bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Intra- and Postoperative Complications during Lumbar XLIF Surgery in a Consecutive Series of 144 Cases
Authors: Buric Josip , Del Gaizo Carmine 
Published: May 2015

Introduction Retrospective analysis of intra- and postoperative complications in a consecutive series of 144 patients operated for lumbar extreme lateral interbody fusion (XLIF). Patients and Methods A total of 144 patients, with a minimum follow-up of 6 months, affected with degenerative spinal conditions of the lumbar spine, were treated with XLIF with and without posterior instrumentation. Data were collected by retrospective analysis of hospital files and confidential computer-held database. Documented complication types and rates of this series were compared with previous reports on lateral approach fusions. Results A total 179 levels were treated of whom 61% at one level, 30% at two levels, 6% at three levels, and 3% at four levels. Overall, 55% included level L4–L5. A total of 82.7% included supplemental internal fixation with 96% including bilateral pedicle screw fixation. A total of 27 (25.6%) events occurred in 22 (21.1%) patients. There were 9 (8.6%) permanent complications lasting longer than 6 months and 18 (17.3%) temporary complications that resolved inside the 6 months post-op period. Overall, 10 (9.6%) complications were judged severe: three cases of permanent nerve root lesion, two surgically treated adjacent level syndromes, one surgically treated subsidence, one deep infection, one vascular lesion, and one post-op pancreatitis. Overall, 17 (16.3%) were judged nonsever complications and solved during the 6-month follow-up. Overall, 24 events were XLIF related whereas 3 were not related to XLIF (one pancreatitis and two infection of posterior instrumentation). Conclusion Compared with open anterior interbody fusion approaches, the extreme lateral approach with XLIF technique resulted in a lower incidence of infection, visceral and neurologic injury. Some specific approach-related mild and temporary events such as nerve-root irritation could be regarded more like a approach comorbidity rather than a real complication.
Is the Lasègue Sign a Predictor of Outcome in Lumbar Disc Herniation Surgery?
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , Volquind Daniel , da Silva Pedro Guarise 
Published: May 2015

Introduction The Lasègue Sign (LS) is frequently observed in patients with LDH. There is evidence that the persistence of the LS in the postoperative period is related to poor clinical outcome. However, the clinical relevance of this sign in the preoperative period of LDH is controversial. The purpose of this study is to evaluate the predictive value of the LS in patients who undergo microdiscectomy because of LDH, and to investigate its relation with the health-related quality of life (HRQoL) measures during 1-year follow-up. Patients and Methods A total of 95 patients with clinical and radiological diagnosis of LDH who underwent microdiscectomy were included. The patients were assessed by a neurological examination and answered validated instruments to assess pain, disability, QoL, and mood disorder in the preoperative period, and 1, 6, and 12 months after surgery. Results A preoperative LS was identified in 56.8% ( n = 54/95) of the cases. There was no difference between the groups in the preoperative period regarding HRQoL. At 1-year follow-up, no statistically significant difference in HRQoL was observed in the Lasègue group. The discrimination capacity of the preoperative LS to determinate variations in HRQoL outcomes 1-year postoperatively was low. Conclusion LS is not a good predictor of outcome after microdiscectomy for LDH.
Laminar Dye Injection in Dorsal Tumor Level Localization
Authors: El Fiki Ahmed 
Published: May 2015

Introduction Dorsal lesions localization has been always challenging with high incidence of missed level. Although development of diagnostic tools but it is not always available in many centers. Patients and Methods During the period from December 2010 to June 2013, 14 cases with dorsal intraspinal lesions were operated with preoperative localization using dye injection in the assigned laminae over the lesion. CT dorsal spine done preoperative and fluoresce was injected into the proper level lamina. Results In the 14 patients, it was easy to localize the target lamina by the color of the dye and in 13 patients it was over the lesion. There was no side effect from injecting dye locally in spine. The use of intraoperative fluoroscope was obviously limited. Conclusion Preoperative laminar dye injection is safe and effective technique in dorsal spine leveling especially in limited resource centers. Although it is little invasive but its results are much better than surface metallic localizers.
Efficiency in Adult Spinal Deformity Surgery: A Multicenter Comparison of Resource Use
Authors: Robinson Chessie , Hostin Richard , O'Brien Michael , McCarthy Ian , Gupta Munish , Lafage Virginie , Hart Robert , Schwab Frank , Smith Justin , Ames Christopher 
Published: May 2015

Introduction Decision makers and payers are placing increasing scrutiny on the costs and outcomes associated with complex spine surgery. To justify higher cost practice patterns, there must be evidence of additional patient benefit; however, little is currently known regarding the variation in resources used and associated outcomes in complex spine surgeries. Our study examines multicenter variability in patient-level surgical resource use, including implants, biologics, and length of stay, alongside health-related quality-of-life (HRQoL) improvements following adult spinal deformity (ASD) surgery. Material and Methods This is a retrospective analysis of a multicenter prospective database of consecutive patients with ASD. HRQoL outcomes were calculated from the ODI, SRS-22, and SF-36 domain scores. Changes in HRQoL were estimated as the difference between baseline and 2-year values. Patient-level surgical resources included blood use, bone morphogenetic protein (BMP), volume (ccs), length of stay (LOS), and implants. Patients were classified by sagittal modifier and analyzed across centers. The three sagittal modifier types are defined as follows: mild (SVA < 4 cm, PT < 20 degrees, PI–LL within 10 degrees), moderate (at least 1 of SVA 4–9.5 cm, PT 20–30 degrees; PI–LL 10–20 degrees, and no severe modifiers); and severe (at least 1 of SVA > 9.5 cm, PT > 30 degrees, PI–LL > 20 degrees). Statistical analysis was performed using analysis of variance (ANOVA) and multivariable regression methods comparing HRQoL outcomes and resource use across center, considering the overall patient cohort and each modifier group. Results Baseline and 2-year HRQoL data were available for 226 surgical patients with ASD, with an average age of 56 (range, 18–84 years) years who were predominantly female ( N = 189, 84%). Significant differences were found in the average 2-year change in HRQoL across centers, however, this difference becomes insignificant after controlling for patients within the same major modifier groups ( p > 0.05). Significant differences were found across centers in average resources used per surgery ( p < 0.05), with only LOS not reaching significance ( p > 0.05). Significant differences were found in average BMP and screw use across all modifier groups. After accounting for clinical, demographic, and regional characteristics at the patient level, variation among centers persisted in both screw use and total BMP volume with no corresponding statistical differences in HRQoL outcomes. Conclusion The use of additional surgical resources does not appear to impact 2-year HRQoL outcomes following surgery for ASD. To improve efficiency in ASD surgery, standardization of physician practice patterns and resource use could help curb costs without negatively impacting patient HRQoL.
Long-Term Cost-Effectiveness of Adult Spinal Deformity Surgery
Authors: McCarthy Ian , Robinson Chessie , Hostin Richard , O'Brien Michael , Ames Christopher , Gupta Munish , Lafage Virginie , Hart Robert , Smith Justin , Schwab Frank 
Published: May 2015

Introduction There is a lack of long-term outcomes in the existing cost-effectiveness literature. This study examines the long-term cost-effectiveness of surgical treatment of ASD with a Markov model populated by estimates from literature and observed data on hospital costs and outcomes. Using estimates from literature and observed data on costs and health-related quality-of-life (HRQOL) outcomes, we simulate costs and outcomes for surgical and nonsurgical treatment to estimate incremental cost-effectiveness ratios (ICERs) after 10- and 20-year follow-up. Material and Methods We develop a robust Markov model with parameter uncertainty, incorporating costs, and outcome distributions from published literature and observed patient data. Summary statistics on mortality rates, revision rates, and nonsurgical costs are taken from the literature, whereas statistics for surgical costs and QALYs are taken from a single-center, retrospective administrative data set and a multicenter prospective data set. Costs of surgery are measured as total hospital costs from administrative records. QALYs were calculated from the SF-6D. We projected costs and QALYs for the surgical and nonsurgical populations allowing varied readmission, cost, and QALY outcomes over 10- and 20-year follow-up. Costs for surgical and nonsurgical patients are intended to reflect the full spectrum of services incurred for surgical or nonsurgical care (e.g., physical therapy, pain management, etc.). Costs and QALYs were in 2010 dollars and discounted at 3.5%. Our results are based on 1,000 simulated patients, each proceeding through 6-month cycles over a 10- and 20-year follow-up periods. Confidence intervals are formed by repeating the simulations for 1,000 iterations. Results Discounted surgical costs averaged $170,523 over 10-year follow-up, with average discounted QALYs of 6.3. Meanwhile, nonsurgical costs averaged $40,046 over 10-year follow-up with average QALYs of 5.4. This resulted in an average ICER from surgical treatment of $144,000 (95% CI: $121,500–$177,500) per QALY gained. Over 20-year follow-up, surgical costs averaged $208,616 and QALYs averaged 9.8, whereas nonsurgical costs averaged $63,467 and QALYs averaged 8.6. Over 20-year follow-up, the ICER decreased (became more cost-effective) to $115,000 (95% CI: $88,850–$156,200) per QALY gained. Conclusion Our results illustrate the potential for surgical treatment for ASD to be cost-effective over extended follow-up compared with nonsurgical treatment. These findings argue in favor of longer follow-up in ASD studies for accurate cost-effectiveness comparison. Future research should also pursue measurement of indirect costs/benefits resulting from changes in absenteeism or productivity.
A Model of Spinal on Call: Orthopedic Spinal Rapid Access Service: Results of 6-Month Prospective Audit
Authors: Khatri Manoj , Kelsall Catherine 
Published: May 2015

Introduction Provision of structured on-call rota for spinal conditions can be challenging in the most orthopedic department because of the limited number of spinal surgeons. Spinal emergencies are therefore managed often by general orthopedic surgeons with potential of suboptimal outcome. Spinal conditions are managed in our institute with a team of spinal surgeons and nonmedically qualified spinal clinicians. Orthopaedic Spinal Rapid Access Service (OSRAS) was developed in our institute to provide a structured pathway for management of urgent spinal pathologies during working hours of Monday to Friday. It was delivered through a published rota by a multidisciplinary team of nonmedically qualified spinal clinicians carrying a bleep and a spinal surgeon. Aim This study aims to evaluate the efficacy of OSRAS through a prospective audit. Materials and Method New service development protocol was followed and board approval for this project was obtained. A spinal on-call rota was designed and was published to limited number of clients. The data obtained for all patients who were referred to the OSRAS services were collected prospectively in a predesigned performa that was approved by the audit department in our institute and analyzed. Results Between Nov 2013, 1, and April 30, 2014, 177 patients (48 males and 119 females) with an average age of 50 (range, 17–95 years) years were referred to OSRAS. Wednesday was the busiest day with 26% referral in AM and 74% in PM. Main source of referrals were as follows: regional MSK services (50), triage (34), ED (27), and GPs (20). The reasons were as follows: suspected CESI ( n = 100), acute LBP ( n = 30), pathological fractures ( n = 23), progressive neurology ( n = 16), discitis ( n = 5), and spinal stenosis ( n = 2). Depending on clinical needs, 29 patients were seen on the same day, 33 next day, 53 within 2 to 5 days, and 31 patients more than 5 days. Overall, 80 patients were discharged, 36 listed for surgery, 27 required further follow-up, and 31 patients were given telephone advise only. High user satisfaction rating was obtained. Conclusion We propose an OSRAS model as a safe and cost-effective alternate to often unsatisfactory current emergency department model that can provide a structured pathway for timely expert management of serious spinal pathologies therefore prevent potential consequences while avoid unnecessary admissions.
Unilateral Tubular Approach for Bilateral Laminectomy: Effect on Ipsilateral and Contralateral Buttock and Leg Pain
Authors: Alimi Marjan , Hofstetter Christoph P. , Torres-Campa Jose M. , Cong Guang-Ting , Njoku Innocent , Härtl Roger 
Published: May 2015

Introduction Tubular laminectomy is an effective treatment for lumbar spinal stenosis (LSS) with neurogenic claudication. Most surgeons familiar with the procedure agree that the tubular approach appears to afford a more complete decompression of the contralateral thecal sac and nerve root, as compared with the ipsilateral side. With this study, we sought to answer the question whether this is reflected in clinically significant differences between the ipsilateral and contralateral side pain improvements. Patients and Methods Patients with isolated LSS and equal preoperative leg VAS scores, who underwent a tubular (MIS) laminectomy between 2004 and 2011 were identified. The extent of VAS score improvement on the approach side was compared with the extent of improvement on the contralateral side, at the last follow-up. We tested the hypothesis that the pain relief would be the same on both sides regardless of the approach side. Results A total of 33 patients were included in our retrospective cohort. At the latest follow-up of 25.8 ± 3.4 months, there were statistically significant improvements in ODI and back VAS scores ( p = 0.002 and p < 0.0001, respectively). In addition, buttock VAS scores were significantly improved both on the ipsilateral and the contralateral side ( p < 0.001, and p = 0.001, respectively). Similarly, leg VAS scores were improved significantly on both the sides ( p < 0.001, and p = 0.001, respectively). There were no statistically significant differences between the extent of pain improvement on the ipsilateral and the contralateral side, either for buttock or leg pain. Conclusions Minimally invasive tubular laminectomy through a unilateral approach results in clinically effective bilateral decompression.
Accuracy of Pedicle Screw Placement in Dystrophic Neurofibromatosis Scoliosis: A Comparison between Free-Hand and 3D O-Arm Navigation Technique
Authors: Liu Zhen , Jin Mengran , Zhu Zezhang , Qian Bang-Ping , Wang Bin , Sun Xu , Zhu Feng , Yu Yang , Qiu Yong 
Published: May 2015

Introduction Recently, the importance of intraoperative navigation in scoliosis surgery has been increasing. Multiple studies have proven the superiorities of computer-assisted scoliosis surgery. Using intraoperative 3D images for navigational purposes has several advantages and should increase the accuracy and safety of pedicle screw placement. The purpose of the present study was to assess the accuracy of O-arm navigation-based pedicle screw insertion in dystrophic neurofibromatosis scoliosis and compare it with free-hand pedicle screw insertion technique. Patients and Methods A total of 32 patients with dystrophic neurofibromatosis scoliosis were nonrandomly included in the two groups, one consisting of O-arm navigation-based pedicle screw insertion (13 patients, Group A) and the other with free-hand technique (19 patients, Group B). A total of 213 pedicle screws were placed in apical region, 92 pedicles were inserted assisted by O-arm navigation system and the rest were inserted by free-hand technique. The postoperative CT scan image were reviewed and analyzed for pedicle violation. The screw penetration was divided into the following four grades: grade 0 (ideal placement), grade 1 (penetration < 2 mm), grade 2 (penetration between 2 and 4 mm), grade 3 (penetration > 4 mm). Results The mean age in group A was 14.8 years (range,11–22 years), whereas in group B was 15.3 years (range, 6–30 years). The preoperative Cobb angle of the main curve in group A was 70.3 ± 6.7 degrees compared with 62.2 ± 8.7 degrees in group B. The correction rates were comparable between group A (75.7%) and group B (78.1%), and the difference was not statistically significant ( p > 0.05). The overall perforation rate was 27.7% (59/213) in all 32 patients, and group A had a perforation rate of 20.7% (19/92) in comparison to 33.1% (40/121) noted in group B ( p < 0.05, χ2 test) separately. Moreover, the lateral margin was the most common site of perforation for 73.4% (14/19) in group A and 50.0% (20/40) in group B. Conclusion O-arm navigation does provide superiority over conventional free-hand technique in terms of accuracy of pedicle screw insertion in dystrophic curves associated with neurofibromatosis type 1. The lateral cortex is the most common site of screw perforation in either technique.
The Role of Minimal Invasive Split Laminotomy, the Alternative Parasplit Approach and the “Arch bone” Technique in Surgical Removal of Axial Longitudinal Pathologies in the Spinal Canal
Authors: Banczerowski Peter , Papp Zoltán , Veres Róbert , Vajda János 
Published: May 2015

Introduction Conventional approaches to open the spinal canal carries the risk of spinal deformities, instability, subluxation, and invariably separate the muscle attachments from the spinous processes and laminae. Damage to these muscles and bony connections can lead to persistent axial pain and cervical malalignment. With the aim of preserving and reconstructing the posterior structures, the authors developed a novel minimal invasive multilevel spinous process splitting and distraction laminotomy approach, the “arch bone” and the additional rescue parasplit technique. Patients and Methods These novel techniques were used in 70 adult patients with mainly midline located intramedullary pathologies of the cervical, thoracic, and thoracolumbar spine. All muscle attachments on the spinous processes and laminas, as well as the laminas themselves, were completely preserved. With the aim of moderate enlargement of the spinal canal, a spacer was placed between the bony parts facing each other in case of total resection of an intramedullary tumor was not possible. When midline splitting is not feasible or convenient because of anatomical differences of the spinous processes and laminas, we used the parasplit approach. The patients were followed with regular MRI, CT scans, fluoroscopy, and neurological examinations. Results The midline opening of the spinal canal gave a key-hole approach, achieving an adequate view of the intraspinal space for surgery in its entire longitudinal extension. The approach used did not affect the extent of resection proved by MRI evaluation or neurological outcome. The numbers of splitted laminae were 3 to 10. The incidence of postoperative local pain was lower, within acceptable limits (VAS: 2–4). The average length of hospital stay was 6.7 days. Average follow-up was 58 months. Instability and deformity was detected in none of the patients on the flexion–extension lateral radiographs during the follow-up period. Conclusion These surgical approaches suitable for exploring and removing different intramedullary pathologies, help in preventing damage to crucial posterior stabilizers of the spine. Its major advantage is that unnecessary exposure and tissue trauma is reduced, and structures not directly involved in the pathologic process are preserved. In contrast to conventional spinal canal approaches, leaves the muscle attachments intact, disintegration of vertebral arches and facet joints is reduced. Furthermore, these techniques are suitable methods for all spinal segments in all age group. Although the clinical and radiological results are very promising, the limited follow-up period precludes conclusions regarding the long-term results of the procedure, especially with respect to kyphotic deformity.
The Value of Routine Postoperative Radiographs after Elective Lumbar Spinal Fusion Surgery
Authors: Carter Sarah , Khatri Manoj , Ali Syed 
Published: May 2015

Introduction Both intra- and postoperative radiographs are traditionally obtained after instrumented lumbar spinal surgery; however, the clinical advantage of routine postoperative images has not been demonstrated. The aim of this study is to explore the usefulness of routine predischarge postoperative radiographs in patients undergoing instrumented spinal surgery. Patients and Methods Patients ( n = 124) who underwent a lumbar spinal fusion were identified from a retrospective database, 58 patients were excluded. Unaltered intraoperative and predischarge postoperative PACS images for 66 patients were reviewed and were scored for the following: (1) Quality (0 = nondiagnostic, 1 = suboptimal, 2 = diagnostic, and 3 = good quality), (2) Focus (number of vertebra and disc seen), (3) Centering using a numbered [1–9] grid system, and (4) Rotation. Results A total of 66 radiographs were analyzed for the following: (1) Quality: 60 AP and 56 lateral intraoperative images whereas 57 AP and 39 lateral postoperative images were diagnostic; (2) Focus: average number of unnecessary vertebra seen in intraoperative AP and lateral images were 0.89 and 1.09, whereas on postoperative AP and lateral images were 8.05 and 6.45, respectively; (3) Centering: 48 AP and 51 lateral intraoperative images, whereas 27 AP and 20 lateral postoperative images were adequately centered; and (4) Rotation was adequate in both intraoperative and postoperative images. Conclusion Intraoperative images scored higher in all parameters suggesting that routine postoperative prehospital discharge radiographs are unnecessary unless specifically indicated and this practice should be discontinued with benefits including reduction of radiation dose (and subsequent sequelae), fiscal burden, and length of stay.