Technique (V-Shaped Rod)
Authors: Zhang X. , Liang Y. , Wu W. , Cao P. 
Published: May 2014

Introduction Spondylolysis developed during individual growth. In this article, direct repair of the pars defect was used to treat lumbar symptomatic spondylolysis without spondylolisthesis in young patients. Indication and postoperative outcomes of this operation were analyzed, to investigate the method of early treatment of spondylolysis, which can avoid the complication of spinal fusion for delayed isthmic spondylolisthesis caused by spondylolysis. Materials and Methods Twelve cases of lumbar symptomatic spondylolysis were retrospectively reviewed; all the cases received direct repair for the pars defect during 2005 to 2011, and was followed up for at least 2 years. Among them, there are eight cases of male and four cases of female, average 24.5 years old; there are 10 L5 spondylolysis and 4 L4 spondylolysis. They have low back pain and X-ray-confirmed bilateral spondylolysis without spondylolisthesis. There was no disc degeneration on MRI. The operation includes pars debridement, pedicle screw insertion, V-shaped rod connection, and bone autograft. VAS score was used to evaluate the pain status of the patient. Results All the patients got symptoms relieved, VAS score was reduced from 4.8 preoperation to 2.3 postoperation, and they all resumed to original work. During follow-up, the pars defect attained bony union in X-ray and 3D CT scan. Conclusion For the developmental spondylolysis with severe local symptom, but no disc degeneration, direct repair for the pars defect with pedicle screw and V-shaped rod and bone autograft can be used to heal the pars defect. This treatment, which is safe and effective, can reduce occurrence of disc degeneration caused by lumbar instability and delayed spondylolisthesis, avoid complications caused by spinal fusion. Disclosure of Interest None declared
Comparative Evaluation of in Vivo Radiographic Outcomes between Different Implants in Single-Level Cervical Disc Arthroplasty at Greater than 2 Years
Authors: Berg A. James , Tankel J. A. , Jensen C. D. , Irwin A. , Purushothaman B. , Reddy G. Raj , Friesem T. 
Published: May 2014

Introduction Cervical fusion alters the biomechanics of the cervical spine. Adjacent levels compensate for motion lost at the fused levels. This may lead to or accelerate the development of symptomatic adjacent segment disease (ASD). Cervical disc arthroplasty (CDA) is a safe and effective alternative to fusion. It is postulated that by preserving motion at the operated level, the adjacent levels will be protected from ASD potentially related to fusion. ASD will develop over the long-term and therefore CDA implants must maintain motion and mimic the normal biomechanics of a native disc to have the protective effect. Implant design may influence a CDA implant's ability to do this. We aim to assess if the three implants with different designs do display different radiographic outcomes in vivo. Materials and Methods All one-level CDA patients with greater than 2-year radiographic follow-up were identified from hospital records. The C2 to C7 Cobb angle was measured on neutral lateral radiographs. The segmental Cobb angle was measured on lateral neutral, flexion, and extension radiographs with motion of the CDA calculated as the difference between the two later measurements. Any disc with < 2 degrees motion was identified as not exhibiting motion. Results A total of 55 patients were included. Average follow-up was 145 weeks. Three different implants were used—Discocerv (Scient’x-Alphatec Spine, France), NuNec (Pioneer Surgical Technology, United States) and PRESTIGE LP (Medtronic Ltd., United States). The most common operated level was C5/6 with 40 implants. Other levels consisted of one C3/4, four C4/5, and ten C6/7. The number of implants, cervical alignment, segment alignment, and segmental motion (in degrees) is shown in Table 1. There was no statistically significant difference in any outcome between the implants. One PRESTIGE LP required revision after 2 years. Bony fusion was observed in 12.5% of Discocerv, 14.3% of NuNec, and 12.1% of PRESTIGE LP. Twenty-five percent of Discocerv cases had some degree of subsidence, while this was seen in 7.1% of NuNec and 6.1% of PRESTIGE LP implants. Conclusion Our results indicate that CDA implant type influences the alignment of the replaced segment and preservation of motion. This may be due to the different biomechanical designs of the implants. While statistically significant differences were not observed, differences may be clinically significant. We acknowledge that limited conclusions can be drawn from our results due to differing group sizes, but our study serves as a basis and highlights the need for further in vivo and in vitro studies. Disclosure of Interest A. Berg: None declared J. Tankel: None declared C. Jensen: None declared A. Irwin: None declared B. Purushothaman: None declared G. Reddy: None declared T. Friesem: Conflict with RTI Surgical, Globus Medical
An Imaging Anatomical Study on Percutaneous Kyphoplasty for Lumbar via a Unilateral Transverse Process-Pedicle Approach
Authors: Wang Q. , Wang S. 
Published: May 2014

Introduction Objective The aim of the study is to investigate the anatomical feasibility of percutaneous kyphoplasty for lumbar osteoporotic vertebral compression fractures via a unilateral transverse process-pedicle approach (TPA). Summary of Background Kyphoplasty via a unilateral approach has been reported and good clinical results have been achieved. However, because of the lack of an anatomical study, these approaches have yet to be popularized. Materials and Methods A total of 150 lumbar vertebral bodies of 30 patients were simulated kyphoplasty on computed tomography (CT) films through conventional pedicle approach (CTA) and the TPA, respectively. Anatomical parameters including the distance between the entry point and the midline of the vertebral body, the puncture inclination angle of medial inclination, were measured and compared. Results The distance between the entry point and the midline from L1 to L5 lumbar levels varied from 20.6 ± 2.2 mm to 28.6 ± 2.9 mm in the CTA group and from 23.6 ± 2.2 mm to 33.6 ± 2.9 mm in the TPA group. The entry point in the TPA group was 3.0 ± 2.1 mm to 5.1 ± 2.7 mm more lateral than that in the CTA group. The medial inclination angles in the TPA group were greater than that in the CTA group and the safe range of the puncture angles was also wider. Conclusion The entry point through a transverse process-pedicle approach was localized at the midline of the transverse process, 3.0 to 5.1 mm outside the lateral margin of the pedicle projection. Compared with CTA, the angle of inclination in the TPA approach was much larger with a wider safe puncture range. The TPA approach allowed an easy puncture to meet or surpass the midline of the lumbar vertebral body. Disclosure of Interest None declared
Comparison of Cervical Motor Function between Artificial Cervical Disc Replacement with Prodisc-C and Anterior Cervical Discectomy and Fusion for the Treatment of Cervical Spondylotic Myelopathy
Authors: Zhou Q. , Chen D. , Kopjar B. , Shi R. , Xu J. , Luo F. , Dai F. , He Q. , Li H. 
Published: May 2014

Introduction The objective of this study was to compare outcomes of cervical disc replacement (ACDR) using Prodisc-C (Synthes, Inc.) and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic cervical spondylotic myelopathy. Materials and Methods A total of 40 patients with radiologically confirmed symptomatic cervical spondylotic myelopathy were enrolled between March 2008 and August 2011 into prospective ongoing study and received ACDR ( N = 20) or ACDF ( N = 20) at discretion of operating surgeon. Patients were followed up at pre-specified intervals at 1, 3, 6, 12, and 24 months postoperative. Follow-up evaluations consisted of visual analogue scale (VAS) for neck and arm pain intensity, Neck Disability Index (NDI), and radiologic evaluations of intervertebral disc height, cervical curvature, total cervical range of motion, and segment contribution to total cervical range of motion (ROM). Results Both groups improved in VAS and NDI scores after surgery. The NDI score improved ( p < 0.01) from 34.06 preoperative to 16.81 at 24 months in the ACDR group and from 35.60 preoperatively to 17.28 at 24 months in the ACDF group. The difference between the groups was not significant. The VAS for neck and arm pain intensity showed better outcomes in ACDR than in ACDG group at 6 months follow-up ( p < 0.05). This difference disappeared at 24 months follow-up. The disk height at the index level increased in both groups postoperatively. There were no changes in disk height at the first cephalic and caudal levels in either group at any follow-up. The total cervical range of motion (ROM) improved at all follow-up evaluations in the ACDR group ( p < 0.05). There were no changes in overall ROM in the ACDF group (Fig. 1). The overall ROM was higher at 24 months in ACDR compared with ACDF (49.93 ± 11.91 and 41.11 ± 9.80, respectively, p < 0.05). Conclusion ACDR and ACDF are effective in improving functional outcomes in subjects with symptomatic cervical spondylotic myelopathy. Range of motion outcomes are superior in ACDR compared with ACDF. Disclosure of Interest Q. Zhou: Conflict with AO International, Southwest Hospital D. Chen: None declared B. Kopjar: Conflict with AO Foundation, Smith & Nephew, Cerapedics R. Shi: None declared J. Xu: None declared F. Luo: None declared F. Dai: None declared Q. He: None declared H. Li: None declared
The Influences of Different Insertion Conditions of Coflex Interlaminar Dynamic Stabilization on the Lumbar Spine Sagittal Alignment: A Perspective Clinical Study
Authors: Hai Y. , Liu Y. , Yang J. 
Published: May 2014

Introduction Selective decompression with interspinous distractive device insertion is one of the surgical options for the treatment of degenerative lumbar spine stenosis. Concerns of loss of lordosis and change of the sagittal alignment of the lumbar spine after interspinous distractive device insertion have been raised. To evaluate the influence of interspinous distractive device insertion on the sagittal alignment of the lumbar spine, a perspective clinical study was conducted. Materials and Methods From 2008 to 2010, 59 consecutive patients with single level degenerative lumbar stenosis at L45 were treated with selective decompression and Coflex interlaminar dynamic stabilization. There were 21 male and 38 female with an average age of 62.4 years (52-73). After decompression, Coflex device was inserted randomly under nonload condition (no distraction between spinous processes, NL group) and preload condition (3-5 mm distraction between spinous processes, PL group). Radiographic evaluation of the change of sagittal angle of the index level (IA), sagittal lordosis of the lumbar spine (LL), and the range of motion of the lumbar spine (ROM) were using standing lateral and flexion-extension lateral X-rays, pre- and postoperatively and 6 months postoperatively. Statistical analysis was conducted and t-test comparison was evaluated utilizing SPSS 16 computer software. Results All patients underwent surgery safely and no major intraoperative complications such as neurological injury, dural tear, spinous fracture, and infection were occurred. The change of sagittal alignment of index segment and lumbar spine, as well as the ROM of the lumbar spine, is shown in Table 1. The sagittal lordosis at the index segment and lumbar spine was decreased in the PL group comparing with the NL group ( p < 0.05), but there was no significant change of the ROM of the lumbar spine in both groups. Conclusion Although Coflex inter-laminar insertion under pre-load condition decreased the sagittal lordosis of the index segment and the lumbar spine, the range of motion of the lumbar spine was maintained. Large patients and longer follow-up evaluation is warranted to evaluate the influence of the sagittal alignment as well as the relationship with the clinical outcome. Disclosure of Interest None declared
The Role of Statins in the Osteogenesis on Bone Fusion Using Bone Marrow-Derived and Adipose-Derived Stem Cells
Authors: Kim J. , Shim H. , Kim S. , Hong Y. , Choi N. , Hwang J. , Kwon B. 
Published: May 2014

Introduction Statins are commonly prescribed drugs that inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG Co-A) reductase, decreasing hepatic cholesterol biosynthesis by reducing serum cholesterol concentrations. Several studies demonstrated statins enhance new bone formation and increase bone volume in an animal. In this study, simvastatin and lovastatin were employed to elucidate the osteogenic effects of stains on the culture system of two stem cells; human bone marrow-derived (hMSC) and adipose-derived stem cell (hADSC). Materials and Methods In this study, simvastatin and lovastatin were employed to elucidate the osteogenic effects of stains on the culture system of two stem cells; human bone marrow-derived (hMSC) and adipose-derived stem cell (hADSC). There are two experimental conditions: (1) statins supplemented along with other osteoinductive supplements and (2) without them. The statins increased the expression of the osteogenic markers, such as alkaline phosphatase (ALP) activity and alizarin red S staining(ARS) on both conditions. These results were verified with gene mRNA levels using PCR. Finally, ex vivo calvaria organ culture model was investigated by H&E and Masson trichrome staining. Results The statins increased the expression of the osteogenic markers, such as alkaline phosphatase (ALP) activity and alizarin red S staining (ARS) on both conditions. These results were verified with gene mRNA levels using PCR. There were almost the same trends in the expression of osteogenic makers induced from stem cell, although MSC was differentiated slower than ADSC. Also, neonatal murine calvarial was introduced to find the osteogenic effects of statins in ex vivo. It is observed that the bone density and thickness in the dissected calvarial tissue was enhanced in culture system including statins. Conclusion Our results suggests that statins could stimulate the differentiation of stem cell into osteoblasts and also affect the process of bone formation, resulting in the increase of mineralization induced by them. It implies that statins can be candidates as osteoinductive materials for bone fusion Disclosure of Interest None declared
Lumbar Facet Joint Orientation in Degenerative Spondylolisthesis: The Role of Ethnic Variation in Asia Pacific—A Study from the AOSAP Research Collaboration
Authors: Williams R. , Rajasekaran S. , Kawaguchi Y. , Acharya S. , Kawakami M. , Satoh S. , Chen W. J. , Park C. K. , Lee C. S. , Foocharoen T. , Nagashima H. , Kuh S. , Zheng Z. , Condor R. , Ito M. , Iwasaki M. , Jeong J. H. , Luk K. , Prijambodo B. , Rege A. , Jahng T. A. , Luo Z. , Tassanawipas W. A. , Acharya N. , Pokharel R. , Shen Y. , Ito T. , Zhang Z. , Aithala J. , Kumar G. Vijay , Jabir R. Ahmad , Basu S. , Li B. , Moudgil V. , Sham P. , Samartzis D. 
Published: May 2014

Introduction Degenerative spondylolisthesis (dSpl) can lead to various symptoms, including low back pain. Lumbar facet joint orientation has been reported to be associated with the development of dSpl. The role of ethnicity regarding facet joint orientation remains uncertain. As such, the following study was performed across a wide-ranging population base to assess the role of ethnicity in facet joint orientation in patients with dSpl in the Asia Pacific region. Materials and Methods A multinational, multiethnic cross-sectional image-based study was performed in 34 institutions in Asia Pacific, identifying 448 cases. Lateral standing X-rays and axial MRIs and/or CT scans were obtained for patients with lumbar dSpl. Magnitude of slip displacement, level of dSpl, and left/right facet joint angulation, width-curvature ratio, and gap width were noted on image assessment. Facet joint measurements were performed at each level from L3-S1. Gender, age, BMI, and ethnicity were also noted. Results The study included 389 patients with known ethnic origin (mean age: 61.4 years; 36.7% males, 63.3% females). The mean BMI was 25.6 kg/m2. The level of dSpl was most prevalent at L4/L5 (72.4%). There were 28.8% Indian, 28.5% Japanese, 17.5% Chinese, 8.2% Korean, 6.2% Thai, 4.6% Caucasian, 2.3% Filipino, 2.3% Malay, and 1.3 were of mixed Asian origin. Accounting for patient demographics and displacement, there was a statistically significant difference between ethnicity to that of left/right facet joint angulations, width-curvature ratios, and gap widths from L3-S1 between specific ethnic groups ( p < 0.05). Conclusion This is the largest study to address the role of ethnicity upon lumbar facet joint orientation in dSpl. Ethnicity plays a role in facet joint orientation and may influence the occurrence and severity of dSpl or be a potential consequence. An understanding of ethnic variability may be one factor which assists in identifying those patients at risk of postsurgical development or progression of dSpl. Acknowledgments This study was funded by AOSpine Asia Pacific. Disclosure of Interest None declared