bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the Cage Height, Diameter, and Positioning on Clinical and Radiographic Outcome of the Extreme Lateral Interbody Fusion
Authors: Hofstetter Christoph P. , Alimi Marjan , Tsiouris Apostolos J. , Elowitz Eric , Härtl Roger 
Published: May 2015

Introduction Extreme lateral interbody fusion (ELIF) is a novel technique for anterior spinal fixation and indirect decompression of neural elements. The aim of this study was to determine certain parameters of the interbody cage that would result in better radiographic and clinical outcomes. Patients and Methods We performed a retrospective analysis of 145 ELIFs in 90 patients. Intervertebral disc height, foraminal height, cage position, and lumbar lordosis were determined on preoperative, postoperative, and the latest follow-up studies. Clinical outcomes were evaluated by Oswestry Disability Index and Visual Analogue Scale. Results At the time of last follow-up (17.7 ± 1.1 months), two of the following factors determined restoration of foraminal height: the amount of increase in the disc height (implant height—preoperative disc height) and the footprint of the intervertebral spacer. Cages that had increased the disc height by 6 to 9 mm yielded in significantly greater restoration of foraminal height compared with the grafts that had increased the disc height by 0 to 3 mm ( p < 0.01) or 3 to 6 mm ( p < 0.05). In addition, 22 mm spacers allowed for a significantly higher increase in the foraminal height compared with 18 mm spacers ( p < 0.001). Interestingly, neither cage position nor posterior instrumentation had statistically significant influence on restoration of foraminal height. Both, lordotic and nonlordotic cages allowed for increased lumbar lordosis on postoperative imaging. Clinical evaluation revealed a mean ODI, VAS back, buttock, and leg pain improvements of 21.1%, 3.7, 3.6, and 3.7 points, respectively. Conclusions In ELIF, cage width and height but not cage position, determine restoration of foraminal height.
Saphenous Nerve Somatosensory Evoked Potentials Monitoring during Lateral Interbody Fusion
Authors: Bederman Samuel S. , Jain Nick , Yanni Daniel , Guillen Heriberto , Lilit Mnatsakanyan 
Published: May 2015

Introduction Lateral transpsoas interbody fusion (LIF) is a novel minimally invasive technique reducing risks related to traditional anterior approaches. Despite advantages, transpsoas exposure carries up to 30% risk of lumbar plexus injury. Intraoperative neuromonitoring is utilized to prevent postoperative deficits, but to date there is no reliable technique to detect upper lumbar plexus injury. Materials and Methods Saphenous nerve somatosensory-evoked potentials (SSEPs) were obtained by stimulation of inferior medial thigh with needle electrodes and recording from scalp. Primary outcome was measured by testing reproducibility of SSEPs at baseline, changes during procedure, and relevance to standard modalities. Intraoperative changes were identified and correlated to primary outcome. Results A total of 38 patients were included in the study (average age 63.5 years, 25 females, 13 males) and underwent surgery on 88 total levels. Reliable saphenous SSEPs were recorded bilaterally in 34 of 38 patients. Reduction of amplitude > 50% in two cases was observed during expansion of the tubular retractor. The posterior tibial SSEP remained unchanged. The saphenous returned to baseline after collapsing the retractor and no clinical deficits were observed. Conclusion Saphenous SSEPs can be used to detect electrophysiological changes to prevent femoral nerve injury during LIF. A larger sampling size is underway as to validate whether this technique offers increased sensitivity/specificity, and correlates with the postoperative outcomes.
Incidence of Lumbar Plexopathy while Utilizing Mechanomyography for Transpsoas Lateral Lumbar Interbody Fusion
Authors: Zavatsky Joseph M. , Waddell Bradford S. , Briski David C. , Sama Andrew , Wollowick Adam , Zahrawi Faissal 
Published: May 2015

Introduction Previous studies utilizing electromyography (EMG) have reported that the incidence of thigh complications during transpsoas lateral lumbar interbody fusion (LLIF) ranged from 0.7 to 75%. The reliability of EMG has been questioned because of false-positives, false-negatives, and electrical interference from common operating-room equipment. Mechanomyography is a new neuromonitoring technique that functions by measuring the mechanical activity in muscles, or “twitch,” noninvasively using surface-mounted accelerometers on the skin following nerve stimulation and muscle contraction. MMG may provide an alternative to EMG for neuromonitoring. In this study, we evaluated the incidence of thigh complications during transpsoas LLIF utilizing MMG to monitor the lumbar plexus. Materials and Methods A retrospective review of prospectively collected data of four different surgeons at four separate institutions was performed. A total of 85 consecutive patients, with 175 instrumented levels, were included who underwent transpsoas LLIF surgery (L1–L5) during a 1-year period. Immediate postoperative and routine follow-up clinical examinations at 3, 6, and 12 months were obtained. Results The rate of all ipsilateral thigh symptoms (pain, numbness, and weakness) was 21.2% (18/85). Eight patients (9.4%) had iliopsoas or quadriceps weakness (3/5 motor strength). Overall, 10 patients (11.8%) had anterior thigh pain and/or numbness. Most patients with postoperative thigh symptoms (16/18) had 3 or 4 level procedures performed for adult degenerative scoliosis (ADS) and included the L45 level. All thigh symptoms resolved within 3 months. Conclusion MMG is a safe and effective alternative to EMG for nerve mapping during transpsoas LLIF surgery and overcomes deficiencies related to the high rates of false-positives and false-negatives inherent to EMG. In addition, unlike EMG, MMG is not affected by electrical artifact seen with common operating-room equipment such as the bovie electrocautery and bair hugger body warmer. With the use of MMG, the rate of ipsilateral thigh symptoms was 21.2%, which is consistent with currently reported rates for transpsoas LLIF procedures utilizing EMG. In our study, most thigh symptoms occurred in patients with multilevel LLIF procedures performed and direct trauma to the psoas may have contributed to our results and the actual rate of nerve-related thigh symptoms might be lower. All symptomatic patients had L45 included in their construct. MMG is a safe alternative to EMG to monitor the lumbar plexus when performing transpsoas LLIF.
Novel Minimal Invasive Surgical Techniques for the Treatment of Segmental-Lateral Pathologic Lesions of the Spine
Authors: Papp Zoltan , Vajda János , Veres Robert , Banczerowski Peter 
Published: May 2015

Introduction Laminectomy, commonly used dorsal approach for the surgical removal of most of the pathologic lesions, situated in the spinal canal and the neuroforamen destroying the dorsal stabilizing structures of the spinal column. Retraction and detachment of the longitudinal muscles, removal of the vertebral arches (laminectomy), and injury of the joint capsules and ligaments are responsible most of short and late-time complications. Among these complications, spinal deformities, segmental instability, and permanent spinal pain are most often mentioned in the literature. The main objective of the authors was to develop and evaluate the novel minimally invasive techniques suitable for exploring and treating different segmental-lateral pathologies, expanding to the neuroforamen or even paravertebrally, with preservation of the stability of the spine. One of the key issues of this article was to summarize these procedures, with evaluating the safety and efficacy in the routine spine surgery. Patients and Methods A total of 167 patients were operated and followed up during 2000 to 2011 in our Institute with segmental lateral spinal pathologies. For the surgical treatment, we used “Over-the-top” decompression, hemi–semi laminectomy, supraforaminal burr-hole, open-tunnel, and paravertebral approaches alone or in combination. These surgical techniques are mostly our developments, or modifications of previously used surgical techniques. Results The new surgical procedures developed or modified by our team are effective techniques for treating the spinal pathologies located in the spinal canal, neuroforamen, or even the paravertebral space. The posterior stabilizing structures of the spine, as the vertebral laminae and the longitudinal musculature are mostly preserved. Leaving the longitudinal paraspinal musculature innervations intact, and with the preservation of the bone–muscle attachments and ligaments, the dynamic stability of the spine remains unchanged. Retaining the bony structures (vertebral arches) and the vertebral joints the static stability of the spinal column remain intact, the chance of developing the long-term spinal deformation is minimal. During the follow-up, we performed static and dynamic X-ray, MR, and CT scans, completed with neurological examinations to evaluate the progression of the illness, the neurological deficit, and the actual state of the spinal column. With clinical use and evaluation of the various surgical approaches, we determined the main indications and contraindications of the surgical procedures, highlighting the pit-falls and limitations. Conclusion The aforementioned minimally invasive surgical approaches are suitable for treating segmental–lateral spinal pathologies. For the routine clinical use, we organized the surgical techniques into a complete framework based on the location of the pathologic lesions.
Fat Fraction Quantification of Lumbar Paravertebral Muscle in Magnetic Resonance Imaging using Six Echoes Dixon Technique
Authors: Shin Dong-Eun , Seo Jeong Ho , Kim Hak-Sun , An KiChan , Lee Young-Sang 
Published: May 2015

Introduction Increasing studies on the muscles volume in the lumbar spine of low back pain patients is available in the literature. So far, these studies were focused only on the volume of the muscle, but the quality of muscle is more important, and the quality of muscle can be evaluated with the fat fraction ratio. To measure fat fraction of muscle, currently, 2, 3 points echo Dixon techniques were used, but its accuracy is a problem. Therefore, we use the first 6 points echo Dixon and to compare accuracy of 2 echo Dixon, 3 point Dixon imaging with that from MR spectroscopy as reference. Patients and Methods A total of 69 patients (39 women and 22 men; 54.3 ± 19.1) underwent MRI at a 1.5 T scanner. In addition, using T2-corrected Dixon sequence with 2, 3, and 6 echoes were obtained at the L4–L5 levels for fat-signal fraction. Fat-signal fraction from MR spectroscopy was also obtained at lumbar muscles of L4–L5 levels. Fat-signal fractions were measured directly by drawing region of interest at the automatically obtained fat-signal fraction mapping images from the three sequences. ROIs were drawn at the three consecutive slices of mapping images at the same location of the spectroscopic voxel by two musculoskeletal radiologists in consensus and the average values were obtained. The Student t test and Bland–Altman plots were used to quantify agreement between the values obtained from mapping images and those from spectroscopy. The p values < 0.05 were considered to be statistically significant. Results A total of 120 spectroscopic measurements were performed bilaterally. Mean spectroscopic fat-signal fraction percentage was 14.0 ± 11.8 (range, 2.9–63.6). Correlation between spectroscopic and all imaging-based fat-signal fractions was statistically significant ( R2 = 0.92 [2 echo], 0.91 [3 echo], and 0.96 [6 echo], all p < 0.001). Fat-signal fractions obtained from 6-echo T2-corrected Dixon sequence best correlated among all imaging-based fat-signal fractions with statistical significance ( p < 0.001). Conclusion T2-corrected 6-echo Dixon sequence best correlates with spectroscopic fat-signal fractions as compared with 2 echo and 3 echo sequences, thus being expected to be used as an accurate quantification tool for measurement of muscle fat quantification in lumbar spine MR imaging.
Treatment of C2 Vertebral Body and Dens Tumors with Intraoperative Transoral or Transpedicular Vertebroplasty and Occipitocervical Posterior Fixation
Authors: Papp Zoltan , Marosfoi Miklos , Szikora Istvan , Banczerowski Peter 
Published: May 2015

Introduction Metastatic spinal tumors of the atlantoaxial region are quite uncommon thus surgical treatment is difficult and challenging procedure. The origin of these metastatic tumors are mainly breast, lung, and prostate neoplasms, or part of hematopoietic disorders such as myeloma multiplex, lymphoma. Clinical management of the C2 metastatic lesions includes open surgery, radiotherapy, vertebroplasty, and external immobilization. The aim of our study was to evaluate the safety and efficacy of simultaneous intraoperative transoral or transpedicular vertebroplasty combined with posterior fixation in case of C2 vertebral metastatic disease. Patients and Methods We enrolled five patients with osteolytic C2 vertebral metastasis. The origin of the metastatic tumors was breast cancer in two cases, lung cancer in two cases, and multiple myeloma in one case. In three cases, we made purely posterior approach by dorsal open C2 biopsy and transpedicular vertebroplasty followed by posterior occipitocervical fixation. In the other two cases, patients underwent transoral C2 biopsy and vertebroplasty and dorsal occipitocervical fixation in the same session. The patients were followed with regular fluoroscopy, MRI, CT scans, and neurological examinations immediately after the operation and thereafter at 6 months. The HALO fixation device was removed after the first postoperative CT examination. Results During our 8 to 19 months (average 13 months) follow-up period, we had no surgical or neurological complications with respect to this combined approach. The incidence of postoperative cervical pain was lower, compared with the preoperative pain. Preoperative VAS was 7 (6–8), while postoperative VAS was 3.5 (2–5). On postoperative neurological and radiological follow-up, no surgical or neurological complications developed with respect to this combined approach of the atlantoaxial region of the spine. The average volume of PMMA injected was 4 mL. We filled more than 60% of each patient's C2 vertebral body and dens. Conclusion In this small series of simultaneous intraoperative transoral or transpedicular vertebroplasty and dorsal occipitocervical fixation proved to be a safe and effective treatment for patients with osteolytic C2 metastatic tumors. These techniques may provide excellent pain relief and improvements in quality of life. The true value of these combined techniques should be evaluated in larger series.
Systematic Review of Surgical Treatment Outcomes of Prostate Metastases to the Spine
Authors: Clarke Michelle , Molina Camilo , Fourney Daryl , Fisher Charles , Gokaslan Ziya , Schmidt Meic , Rhines Laurence , Fehlings Michael , Laufer Ilya , Patel Shreyaskumar , Rampersaud Raja , Reynolds Jeremy , Chou Dean , Bettegowda Chetan , Mendel Ehud , Weber Michael , Sciubba Daniel 
Published: May 2015

Introduction Treatment of symptomatic spinal metastases through surgical decompression and reconstruction is known to improve quality of life in patients with cancer. However, most studies have been performed on patients with mixed tumor histopathology. We systematically review the literature for prognostic factors specific to the surgical treatment of prostate metastases to the spine to determine the indications and outcomes of the surgical treatment. Material and Methods A systemic review of the literature was conducted to answer the following questions: Q1. Describe the survival and functional outcomes of surgery or vertebral augmentation for prostate metastases to the spine; Q2. Determine whether overall tumor burden, Gleason score, preoperative functional markers, and favorable hormonal naivety for operative intervention; Q3. Establish whether clinical outcomes vary with the evolution of operative techniques. Expert consensus was obtained using a modified Delphi process. Results A total of 16 studies met the preset inclusion criteria. These studies were all retrospective series with a level of evidence of IV. Included studies consistently showed a large effect of hormone naivety on overall survival. In addition, studies consistently demonstrated an improvement in motor function and the ability to maintain/regain ambulation following surgery resulting in moderate strength of recommendation. All other parameters were of insufficient or low strength. Conclusion There is scant literature on the surgical treatment of prostate metastases to the spine, which represents an opportunity for future research. On the basis of the existing evidence, it appears that the surgical treatment of prostate metastases to the spine has consistently favorable results. While no consistent preoperative indicators favor nonoperative treatment, hormone naivety and high Karnofsky Performance Scores have positive effects on survival and clinical outcomes.
Radiotherapy-Induced Tumors of the Spine, Peripheral Nerve, and Spinal Cord
Authors: Falavigna Asdrubal , Righesso Orlando , da Silva Pedro Guarise , Cagliari Carolina , Mourão Livia , Teixeira William 
Published: May 2015

Introduction The development of a secondary malignancy in the field of radiation is a rare, but well-recognized hazard of cancer treatment. Radiotherapy-induced (RT-I) tumors have become increasingly important because of the longer life of the general population, even the oncologic patients. The goal of this study is to report a case of RT-I neural tumor located in the spine and to perform a systematic review of the secondary tumor induced by radiotherapy to the spine. Materials and Methods A case of neural tumor secondary to radiotherapy to the spine was reported and a literature search of the cases of RT-I spine tumors was performed using an online database, Pubmed.gov. After exclusion criteria, 22 articles with 28 cases were included in the study. The variables analyzed were patient's age, gender, primary and secondary tumor histology, tumor location, time of development of the secondary tumor, treatment options, and outcome. Results The mean age of the patients at diagnosis of the induced tumor was 39.20 ( ± 17.02) years. Most of them were males (62.1%). The main type of primary disease was neural tumors (27.6%). The RT-I tumors were diagnosed within a mean of 17.1 ( ± 9.6) years after the radiotherapy (min 3–max 40). The most common type of histology was fibrosarcoma (20.7%). No difference was found in age, gender, and time for diagnosis between neural and nonneural tumors. The mean survival after the diagnosis of the secondary tumor was 10.66 months ( ± 12.96) and neural tumors had a longer survival period ( p = 0.031). Conclusion Most of the RT-I tumors are secondary to the treatment of Hodgkin Lymphoma with radiotherapy, sarcoma being the most frequent. The current gold standard is complete resection with clear margins. The neural tumor type had a longer survival period.
Surgical Treatment of Sharp Angular Kyphotic Deformity with Neurological Deficit due to Neglected Dorsal Hemivertebra in Adult Population
Authors: Gokcen Bahadir , Enercan Meric , Kahraman Sinan , Kilic Mesut , Erturer Erden , Ozturk Cagatay , Alanay Ahmet , Hamzaoglu Azmi 
Published: May 2015

Introduction Treatment of neurological deficit and deformity because of the neglected dorsal hemivertebra is a challenging procedure. Restoration of the sagittal balance is also technically demanding because of the sharp, angular kyphotic deformity. The aim of this study is to evaluate the results of the patients treated by dorsal hemivertebra resection via posterior approach for spinal decompression and deformity correction. Patients and Methods A total of 11 patients (8 M and 3 F) with average age 32.1 years (range, 19–49 years) were operated via dorsal hemivertebrectomy with posterior only approach. In the surgical technique, following 2 to 3 levels above and below pedicle screw fixation, wide laminectomy was performed one level above and below the apex of the deformity and spinal canal was decompressed by removing the dorsal hemivertebra. Deformity correction included sequential gradually compression from posterior and distraction from anterior column to prevent any dural buckling. Finally, an expandable cage was placed for anterior column support and distracted while final compression applied from posterior to correct local kyphosis totally. Spinal cord monitoring was used at all stages of surgery in all patients. Sagittal and pelvic parameters were measured on pre-op and post-op standing X-rays. Results The mean follow-up was 27.5 months (range, 24–32 months). The mean surgical time was 6.5 hours (range, 5–9 hours), average blood loss was 3,200 mL. Pre-op average local kyphosis angle was 57.250 and improved to 9.30 with a correction rate of 83%. There was no significant improvement in other parameters. All patients with neurologic deficit (eight patients ASIA grade D, two patients ASIA grade C, and one patient ASIA grade B) had significant improvement to ASIA grade E. There were no major complications including pseudarthrosis and implant failure. Minor complications included two (18%) superficial wound problems and one (9%) hematoma which responded well to debridement. Conclusion Posterior wide laminectomy and dorsal hemivertebra resection provide decompression of the neural structures. Correction of the local kyphosis and restoring sagittal balance are very challenging in sharp angular kyphosis. Ideal correction technique should include anterior column elongation with gradual posterior compression sequentially and placement of expandable cage to prevent any dural buckling.
Intraspine Interlaminar Device: Clinical, Radiological, and Safety Results of a Mini Case Series (10 Cases)
Authors: Carrabs Gabriele , Sessa Giovanni , Oliva Giovanni , Magliulo Maurizio , Pipola Angelo Michele , Silvestro Antonio , Sica Giuseppe 
Published: May 2015

Introduction Patients with low back pain and neurogenic claudication suffer chronic disability and in 40 to 50% of these, degenerative disc disease (DDD), and foraminal stenosis seem to be the principal causes. This preliminary mini case series assessed the clinical efficacy and radiological results of the Intraspine interlaminar device implanted in 10 patients. Patients and Methods We operated 10 patients (five males and five females) with a mean age of 67.5 years (ranging from 56 to 80 years) at our institution. The mean follow-up was 6 months. We evaluated patients with to the following end points: clinical outcome (according to Odom criteria) and radiological widening of neural foramina. Results A total of 10 Intraspine interlaminar device were implanted in 10 single-level procedures. One month after the surgery, according to Odom criteria, all the patients experienced good-to-excellent functional recovery with improvement of LBP and neurogenic claudication. At 6 months, the patients were clinically stable with two cases of further clinical benefit. The diameter of adjacent (above and below) neural foramina was weakly affected by the positioning of the interlaminar spacer indicating a reduced workload adjacent effect. No complications were associated with surgery. Conclusion The clinical and radiological results suggest that the Intraspine interlaminar device is a safe and effective alternative to commonest interspinous device with the advantage of reduced workload on adjacent levels.