bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes following Complex Combat-Related Lumbosacral Dissociation Injuries
Authors: Wagner Scott , Kang Daniel , Lehman Ronald 
Published: May 2015

Introduction As war injury patterns have changed throughout Operations Iraqi and Enduring Freedom (OIF/OEF), a relative increase in the incidence of complex lumbosacral dissociation (LSD) injuries has been noted. LSD injuries are an anatomic separation of the spinal column from the pelvis, and represent a manifestation of severe, high energy trauma. We assessed the clinical outcomes of combat-related LSD injuries after operative treatment. Methods We performed a retrospective review of all patients surgically managed for complex LSD injuries since the beginning of current combat operations in the Middle East. Results A total of 20 patients met inclusion criteria and were treated as follows: posterior spinal fusion (12), sacroiliac screw fixation (7), and combined anterior–posterior fusion (1). The mean age was 28.2 years. The most common mechanism of injury was mounted improvised explosive device (IED, 50%). On average, 2.2 spinal regions were injured per patient. Neurologic dysfunction was present in four patients. Three patients underwent operative stabilization of their injuries before evacuation to the United States. Median time to surgery from injury was 12 days (range, 0–111 days). There was a 20% wound infection rate. Median follow-up was 45.5 months (range, 23.2–105.3 months), and one-third of all patients were medically retired because of their injuries. At most recent follow-up, 45% complained of chronic low back pain and 35% had persistent neurologic deficits; however, 30% were actively engaged in strenuous physical activities, including swimming, distance running, and training for special forces. Conclusion This is the largest series of operatively managed lumbosacral dissociation patients currently reported. Our series suggests that combat-related lumbosacral dissociation injuries frequently result in persistent, long-term neurologic dysfunction, disability, and chronic pain. Operative management carries a high postoperative risk of infection. However, two-thirds of patients were able to remain on active duty after their injuries, and two patients were able to complete marathon training.
A Retrospective Clinical and Fusion Analysis of the STALIF-C Device with Stem Cell Derivative Bone Graft Material
Authors: Elshihabi Said 
Published: May 2015

Introduction Perform a retrospective review of a single site experience with the STALIF-C (Centinel Spine) integrated cervical fusion device and OsteoCel + stem cell–derived allograft material (NuVasive, Inc.). Material and Methods We reviewed all charts of patients undergoing an anterior cervical discectomy and fusion (ACDF one, two, and three levels), utilizing the STALIF-C device and Osteocel + bone graft material. Data comprised patients from January 2012 to April 2014, with an average final imaging follow-up of 5 months. All patients underwent the ACDF by the same surgeon at the same institution. Fusion criteria were assessed primarily by thin cut CT scans with multimodal reconstructions, but also with dynamic X-rays if CT imaging was unavailable. We implemented a standardized CT fusion criteria, for which all images were read by an independent Board Certified Neuroradiologist. Criteria for fusion was based on a grade 1 to 5 scale (CT imaging), and/or no movement on dynamic X-rays of greater than 2 degrees. Results A total of 101 patients were included in the study, with imaging and clinical follow-up obtained in 101 patients (100%). There were 39 males and 62 females, with an average age of 54. The break down in the number of levels treated was as follows: One level (49%), two levels (36%), and three levels (15%). Overall, 14% of the patients were active smokers, 11% had a history of former nicotine abuse, and 74% were nonsmokers. All the follow-up fusion assessments were done with thin cut CT scans with sagittal and coronal reconstructions, and dynamic X-rays. The fusion rates for the levels treated were as follows: one level (98%), two levels (94%), and three levels (87%). The integrated fusion rate was 95% without separating the procedures by levels. There were no incidents of hardware failure or break, with only one patient requiring a posterior cervical fusion for symptomatic pseudoarthrosis (multilevel fusion patient). Conclusion The STALIF-C integrated cervical fusion device, in conjunction with Osteocel + stem cell–derived bone graft material is a safe, effective, and reproducible fusion construct in the treatment of cervical degenerative disc disease. The rates of fusion, as compared with systematic meta-analyses in the literature, are comparable and in some cases superior to reported rates using standard cervical plating and cage constructs. To the best of our knowledge, this is the largest review analysis of any integrated cervical fusion device.
Surgical Outcome of Z-Plasty for Cervical Myelopathy: A Retrospective Study with Mean Follow-Up of 5 Years
Authors: Vu Truc , Vo Si 
Published: May 2015

Introduction It is generally accepted that laminoplasty is a safe and reliable surgical treatment for cervical spine myelopathy (CSM) because of the spinal canal stenosis. There are multiple techniques of laminoplasty for spinal cord decompression and most of them require expensive instruments or spacers to stabilize the lamina. In the Hospital for Traumatology and Orthopaedics at Ho Chi Minh city, Vietnam, we performed the Z-plasty operation (Sakou technique) since 2004 to present for patients with CSM with an effort to reduce the cost of treatment. Patients and Methods It is a retrospective study. Patients suffered from CSM treated by Z-plasty technique are selected. We performed the Sakou technique, which open one lamina to the left, then the next lamina to the right and the next one to the left, consecutively and respectively. To keep the lamina opened, we tight them in pairs with unabsorbable sutures. Patients were instructed to wear hard collar for 1 week, and then started to follow our rehabilitation program. We use JOA score system and recovery ratio of Hirabayashi to evaluate the neurologic outcome. For functional outcome of cervical spine evaluation, we use the Neck Disability Index (NDI). Results There were 36 patients with a mean follow-up of 5 years (range, 1–10 years), sex ratio approximately 3:1, and a mean age of 61 years. The mean operating time and blood loss per lamina were 40 minutes and 55 mL, respectively. The final canal expanding ratio was 25%. For surgical complications, there were only three cases of C5 palsy with full recovery after 1 year. There was no case of dura tear or infection. The mean pre- and postoperative JOA score were 11.1 and 14.7, respectively. The recovery ratio was 68%, with 71% of cases considered as good and excellent. For clinical outcome, the mean NDI was 0.18 with 88% of cases considered as good and excellent. The mean preoperative and final lordotic angle of cervical spine were 21.1 and 19.3 degrees, respectively, with no statistical significance. Conclusion The Z-plasty is a safe and reliable technique with a good outcome on neurological, anatomical, and clinical aspect which can be compared with other techniques. The absence of foreign bodies such as titanium plates or spacers reduces considerably the risk of infection and the cost of treatment. Considering the risk–benefit and cost–benefit ratio, this operation is particularly suitable for low-income patients in the developing countries.
A New Source of Structural Autograft for ACDF Surgery: Cervical Laminae
Authors: Liu Jiaming , Xiong Xu , Liu Zhili 
Published: May 2015

Background Autograft bone as a fusion substrate is still the gold standard in the procedure. However, few studies have reported that using autologous cervical laminae as the bone graft in ACDF during the combined posteroanterior cervical spine surgery. Objective This study aims to evaluate the feasibility of using autologous cervical laminae as the bone graft in ACDF and to describe the clinical and radiographic outcomes in patients undergoing combined posteroanterior cervical surgery using autologous laminae as bone graft in ACDF. Material and Methods Computed tomography (CT) scan of the cervical spine were performed in 50 adult cases. The heights of the laminae and the middle intervertebral space from C3 to C7 were measured on the CT planes. Then, 16 patients (nine males and seven females) with cervical spondylotic myelopathy underwent one-level combined posteroanterior procedure with anterior plate fixation from January 2010 to January 2013. Patients underwent combined posteroanterior surgery with laminectomy and ACDF. The structural laminae obtained from laminectomy were used as bone graft in ACDF. The clinical and radiographic outcomes of the patients were analyzed and the effectiveness and safety of the surgery was evaluated. Results The average height of the laminae and the middle intervertebral space from C3 to C7 were 11.18 ± 1.05 mm and the 5.75 ± 0.58 mm, respectively. Statistical significant difference was found between the heights of the laminae and the space ( p < 0.001). All the patients were followed up and the average follow-up period was 25.5 ± 3.1 months. All patients had immediate postoperative resolution of symptoms and radiographic evidence of solid fusion 3 months later. Postoperatively, excellent results were reported in 62.5%, good results in 18.8%, and fair results in 18.8% of the patients according to Odom criteria. Visual analog scale score of the neck and extremities pain was significantly decreased after the surgery ( p = 0.014). The average preoperative and postoperative lordosis angles of the cervical spine were 24.42 ± 13.84 degrees and 32.91 ± 7.79 degrees, and the difference was significant ( p < 0.01). Little loss of the angle was noted at final follow-up (32.91 ± 7.79 vs. 29.30 ± 7.88 degrees, p = 0.51). Anterior intervertebral space height was significantly increased ( p < 0.001) after the surgery and a little declined at final follow-up ( p = 0.43). No intraoperative complication was noted in the patients and three patients got self-limiting dysphagia postoperatively, who recovered spontaneously. Conclusion The height of the cervical laminae is adequate for bone graft in ACDF. Structural autograft harvested from the laminae provides a viable alternative to AIC grafting.
Ca2+ Regulates the Expression of Type II Collagen and Aggrecan in Intervertebral Disc Cells by Activating the Extracellular Calcium-Sensing Receptor
Authors: Bokhari Rakan , Epure Laura , Antoniou John , Mwale Fackson , Grant Michael 
Published: May 2015

Introduction Intervertebral disc (IVD) calcification frequently occurs with age as demonstrated by radiographic analysis of elderly spines and is enhanced in patients with scoliosis. In one study by Chanchairujira K. et al (Spine 2004;230:499–503), the degree of disc degeneration as measured by disc space height was significantly correlated with IVD calcification. Several systemic disorders such as hyperparathyroidism and chondrocalcinosis, which are related to calcium handling, arthritis, trauma, vertebral fusion, and infection, have been associated with IVD calcification. Our preliminary data suggest that ionic calcium content and expression of the extracellular calcium-sensing receptor (CaSR) are increased in NP and AF cells of human Thompson graded discs, however, a role in disc degeneration remains unknown. Material and Methods Cells: Human NP and AF cells were incubated in culture media containing various concentrations of calcium (1.0, 1.5, 2.5, and 5.0 mM) a CaSR agonist (5 µM), or IL-1β (10 ng/mL) for 7 days. Lysates were extracted and the expression of aggrecan and type II collagen (Col II) were measured by Western blotting. IVDs: Caudal IVDs from the tails of 20- to 24-month-old steers were isolated and the vertebral bone was removed. IVDs were cultured for 4 weeks in culture medium containing calcium (1.0, 2.5, or 5.0 mM), or a CaSR agonist (5 µM). NP and AF tissues were subjected to guanidium extraction and Western blotting was performed to determine the expression of aggrecan and Col II. Histological sections were prepared to determine degree of mineralization by von Kossa staining and expression of alkaline phosphatase. Results The expression of aggrecan and Col II decreased dose-dependently in both NP and AF cells following incubation with calcium or the CaSR agonist. A similar phenomenon was observed in the expression of aggrecan and Col II in IVDs following calcium incubation. In addition to decreases in Col II and aggrecan, increase in mineralization and expression of alkaline phosphatase was observed in calcium-incubated IVDs. Conclusion Our results suggest that changes in the local concentrations of calcium are not benign, and that activation of CaSR may be a contributing factor in IVD degeneration.
Evaluation of Proximal Junctional Kyphosis following Posterior Thoracic Instrumentation: The Effect of Posterior Anatomical Structures and Facet Joints: A Biomechanical Analysis on Fresh Sheep Spine
Authors: Korkmaz Murat , Akgul Turgut , Ozkunt Okan , Sariyilmaz Kerim , Dikici Fatih , Yazicioglu Onder 
Published: May 2015

Introduction Proximal junctional kyphosis (PJK) has traditionally been defined by a 10 degree or greater increase in kyphosis at the proximal junction as measured according to Cobb method. Especially patients who have advanced spine deformity are prone to PJK and it is related with aggressive treatment protocols. In this biomechanical study, we aimed to evaluate interspinous ligament complex disruption and facet joint degeneration on PJK development. Material and Methods Randomly selected 21 sheeps were operated via posterior approach and pedicle screws were instrumented from T2 to T7. Three groups with seven samples were established to create junctional disruption. First group selected as control group (CG), of which posterior soft tissue and facet joints were preserved intact. In the second group (spinous group, SG), interspinous ligament complex which one segment cranial to UIV has been transected, and third group (facet group FG) where facet joint excision was performed. 25 N, 50 N, 100 N, 150 N, and 200 N forces applied at frequency of 5 Hz as 100 cycles axial to the samples. To determine strength of proximal junctional area in static loading 250 N, 275 N, and 300 N forces was applied. Changes in the proximal junctional region were defined radiologically. Lateral X-ray views were taken to measure interspinous distances, kyphosis angles, and discus heights. Abnormal PJK was defined by a proximal junctional angle greater than 10 degree and at least 10 degree greater than the corresponding preoperative measurement. Results In CG group, average interspinous distance was 6.6 ± 1.54 mm and kyphosis angle was 2.2 ± 0.46 degree before biomechanical testing, and they were measured as 9.4 ± 1.21 mm and 3.3 ± 0.44 degree respectively after forces applied to samples. In SG group, average interspinous distance was 6.2 ± 1.71 mm and kyphosis angle was 2.7 ± 1.09 degree before the experiment, and they were measured as 20.8 ± 5.66 mm and 15.1 ± 2.33 degrees, respectively, after biomechanical testing. In FG group, average interspinous distance was 4.8 ± 1.15 mm and kyphosis angle was −1 ± 4.14 degree before experiment, and they were measured as 11.1 ± 1.96 mm and 11 ± 2.87 degree, respectively, after forces applied to samples. Statistically significantly junctional kyphosis development was detected on both FG and SG group than group control group ( p < 0.05). PJK was seen significantly more frequently on SG group than FG group ( p < 0.05). Disc distances were similar in all groups ( p > 0.05). Conclusion Protecting interspinous ligament complex and facet joint on surgical treatment of spine deformity is mandatory to prevent PJK. To our knowledge, this is the first biomechanical study that reveals that the interspinous ligament complex is more effective in preventing PJK development than facet joints.
Comparison of the Clinical Outcome and Biomechanical Segmental Stability of Bilateral Laminotomy versus Bilateral Facet-Sparing Laminectomy in the Treatment of Spinal Stenosis
Authors: DiLorenzo Daniel , Moisi Marc , Page Jeni , Oskouian Rod 
Published: May 2015

Introduction The objective of decompressive surgery for lumbar or cervical stenosis is to treat the compressive pathology while minimizing iatrogenic destabilization of the spine. The surgical technique has consequently evolved from the radical laminectomy to a facet-sparing laminectomy and more recently to midline preserving techniques including bilateral laminotomy. Cadaveric studies have supported and characterized the biomechanical advantages of the bilateral laminotomy over facet-sparing laminectomy. In this study, we characterize and compare outcome and long-term follow-up between patients who have been treated with either of these two techniques at our institution. Patients and Methods We reviewed 100 patients comprising 50 who underwent bilateral facet-sparing laminectomy and 50 who underwent bilateral laminotomy. Clinical outcome measures include reduction in pain as assessed using visual analog scale. Biomechanical outcome measures included segmental motion at the operated segment as measured on postoperative flexion–extension X-rays obtained at long-term follow-up. Results Analyses of each of the surgical technique cohorts were performed. Clinical outcome as assessed by visual analog scale ratings was comparable between the two groups of patients undergoing either of bilateral laminectomy or bilateral laminotomy. An increase in the segmental angular movement at the operated level as measured from flexion extension studies was less in the patients undergoing bilateral laminotomy as compared with those undergoing bilateral laminectomy. Conclusion The bilateral laminotomy achieves successful decompression of spinal stenosis while preserving biomechanical stability of the involved spinal segments. For properly selected patients, this may provide a surgical option with clinical and biomechanical outcomes which are superior to those provided by facet-sparing laminectomy, which has supplanted to original radical laminectomy. Sparing of the midline osteoligamentous structures, as achieved using the bilateral laminotomy, represents a further advancement in surgical technique in the treatment of spinal stenosis, providing satisfactory clinical outcomes while further minimizing disruption of the normal spinal biomechanical stability.
Sacral Screw Strain in a Long Posterior Spinal Fusion Construct with Sacral Alar-Iliac versus Iliac Fixation
Authors: Kang Daniel , Lehman Ronald , Wagner Scott , Lenke Lawrence , Kebaish Khaled 
Published: May 2015

Introduction Long instrumented posterior fusion constructs to the lumbosacral spine have a significant rate of pseudoarthrosis and S1 screw failure. With the increasing popularity of Sacral Alar-Iliac (S2AI) fixation with its purported advantages of (1) decreased implant profile and (2) obviating the need for a lateral offset connector, the biomechanical properties with respect to S1 screw strain remain unknown. We set out to compare the biomechanical effect of S2AI versus traditional iliac screw fixation on S1 screw strain. Methods Five fresh-frozen human cadaveric specimens were instrumented from L2–pelvis, maintaining all osteoligamentous structures, with bilateral titanium 6.0 × 40-mm pedicle screws and 5.5-mm cobalt–chromium rods. Bilateral S1 pedicles were instrumented with 8.0 × 50-mm screws that were centrally cored out and two uniaxial strain gauges inserted at 0 and 90 degrees. S2AI fixation and/or iliac fixation with 8.0 × 80-mm titanium pedicle screws was performed to evaluate the following four different constructs: (1) bilateral S1 screws (control); (2) bilateral S2AI; (3) bilateral iliac; (4) hybrid (S2AI with contralateral iliac). Bilateral S1 screw strain was measured (microstrain), and pure moment loads (12.0 Nm) were applied in axial rotation (AR), flexion extension (FE), and lateral bending (LB). One way repeated measure ANOVA was used to analyze the S1 screw strain data. Results Compared with S1 screws alone, both S2AI fixation and iliac fixation significantly reduced sacral screw strain in FE by 58 and 67%, respectively ( p < 0.05), in AR by 35 and 41%, respectively ( p < 0.05), while no significant difference in LB for either construct ( p > 0.05). Hybrid constructs demonstrated a significant reduction in only FE, with reduction in screw strain by 56% for S2AI fixation and 59% for iliac fixation, with no difference in AR and LB moments. When S2AI fixation and iliac fixation were compared, there was no significant difference in screw strain for all bending moments ( p > 0.05). Similarly, hybrid constructs demonstrated no side-to-side significant difference between S2AI fixation and iliac fixation for all bending moments ( p > 0.05). Conclusion Both S2AI fixation and iliac fixation provide significant reduction in S1 sacral screw strain compared with sacral fixation alone. Bilateral S2AI fixation is a viable and biomechanically comparable to alternative traditional iliac fixation, and presents another option to achieve protection of the S1 sacral screws for long segment constructs to the pelvis.
Establishing the Injury Severity of Thoracolumbar Trauma: Confirmation of the Hierarchical Structure of the AOSpine Thoracolumbar Spine Injury Classification System
Authors: Schroeder Gregory , Vaccaro Alexander , Kepler Christopher , Koerner John , Oner Cumhur , Dvorak Marcel , Vialle Luiz , Aarabi Bizhan , Bellabarba Carlo , Fehlings Michael , Schnake Klaus , Kandziora Frank 
Published: May 2015

Introduction The AOSpine Thoracolumbar Spine Injury Classification System was recently published and combines elements of both the Magerl system and the Thoracolumbar Injury Classification System (TLICS); however, the injury severity of each fracture has yet to be established. The objective of this study is to develop a validated regional and global injury severity scoring system for thoracolumbar trauma. Material and Methods A survey was sent to 100 AOSpine members from all six AO regions of the world (North America, South America, Europe, Africa, Asia, and the Middle East). Each respondent was asked to numerically grade the severity of each variable of the AOSpine Thoracolumbar Spine Injury Classification System including the morphology, neurologic grade, and patient-specific modifiers. A grade of zero was considered to be not severe at all, and a grade of 100 was the most severe injury possible. Results A total of 74 AOSpine surgeons from all six AO regions of the world numerically graded the severity of each variable of the AOSpine Thoracolumbar Spine Injury Classification System to establish the injury severity score. The reported fracture severity increased significantly ( p < 0.0001) as the subtypes of fracture type A and type B increased, and a significant difference ( p < 0.0001) in severity was established for burst fractures with involvement of two versus one end plates. Finally, no regional or experiential difference in severity or classification was identified. Conclusion Development of a globally applicable injury severity scoring system for thoracolumbar trauma is possible. This study demonstrates no regional or experiential difference in perceived severity or thoracolumbar spine trauma. The AOSpine Thoracolumbar Spine Injury Classification System provides a logical approach to assessing these injuries and enables rational strategies for treatment.