bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Risk Factors, for Complications Associated with Growing Rods, in the Management of Progressive Early-Onset Scoliosis
Authors: Meneses David , Montero Carlos , Alvarado Fernando , Godoy Wilmer , Alcalá Gabriel 
Published: May 2015

Introduction Growing-rod spinal instrumentation systems are a valuable option for managing progressive early-onset scoliosis. However, some studies had suggested that its efficacy may be lost over a period time and could be counterbalanced by a high rate of complications. The objective of this study was to determine the efficacy and safety of growing rods for the treatment of progressive early-onset scoliosis. Materials and Methods An Institutional Review Board approved cross-sectional study was performed, including patients with early-onset scoliosis treated with growing rods between 1997 and 2012. A retrospective review of the chart and radiographic data were performed. Risk factors for complications were explored using univariate and multivariate analyses. Results Records of 35 patients were included. The mean age at implantation of the rods was 5.8 ± 2.3 years. Overall, 18 patients had a diagnosis of idiopathic scoliosis, 11 with congenital scoliosis, and 6 with neuromuscular scoliosis. The mean Cobb measurement for the preoperative major curves was 66.7 ± 14.4 (range, 42–98) degrees. After a mean of 4 ± 1.4 lengthening procedures, there was a statistically significant improvement in the coronal plane deformity to a mean of 34.9 ± 11.2 degrees ( p < 0.001), resulting in an average decrease of 31.8 ± 14.6 degrees. Following complications have occurred in 11 patients (31.4%): implant failure/fracture (22.9%), surgical site infection (5.7%), and transient brachial plexus injury (2.8%). The only risk factor associated with the presentation of postoperative complications was the total number of lengthening procedures (OR = 2.79). Conclusion Growing rods are effective for reduction of the magnitude of the spinal deformities in patients with progressive early-onset scoliosis before the definite fusion. However, this treatment is related with a relatively high rate of postoperative complications. Those complications appear to be associated with the total number of lengthening procedures previous to the definitive fusion. Therefore, it is advisable to reduce the frequency of lengthening as much as needed for maintaining the correction and allow the longitudinal growing of the spine.
Modification of Goel–Harms Technique in the Surgical Treatment of Atlantoaxial Subluxation after Grisel Syndrome
Authors: Corredor Santos José Alfredo , Alvarado Fernando , Morales Luis Carlos , Rodriguez Munera Andres 
Published: May 2015

Introduction Many etiologies can lead to atlantoaxial subluxation. In Grisel syndrome, this subluxation occurs spontaneously after inflammatory processes of the head and neck. Nonsurgical treatment most often resolves the symptoms; however, in some cases, surgical treatment is necessary to repair the subluxation. Various surgical techniques and instrumentation systems have been used to treat atlantoaxial subluxation, although there is no consensus regarding the best treatment method for the pediatric population. We aim to describe a modified surgical technique for the treatment of atlantoaxial subluxation in a child with Grisel syndrome. Patient and Methods: Our case study involves a 5-year-old female patient with a 6-month history of unresolved Fielding type II atlantoaxial subluxation because of the Grisel syndrome. Despite conservative treatment, the patient's symptoms continued to progress. After two failed closed reduction attempts, open reduction and C1–C2 fusion with a modified Goel–Harms technique was performed with atlas laminar hook and axis pedicle polyaxial screws. A literature review of the surgical treatment of the Grisel syndrome was also performed. Results After surgery, the patient exhibited full clinical and functional recoveries with complete resolution of symptoms. At the 24-month follow-up examination, there was continual evidence of satisfactory reduction and fusion. No complications were observed. On completion of the literature review, seven Grisel syndrome cases were found to have been treated surgically with the minimum patient age being 9 years. Conclusion Conservative management of Grisel syndrome is the most common and effective treatment; however, a few surgical cases have been reported in the literature with good results. We exhibit a safe, new surgical construct for pediatric patients in the treatment of atlantoaxial subluxation and instability, with satisfactory clinical results and solid fusion at 24 months postsurgery.
Vertebral Fracture and Sternum Fracture
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Salgado Castillo Santiago 
Published: May 2015

Introduction The association of the sternum and vertebral fractures has been described previously in the literature. These injuries are frequently overlooked in the initial evaluation. The purpose of this study was to analyze and discuss the diagnostic methods used for these injuries and to highlight the importance of the early recognition of these fractures. Patients and Methods This study is a retrospective analysis of four patients who concomitantly suffered vertebral and sternum fractures by analyzing the clinical histories and imaging tests. Results All the patients were diagnosed with sternum fractures in the initial evaluation, but only one was diagnosed with a vertebral fracture. Conclusions Not recognizing these fractures in the initial evaluation may be associated with the difficulty of exploring the upper thoracic region. In the presence of sternum fractures, a vertebral fracture must be ruled out, whether there are major injuries or not. CT and MRI must be obtained in the event of clinical suspicion, even if the normal X-ray does not show any injuries.
Occipital Condyle Fracture: Clinical Report and Literature Review
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Salgado Castillo Santiago , Roman Veas Javier 
Published: May 2015

Introduction The purpose of our study is to draw attention to the existence of the occipital condyle fracture and the ease with which it can go unnoticed when treating a polytraumatized patient. An injury must be taken into consideration in the event of a cranial trauma with cervical pain because of its potential consequences if such a fracture is not treated correctly. Materials and Methods A retrospective study of four clinical cases in the emergency service, reporting posterior cervical pain, radiating to the base of the neck, slowly progressive, not related to a traumatic event. The clinical evaluation, physical examination, imaging studies, and treatment were done for all the patients. Results Good functional results were obtained with no neurological sequelae. Conclusion The knowledge and suspicion of this rare condition and its correct diagnosis and treatment are crucial to securing a good functional result, thereby avoiding the potential neurological injuries associated with it.
Degenerative Elderly Acute Lumbar Symptoms
Authors: Ricciardi Daniel Oscar , Garfinkel Ignacio , Carrioli Gabriel , Guillermo Ricciardi 
Published: May 2015

Introduction A total of 10 patients with a chronic degenerative spinal stenosis, showed acute signs of compressive radicular compromise. Surgical treatment was deemed necessary for adequate management of acute segmental pain. We think this type of patients should be taken separately, as a different group with clinical and surgical implications. Patients and Methods This study reports 10 patients with lumbar spinal stenosis, that in the course of the natural history, showed acute symptoms correlated to herniated discs, facet joint cyst, and curling flaval ligament compressing neural tissue. Motor deficit was frequent and required urgent decompression. Fusion was added in cases of mechanical concurrent instability. Oswestry disability index and visual analogical scale was measured pre- and postoperatively. Results Clinical and radiologic acute compressive signs were detected in chronic degenerative lumbar stenosis patients. These patients had a good response to surgical treatment according to ODI and VAS records. We propose the acronyms DEALS (degenerative elderly acute lumbar symptoms) to denominate this type of acute clinical presentation.
The Use of Translaminar Subaxial Cervical Screws in Complex Cranio-Cervical Malformations: Two Cases and Review of the Literature
Authors: Weissmann Karen , Costa Marcelo , Mora Samuel , Huaiquilaf Carlos , Correa Cristian , Luna Felipe 
Published: May 2015

Introduction In complex cervical malformations, sometimes we need to make long occipitocervical fusions, even in children. Fixation techniques include the use of wires, hooks, and screws. In C1–C2 instability, we might choose transarticular screws. All these techniques have life-threatening complications and require wide surgical expertise. In complex craniocervical malformations anatomical variations may play a significant role in complications, the safest method to avoid vascular or neurological complications in these cases is yet to be determined. Translaminar screws were first described in the C2 posterior arch as a safe way to place C2 screws and their use has extended to the subaxial spine. In complex malformations, we might find anatomical variations that play to our advantage when using this technique, such as very wide laminas in complex fused vertebral blocs. Aim The aim of this study is to report the use of cervical subaxial translaminar screws in patients with complex craniocervical deformities and review the literature. Patients and Methods We present two female patients with complex craniocervical malformations. The first case is a 21-year-old girl with basilar invagination, posterior occipital malformations, and a type II Chiari who arrived to the ER with a transitory hemiparesia and was deemed hysteric. The second patient is a 13-year-old girl who was referred to us with a mild scoliosis. On further examination, we found a complex Klippel–Feil syndrome, cervicothoracic dysgraphia without meningocele, basilar invagination, type II Chiari, and other symptoms that made us consider a genopathy, still being studied. Both girls presented altered dynamic-evoked potentials. Both patients underwent posterior cervicomedullary decompression and occipitocervical fusion, with subaxial translaminar screws. In the younger girl, C1 posterior arch resection was also necessary. Results Both the patients are asymptomatic and with no complications to report at last follow-up. Discussion Published case series have reported the use of axial and subaxial translaminar screws in atlantoaxial instability, to our knowledge, there have been no reports of their use in complex craniocervical malformations. Conclusion Translaminar screws are a good alternative for subaxial cervical spine fixation in patients with complex occipitocervical malformations. We need longer follow-up and prospective studies to reach further conclusions. Trauma
Assessment of Medial Malpositioning during Thoracic Pedicle Screws Placement with a Contemporary Intraoperative Neurophysiological Monitoring Method
Authors: Cabrera Cousiño Juan Pablo , García Rudy , Lastra Luis , Vigueras Sebastián , Torche Vélez Máximo 
Published: May 2015

Introduction Thoracic pedicle screws placement remains being a challenge despite modern technologies available. To assess neural integrity during these surgeries, intraoperative neurophysiological monitoring (IOM) is indicated. Motor-evoked potentials (MEP) and somatosensory-evoked potentials (SSEP) give valuable information regarding spinal cord function, and pedicle screws stimulation could evaluate medial malpositioning. However, the accuracy of thoracic pedicle screws stimulation is still controversial, using single-pulse stimulation, recording from intercostal and abdominal muscles, and with high false-positive rate. Objective This article aims to demonstrate the superiority of a recently validated IOM method by Blair Calancie, and share our experience with it. Material and Methods Prospective collected and reviewed study since March to October 2014. During T1–T12 level surgeries, we stimulated medial wall of pedicle track before screw placement with a ball-tipped probe using pulse-train stimulation, and recording from lower limbs muscles. MEP and SSEP were performed, and a postoperative computed tomography (CT) scans in all the cases. Results In 21 patients, 240 thoracic pedicle screws were analyzed. In 36 screws of them (17.6%), a medial pedicle breach was informed, and 19 of 36 were redirected correctly more lateral; 8 of 36 pedicles were skipped; and 7 of 36 screws were placed regardless IOM warning criteria (3.4%), with a CT scan confirming medial misplacement > 2 mm. Fluoroscopy and manual pedicle palpation evinced a medial breach in 3 of 36 and 1 of 36 trajectories, respectively, but after pedicle track stimulation was done and informed. We did not observe any MEP or SSEP change during all these screws. Fortunately, no patients developed a new neurological deficit. CSF leak was not reported in this series. Our sensitivity with this method was 93.9%, specificity 97.6%, positive predictive value 86.1%, and negative predictive value was 99.0%. Conclusion Pulse-train stimulation of pedicle track before screw placement has huge superiority over traditional IOM techniques, avoiding spinal cord encroachment and new neurological deficit. This IOM method is highly accurate during thoracic pedicle screws placement.
Multiple Extended Vertebrectomies (41 Cases): Indications, Techniques, and Results
Authors: Luzzati Alessandro , Giuseppe Perrucchini , Scotto Gennaro , Mauri Orietta , Alloisio Marco 
Published: May 2015

Introduction The technical challenges facing the spinal surgeon performing a wide vertebral resection are the relationship of proximity, contiguity, and sometime invasion of great vessels, the parenchymal organs, chest wall, and the central, and peripheral nervous system. Materials and Methods Over the past 14 years (1998–2008), we performed 41 hemi or total multilevel vertebrectomy (two to five vertebrae in a single block), 2 cervical, 25 thoracic, and 14 lumbar, with spine resection varying from a minimum of 3.6 to a maximum of 15 cm. The tumors treated consisted of 28 primary malignant bone lesions (five chondrosarcomas, eight chordoma, four osteosarcomas, four malignant schwannomas, three synovial sarcoma, one fibrosarcoma, one Ewing sarcoma, and two hemangioendothelioma), 7 single metastases from adenocarcinoma (four kidney clear cell, two breast carcinoma, and one thyroid adenocarcinoma), and 6 cases of lung adenocarcinoma. These operations have been often performed in multispecialized team, with a thoracic/vascular/plastic surgeon. Results Thoracic locations have often obliged to partial lung resection associated with extended resections of the chest, two or more ribs, for obtaining surgical margins in healthy tissue. These resections required reconstructions with Marlex nets associated with acrylic cement. In one case, a free microvascularized large latissimus dorsi muscle flap was used. In one case of lower lumbar synovial sarcoma (L3–L4), an associated resection in a single stage of the aortic bifurcation involved by the tumor with the two vertebrae was required. Major vascular axis was so replaced with an aortoiliac bypass. We have systematically performed a 360-degree circumferential reconstruction, linking the short anterior reconstruction to the long posterior hardware, than giving to the entire instrumentation the final compression. The final stability over time has been systematically performed with an anterior interbody fusion between the vertebrae adjacent to the resection, obtained with the iliac autograft with which we have filled different anterior devices (carbon cages, titanium cages, and massive homograft bank) used over the years. The serious complications that we had were as follows: mechanical remote (two cases of kyphosis with severe instability), infectious (six cases, five of which healed with revision surgery), iatrogenic (four cases of injuries to the thoracic duct, all resolved without surgical revision), neurological (five cases of paraparesis, including three with partial recovery at a distance), three local recurrences, one major vascular complication (rupture of an aorta previously irradiated at 25 days postsurgery), and two deaths in the first 30 days Discussion The high-complication rate in our series is explained by the complexity of this type of surgery, which however allows oncological results close to those that we gain in complex reconstructions of the upper and lower limbs.
Suggested Criteria regarding Effectivity of a Posterior Approach for Intradural Extramedullary Spinal Tumors
Authors: Lozano Lady 
Published: May 2015

Introduction Intradural extramedullary spinal tumors are uncommon, with a reported incidence 3 to 10 per 100,000 people, the majority of these lesions are benign (WHO grades I and II) and that are treated by posterior approach with conventional laminectomy. However, there are some factors that influence the surgical success of these tumors, which if not taken into account may change the prognostic patient. We have investigated what are these factors and their influence on surgical outcomes. Patients and Methods We performed a retrospective review of 31 consecutive patients, who presented with intradural extramedullary spinal tumors that was removed by posterior approach with conventional laminectomy between January 2011 and May 2014, the neurological findings obtained during the preoperative stage, and the postoperative follow-up were evaluated according to the Nurick grade with a minimum follow-up time of 6 months. The axial and sagittal anatomical location, the tumor occupancy rate, and tumor extension (evaluated in MRI), as well as histopathological diagnosis, tumor–cord interface, age, and sex were analyzed in relation to the postoperative neurological status (assessed by Nurick grade). Results The group was predominantly female with a ratio female:male, 4.2:1; with a mean 49.5 years (range, 16–85 years). The most common histologic diagnoses were schwannoma and meningioma, with a ratio 1.7:1. Of all the patients, in 64.5% of patients tumor–cord interface was found. The mean tumor occupancy rate was 66.3% ± 16.9. The postoperative neurological status is positively related with the following: age, female sex, dorsolateral axial location, cervical and thoracic sagittal location, tumor occupancy rate, tumor extension three or more levels, tumor–cord interface, and histopathological diagnosis meningioma ( R  = 0.776). Those with greater strength to explain the event of postoperative neurological status are as follows: age, tumor extension three or more levels, and cervical sagittal anatomical location ( p < 0.05). At the postoperative period, Nurick grade was improved from 3 ± 1.2 to 2.5 ± 1.8 [ T (31) = 2.590, p = 0.015]; and from 3 ± 1.2 to 1.7 ± 1.8 [ T (30) = 5.163, p < 0.01) at follow-up time of 6 months. Conclusion Intradural extramedullary tumors can be safely and effectively removed using posterior approach with conventional laminectomy, if it satisfies the following conditions. It has tumor–cord interface, histopathological diagnosis of meningioma, tumor < 3 segmental levels in extension, male sex, lower tumor occupancy rate, lower age, less cervical tumors, and less dorsolateral axial anatomical location.
Lumbar Neural Foraminal Extradural Lipoma: Case Report, Literature Review
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Roman Veas Javier 
Published: May 2015

Introduction Extradural lipoma is a rare condition of which few cases have been described in the literature, and a low percentage of these appear in the lumbar spine. The purpose of our presentation is to describe a new case of this entity, to deepen understanding of the clinical and imaging findings of this condition as well as its treatment. Materials and Methods Retrospective study of a clinical case that arrived for consultation presenting a clinical picture of long-term lumbar pain for 2 years. For 9 months there was bilateral lumbosciatic pain, intermittently more severe on the right side, S1 sensory deficit right side. Clinical evaluation, physical examination, and imaging studies were performed. Results The following were evaluated: history, clinical picture, age, gender, type of images requested and their results, treatment undertaken, and time of evolution of the symptoms. A literature review of this condition was made, comparing what has been published with our experience. Conclusion The lumbar extradural spinal lipoma is a rare benign tumor lesion that can produce backache and neurological compression. When the patient consults because of the appearance of neurological disorders secondary to compression phenomena, MRI is the test of choice for the evaluation of this pathology. Recovery from the symptoms occurs in most cases after surgical decompression.
Mini Open Extreme Lateral Lumbar Corpectomy to Complete 360 Decompression and Stabilization due to Malignant Fibrous Histiocytoma
Authors: Arias Pesantez Carlos Fernando 
Published: May 2015

Introduction Some spine extradural tumors can be able to compress the anterior and posterior aspect of the cord canal and the correct approach allows the total decompression as well as the final construction and stabilization. Patient and Methods: We present the case of a 17-year-old woman with conus medullaris syndrome symptoms. We initiate the posterior approach to achieve decompression, a tumor diagnosis and initial stabilization with transpedicular screws, and for the second time a lumbar corpectomy with extreme lateral miniopen approach to complete the tumor resection, and final 360 grades construction to allow total stability and fusion. Results This patient was discharged after 46 hours of surgery without neurological deficit. Conclusion The mini open lateral and posterior approaches are able to work together conserving the basic principles of total decompression and stabilization with short hospitalization and quick return to normal activities.
Early Onset Scoliosis: A Novel Technique for Treatment of a Progressive Scoliosis using Dual Growing Rod and Posterior Apical Convex Fusion
Authors: Pantoja Samuel , Chahin Andres , Valenzuela Carlos , Arriagada Gonzalo , Chamorro Marcela 
Published: May 2015

Introduction Several different growing rod techniques have been described in the literature to treat progressive scoliosis in young children. The purpose of this retrospective clinical study is to evaluate the effect of dual growing rod and posterior apical convex fusion in early onset scoliosis (EOS). Material and Methods This study retrospectively reviewed the clinical records and radiographs of the 11 children with progressive EOS who failed to respond to conservative treatment and underwent fusionless surgery using dual growing rod and posterior apical convex fusion. Results Fusionless dual growing rod and posterior apical convex fusion allowed maintaining scoliosis correction in all the patients. At an average of 3.1 ± 0.8 years after initial surgery, 11 patients showed a correction of 39. 9% in the magnitude of the original curvature (the average preoperative Cobb angle was 56 [range, 40.96–89.5] and postoperative was 34.27 [range, 24.69–58]). Trunk height increase was documented in all patients. Rod failure was found in three patients. Conclusion Preliminary results from these series of patients show that the presented fusionless dual growing rod and posterior apical convex fusion allows maintaining correction of progressive EOS while permitting spinal growth with a low-complication rate. This procedure is efficacious as long as some guidelines are respected.