bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Anterior Column Defects in Pyogenic Spondylodiscitis: A Systematic Review
Authors: Abdelrazek Mohamed , Robinson Yohan 
Published: May 2015

Introduction Study design: systematic review. Study Rationale: The surgical treatment of the anterior column defect in spondylodiscitis has been controversial for a long time and continues to remain so. Many techniques are described to manage the anterior column defect either through a posterior only method, anterior only method, or a combination of both. Many of the systematic reviews trying to investigate the best evidence for management involve tubercular and pyogenic, also all spinal column levels including cervical spine in their inclusion criteria regarding the differences in pathology, biomechanics, and natural history. Objectives The objective of the article is to present the difference in effectiveness and long-term reliability of all techniques which focus only on pyogenic infections in thoracolumbar segments. Material and Methods A systematic review of literature was performed using PubMed, ISI Web of Science, and Ovid Medline databases using the same search phrase: (anterior OR vertebral body OR defect) AND (spondylodiscitis OR discitis), further search was applied through reviewing references of the included search results. Articles were reviewed by the authors based on predetermined inclusion and exclusion criteria. Results PubMed search yielded 303 results, Ovid Medline yielded 451 results, and ISI Web of Science yielded 279 results. After title review and exclusion of duplication and non-English or German language articles, 32 articles were included and after final full text review 12 articles were included and presented. Three groups were formulated: anterior, posterior, and combined. Comparison included VAS, ODI, healing percentage, kyphosis correction and its maintenance, CRP, neurology, and complications. Conclusion There is a significant superiority of the combined anterior and posterior techniques in maintenance of kyphosis correction on the long-term follow-up, otherwise, due to the diversity of the criteria of evaluation of results in different articles, more clinical research should be directed to investigate the results of surgical management of anterior column defects in pyogenic thoracolumbar levels in particular.
Comparative Mechanical Properties of Commonly Used Spinal Rods
Authors: Melcher Carolin , Schröder Christian , Wegener Bernd , Jansson Volkmar , Birkenmaier Christof 
Published: May 2015

Introduction Pedicle-screw-rod constructs are used for a wide range of applications with strongly varying demands on construct stiffness. Rod stiffness is an important factor determining construct performance. A wide range of rod diameters and materials is available from manufacturers. No catalog has so far been published that would permit surgeons to objectively compare rods based on their specific properties. The goal of our study was to independently and objectively compare the biomechanical properties of spinal rods. Material and Methods Testing was according to ASTM norm F2193. We measured the bending stiffness, bending ultimate moment, bending yield moment, and elastic recoil. Over 200 tests were performed on 63 rods. Results We found decreasing material stiffness from cobalt–chrome (CoCr) and stainless steel (SS) via titanium (Ti) to PEEK. Surprising differences of up to 10% were found between Ti rods from different manufacturers. Differences between materials were most pronounced with small diameters: a 4.5 mm CoCr rod has about twice the stiffness of a 4.5 mm Ti rod, but the difference is only 15% with 6.0 mm rods. CoCr rods provided the highest elastic modulus with 4.5 mm diameter CoCr rods being as stiff as 5.5 mm diameter Ti rods and 5.5 mm CoCr rods being stiffer than 6.35 mm Ti rods. The stiffness of PEEK rods was only 4% that of Ti rods of the same diameter with the exception of carbon fiber-reinforced PEEK, which was close to titanium. Conclusion Our results show surprising variability between the popular 5.5 mm Ti rods from different manufacturers. With smaller diameters, the choice of material is increasingly important and may sometimes allow for using smaller implants while maintaining construct stiffness. Ultimate moment and yield moment determine the load at which a construct can be expected to plastically deform in vivo and what amount of force is required to contour the rod before implantation. The elastic recoil after plastic deformation makes exact contouring more difficult, which makes certain rods less comfortable to use in certain applications. We found considerable differences in the diameters/materials tested for all these parameters.
Biomechanical Effects of Cement Distribution in the Fractured Area on Symptomatic Osteoporotic Vertebral Compression Fractures: A Three-Dimensional Finite Element Analysis
Authors: Jiang Xiaobing , Ye Linqiang , Liang De , Zhang Shuncong 
Published: May 2015

Introduction According to some clinical studies, insufficient cement distribution in fractured area and asymmetrical cement distribution around fractured area were thought to be the reasons for unrelieved pain and recollapse after percutaneous vertebral augmentation (PVA) in the treatment of symptomatic osteoporotic vertebral compression fractures (OVCFs). Materials and Methods Finite element methods were utilized to investigate the biomechanical variance among three patterns of cement distributions (insufficient [ID] and sufficient [SD] cement distribution in the fractured area, asymmetrical cement distribution around the fractured area including upward [BU] and downward [BD] cement distribution). Results Compared with fractured vertebrae before PVA, distribution of von Mises stress in cancellous bone was transferred to be concentrated at cancellous bone surrounding cement after PVA, while it was not changed in cortical bone. Compared with SD group, maximum von Mises stress in cancellous bone and cortical bone and maximum displacement of augmented vertebrae increased significantly in ID group, while asymmetrical cement distribution around the fractured area in BU and BD groups mainly increased maximum von Mises stress in cancellous bone significantly. Similar results could be seen in all loading conditions. Conclusion Insufficient cement distribution in the fractured area may lead to unrelieved pain after PVA in the treatment of symptomatic OVCFs as maximum displacement of augmented vertebral body increased significantly. Both insufficient cement distribution in the fractured area and asymmetrical cement distribution around the fractured area are more likely to induce recollapse of augmented vertebrae because they increased maximum von Mises stress in cancellous bone and cortical bone of augmented vertebrae significantly.
A Systematic Review of Clinical Outcomes and Prognostic Factors for Patients Undergoing Surgery for Spinal Metastases Secondary to Breast Cancer
Authors: Sciubba Daniel , Yurter Alp , Ju Derek , Gokaslan Ziya , Fisher Charles , Rhines Laurence , Fehlings Michael , Fourney Daryl , Mendel Ehud , Laufer Ilya , Bettegowda Chetan , Goodwin C. Rory , Patel Shreyaskumar , Rampersaud Raja , Reynolds Jeremy , Chou Dean , Weber Michael , Clarke Michelle 
Published: May 2015

Introduction Surgical treatment and cement augmentation procedures are effective palliative techniques for the treatment of symptomatic spinal metastases. However, clinical results specific to a breast cancer cohort are generally lacking. We aim to systematically review the literature for clinical outcomes following operative interventions and prognostic factors for the treatment of breast metastases to the spine. Specifically, we describe the survival and clinical outcomes of surgery and cement augmentation procedures for breast metastases to the spine and to determine prognostic variables that may help recognize which patients will perform better or worse following surgery. Methods We performed a literature review using PubMed to identify articles that reported outcomes and/or prognostic factors of the breast cancer patient population with spinal metastases treated with any surgical technique since 1990. Results A total of 19 surgical studies, 4 cement augmentation studies, and 6 nonsurgical prognostic variable studies met the preset inclusion criteria. All but three studies (two surgical and one cement augmentation) were retrospective in nature, and all studies were of level of evidence IV. Median postoperative survival for metastatic breast cancer was 21.7 months (8.2–36 months), mean rate of pain improvement was 92.9% (76–100%), mean rate of neurological improvement was 63.8% (53–100%), mean rate neurological decline was 4.1% (0–8%), and mean rate LTC was 92.6% (89–100%). Kyphoplasty studies reported a high rate of pain control in selected patients. Negative prognostic variables included: hormonal (estrogen and progesterone) and HER2 receptor refractory tumor status, high degree of axillary lymph node involvement, and short disease-free interval (DFI). All other clinical or prognostic parameters were of low or insufficient strength. Conclusion With respect to clinical outcomes, studies consistently found that surgery resulted in neurological improvement for a majority of patients, with a minimal risk of worsening, and kyphoplasty studies reported a high rate of pain control. Increased postoperative survival 2002 onwards was likely due to FDA approval of new chemotherapies. However, specific factors associated with shorter survival following surgery involve hormone and HER2 receptor status and disease-free interval.
Evaluation of the Scoring System in Patients with Spinal Metastases from Nasopharyngeal Carcinoma
Authors: Kumar Naresh , Tan Jonathan , Zaw Aye Sandar 
Published: May 2015

Background The decision of operative treatment of patients with spinal metastases is dependent on the patient's predicted survival. The Tokuhashi, Tomita, Bauer, and Oswestry scores have been devised for survival prediction; however, none of these systems have been evaluated in nasopharyngeal carcinoma (NPC). We aimed to identify prognostic factors for survival, and investigate the predictive value of these scoring systems in predicting survival of the patients with spinal metastases from NPC. Methods We retrospectively evaluated the patients treated at our institution for spinal metastases from NPC. The predicted survival according to the four scoring systems (Tokuhashi, Tomita, Bauer, and Oswestry) was calculated and labeled as A scores. These patients were then rescored by assigning NPC as a good prognostic tumor and labeled as B scores. The predicted survival of scores A and B was compared with actual survival. Potential prognostic factors of survival were investigated using univariate and stepwise multivariate Cox regression analyses. Kaplan–Meier survival estimates, log-rank tests, and Cox regression analyses were done for all scoring systems A and B. The predictive values of each scoring system were calculated using post estimation after Cox regression analyses. Results Eighty-seven patients with spinal metastases from NPC were included in the study. The median overall survival for the whole cohort was 13 months (range: 1–120 months). In multivariate analysis, general condition ( p < 0.01), visceral metastases ( p < 0.01), and vertebral metastases ( p < 0.01) showed significant association with survival. The absolute score of all scoring systems was significantly associated with actual survival, which extended to the different prognostic subgroups of each scoring system. Log-rank test revealed that there were statistically significant differences in survival among the different prognostic groups of all scoring systems ( p < 0.01). Predictive value of survival by modified Tokuhashi score was the highest among all four scoring systems. Conclusions Patients with spinal metastases from NPC have good survival prognosis. All four scoring systems could be used to prognosticate these patients with a statistically significant association with actual survival. The modified Tokuhashi score is the best in doing so.
The Role of Intraoperative Neuromonitoring in Surgery of Lumbosacral Schwannomas: Five Years of Experience in a Single Center
Authors: Vukic Miroslav , Peterkovic Vjerislav , Nemir Jakob , Marasanov Sergej , Rozankovic Marjan , Tolic Tanja , Desnica Ana 
Published: May 2015

Introduction Lumbosacral schwannomas are predominantly benign tumors arising from nerves within the spinal canal. Being one of the most common intradural extramedullary tumors, spinal schwannomas comprise up to 30% of such lesions. Surgery is the primary treatment modality and after total resection recurrence is rare. We present our experiences and results with patients operated on lumbosacral schwannomas with the use of intraoperative neuromonitoring with evoked potentials (SSEP, MEP, muscle EMG, cauda mapping). Materials and Methods A retrospective review of prospectively collected data from patients with a diagnosis of lumbosacral schwannomas operated at University Hospital Centre Zagreb, Croatia, from January 2009 to May 2014 was performed. We analyzed preoperative and postoperative medical records, pathological findings, radiographic studies, and clinical outcome of patients treated surgically for lumbosacral schwannomas. Surgical outcome was compared with evoked potential changes during surgery for lumbosacral schwannoma that significantly differed from baseline values. Results In the analyzed period, 26 patients were operated on for lumbosacral schwannomas at our institution. Of these were 11 male and 15 female patients. Mean age was 49.8 years. There were 4 giant and 22 nongiant schwannomas. Giant spinal schwannoma was defined as a tumor that extends over two or more vertebral levels, erodes vertebral bodies, and/or extends into the extraspinal space disrupting myofascial planes. Low back pain and radiculopathy were the most common presenting symptoms, rarely associated with urinary incontinence. Nongiant schwannomas were treated using minimal invasive unilateral approach, while giant schwannomas were treated using laminoplasty technique. In all patients, intraoperative neuromonitoring with SSEP, MEP, and spontaneous EMG was performed. Postoperatively, 21 patients fully recovered from preoperative neurological symptoms at 6-month follow-up. In 12 patients, SSEP changes occurred during surgery that differ from baseline values but had no impact on outcome. Four patients had transient neurological worsening which was in concordance with intraoperative SSEP and EMG disturbance findings. Out of 26 tumors excised, 2 were malignant schwannomas. One of the patients with the diagnosis of malignant schwannoma had to be reoperated for recurrence and died 2 years later. One patient with giant schwannoma developed an intracranial epidural hematoma postoperatively. Conclusion Intraoperative multimodality (SSEP, EMG) monitoring properly used and understood is a useful tool in lumbosacral schwannoma surgery. It assists the surgeon through the procedure as a means of intraoperative guidance allowing for completeness and safety of tumor removal and as such can influence the surgical outcome.
Metastatic Spine Tumor: A 5-Year Review of Survival Rate with Tokuhashi Score
Authors: Kumar Renjit , Menon K. Sajesh , Ramachandara Krishnakumar , Abubakar Mohammed Kabir , Waheed Irshad Ahmed 
Published: May 2015

Introduction The ability to predict the outcome of surgical intervention in patients with metastatic spine tumor will help reduce unnecessary surgery in patients with advance disease, while encouraging surgery in patients who are likely to benefit. The Tokuhashi predictive score has provided a template that can be used to assess the suitability of treatment modality. The aim of the study is to compare outcomes of surgeries done with the Tokuhashi predictive score over a 5-year period at the Amrita Institute of Medical Sciences, Kochi, India, from January 1, 2007 to December 31, 2012. Methods Medical records of all patients who had diagnostic and/or therapeutic surgeries for metastatic spine tumor during the study period were retrieved and data were extracted and analyzed. Phone calls and letters were used to trace patients or their relations to ascertain whether the patients were alive or not on June 30, 2014. Results Data of 38 patients, 27 male and 11 female patients, were analyzed. Median age was 55 years. Unknown primary tumor accounts for the highest tumor (13), while carcinoma occurred in 24 patients (63.16%), making it the highest histological type. The Tokuhashi predictive scores are as follows: 0–8 (39.49%), 9–11 (52.63%), and 12–15 (7.89%). Nine patients (23.68%) were alive as on June 30, 2013. Conclusions Tokuhashi score is a reliable parameter for predicting outcome of life expectancies following surgery in patients with metastatic spine tumors. Tokuhashi score can be used to select the choice of treatment modalities in patients with metastatic spine tumors.
Surgery of Intradural Extramedullary Tumors
Authors: Donnarumma Pasquale , Nigro Lorenzo , Tarantino Roberto , Rullo Marika , Delfini Roberto 
Published: May 2015

Introduction Intradural extramedullary tumors (IDEMTs) are uncommon lesions causing pain and neurological deficits. The objective of this study is to evaluate the effects of surgery for IDEMTs analyzing a sample of 107 patients. Materials and Methods Cohort study recruiting all the patients operated for IDEMTs at the Department of Neurology and Psychiatry of “Sapienza” University, Rome, from January 2003 to January 2013. The analysis was conducted on the evaluation of clinical records over a 1-year follow-up. The graphic rating scale (GRS) was used for the assessment of pain. Neurological deficits were detected though neurological examination. The quality of life was evaluated with the EuroQol (EQ-5D). Statistical interpretation of the data was performed using SPSS v19 software (SPSS Inc, Chicago, Illinois, United States). Results A total of 107 patients were recruited. Three were lost to follow-up. Patients reported lower level of pain 1 year after surgery (presurgery = 6.05, postsurgery = 3.65). Mean comparison shows a significant decrease in Δ = −2.400 ( p < 0.001). A total of 92 patients (88.5%) were neurologically asymptomatic 1 year after surgery. Only 12 (11.5%) presented with a deficit, with a global decrease of 39% (chi-square 27.6, p < 0.005). The quality of life in patients operated for IDETMs was middle high (mean rating EQ-5D VAS 61.78%). The lowest levels of quality of life were found in patients with sphincter dysfunctions (mean = 33.4). Conclusion Surgery of IDEMTs has a good outcome. Patients reported lower levels of pain and a drastic reduction in neurological symptoms 1 year after surgery. The quality of life on an average is middle high. It is influenced mainly by the neurological outcome.
Anterior Extrapharyngeal Fixation of the Atlanto–Axial Joints
Authors: Patkar Sushil 
Published: May 2015

Introduction The atlanto–axial joints can be easily exposed from a unilateral submandibular extrapharyngeal approach. Decortication and intrajoint bone grafting can be easily accomplished. Rigid anterior fixation of the joint is possible without any risk to the vertebral arteries. Materials and Methods Between April 2008 and September 2014, 95 patients, 50 male and 45 female patients, in the age group of 12 to 82 years, were offered this procedure. 55 patients had anterior transarticular screws, 40 patients had anterior screw plate fixation (AAD 63 patients, tuberculosis 20, fixed AAD with Basilar invagination 12). All patients underwent preoperative dynamic X-rays of craniovertebral junction, computerized tomography (CT scan) of C1–C2 static and dynamic study with bone window settings and 3D reconstruction, magnetic resonance imaging (MRI), and MR angiography to study the course of vertebral artery. Stevenson technique (22 patients) for exposure to reach the prevertebral space at C1–C2. Technique 1: plate and screws (C1 lateral mass and C2 body); Technique 2: anterior transarticular screws across C1–C2 joint. Results Average procedure time was 3 hours, no case required blood transfusion, reoperation occurred in seven cases; three screw malposition both ipsilateral (right sided), reoperated within 48 hours and screw repositioned correctly. One overdistraction of C1–C2 joint due to screw not piercing the C1 lateral mass and pushing the lateral mass of C1 away from C2 (because of inadequate drilling of C1 lateral mass). Reoperated on the 3rd day and lateral mass of C1 drilled correctly and the screw passed successfully. Two inadequate excisions of odontoid process had to be removed transorally after 3 weeks because of excessive backward angulation of odontoid process. One case of screw loosening that was due to incorrect plate contouring, reoperation after 3 weeks when patient had come for first postoperative follow-up. Follow-up in 75% for 24 months. Rigid fixation in 100%, mortality 0%. Conclusion Anterior extrapharyngeal approach allows for reduction of the atlanto–axial dislocation, opportunity for bone grafting of the joint, and with anterior C1 lateral mass and C2 body screw plate fixation or anterior transarticular screws, provides rigid fixation without any risk to the vertebral artery, venous plexus, or spinal cord.
Treatment of Early-Onset Spinal Deformities, Complications
Authors: Legarreta Carlos , Rosito Gabriel , Maria Escalada , Reviriego Juan , Lutzky Lazaro , Krekun Walter , Medina Sebastian , Cirillo Juan , Tavolaro Trombetta Celeste 
Published: May 2015

Introduction Complications in the treatment of patients with early-onset deformities is a very common situation. When the surgeon assumes the treatment of this disease, he should try to gain control of the spinal deformity and obtain proper growth of thorax. The main goal of the treatment is to achieve these two aspects, with the lowest incidence of complications for the patient. Patients and Methods This is a retrospective study case series and the level of evidence is IV. We evaluated 13 patients treated with surgical techniques and growth distraction without fusion (MMC 5p, 2p idiopathic infantile scoliosis, spinal dysplasia 1p, 1p SCIWORA, Marfan syndrome 1p, 1p Escobar syndrome, Neurofibromatosis Type I 1p, 1p Thoracogenic scoliosis). The average age at the time of surgery was 4.10 years. The average preoperative angular value was 83.7 degrees (range, 50–135 degrees). We analyzed the following: (1) Risk factors preoperative; (2) Type of mounting; (3) Sequence of distractions; (4) Complications. Results Overall, 13 patients underwent 27 procedures of distraction. Analyzing each case, in particular, we have seen that the frequency of distractions averaged was a procedure each 11 months (range, 7–17 months), and 23% of these patients currently reached last surgery (spinal fusion) after 3.5 years of treatment with distractions (range, 2.10–3.10). In 13 patients, we observed complications in 69% during treatment. Our complications were as follows: (1) superficial infections 6.6%, (2) deep infections 10%, (3) rib fractures 10%, (4) spontaneous fusion 3.3%, and (5) prosthetic loosening. Conclusions In treatment of early onset deformities, the spinal surgeon should be prepared to deal different complications during treatment. On the basis of our experience, we consider it a high-risk pathology.