bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative Cervical Deformity in 215 Thoracolumbar Adult Spinal Deformity Patients: Prevalence, Risk Factors, and Impact on Patient-Reported Outcome and Satisfaction at 2-Year Follow-Up
Authors: Passias Peter , Smith Justin , Soroceanu Alex , Boniello Anthony , Scheer Justin , Schwab Frank , Shaffrey Christopher , Kim Han Jo , Protopsaltis Themistocles , Mundis Gregory , Gupta Munish , Klineberg Eric , Lafage Virginie , Ames Christopher 
Published: May 2015

Introduction Despite recognition of its occurrence, reliable predictors of the development of cervical deformity (CD) following ASD surgery are elusive and the effects unclear. This study quantifies the incidence of CD after ASD surgery, identifies predictors of development and determines the impact outcomes. Materials and Methods This was a retrospective review of a prospective multicenter database evaluating surgical patients with ASD with complete 2-year follow-up. CD was defined by T1S–CL > 20 degrees, C2C7 SVA > 40 mm, or C2C7 kyphosis > 10 degrees. Univariate testing was performed using t tests, or tests of proportion. The impact of CD at 2 years on health-related quality of life (HRQL) and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate. Results A total of 215 patients were included. Overall, 63% were found to have CD at 2 years post-op. Patients with CD had a higher incidence of pre-op CD ( p = 0.0001) and diabetes ( p = 0.05). They also had lower baseline C2–T3 lordosis (5.49 vs. 11.97, p = 0.003), lower C2 tilt (71.5 vs. 79.28, p = 0.0001) and higher C2 slope (18.49 vs. 10.71, p = 0.0001) and T1 (26.08 vs. 22.2, p = 0.036) slopes, and C2-S1 SVA (84.32 vs. 57.57, p = 0.002). Patients with and without CD at 2 years experienced significant improvements in their HRQL scores: SF-36 ( p = 0.0001), ODI ( p = 0.0001), and SRS ( p = 0.0001). Rates of improvement and overall improvement were similar. CD was not a predictor of 2-year patient satisfaction ( p = 0.367). Conclusion Predictors of CD at 2 years include the presence of the following at baseline; CD, diabetes, higher C2 and T1 slopes, higher C2–S1 SVA, and lower C2–T3 lordosis. Significant improvements in 2-year HRQL scores occurred in the presence or absence of CD, and patient satisfaction was unaffected. Although this study identifies several predictors of CD, clinical significance remains unclear and further study is warranted.
Surgical Planning and Neurologic Outcome after Anterior Approach to Remove a Disc Herniation at the C7–T1 Level in 19 Patients
Authors: Falavigna Asdrubal , Righesso Orlando , da Silva Pedro Guarise , de Souza Olivia Egger , Betemps Alejandro , de los Rios Pablo Fernando Vela , Guimarães Rangel , Ziegler Marcus , Riew K. Daniel 
Published: May 2015

Introduction Disc herniations at C7–T1 are uncommon and there are a few large series in the literature describing the anterior treatment of such herniations. The purpose of this study was to report the neurological presentation, outcome, and surgical planning in a series of patients with a symptomatic single level C7–T1 disc herniation who underwent anterior surgical discectomy and fusion. Patients and Methods We performed a retrospective study of patients who underwent surgery for a C7–T1 disc herniation and reviewed the medical records, operative reports, and imaging studies. The surgeons' view line was drawn and its relation to the manubrium and the great vessels was determined on T1 sagittal magnetic resonance imaging (MRI). The location of the herniated disc in the spinal canal was determined using a T2 axial MRI and classified as central, foraminal, and central/foraminal. Loss of muscle strength was evaluated preoperatively and at the last follow-up according to the classification of the Medical Research Council (MRC). The disc space was approached anteriorly by a standard cervical supramanubrial Smith–Robinson approach. Results We identified 19 patients who had undergone C7–T1 discectomy and fusion. The mean age of the sample was 54.26 ( ± 8.65) years. There was a higher proportion of male patients (57.9%, 11/19). The clinical presentation was predominantly motor deficit in 15 of 19 cases (78.9%) in intrinsic hand muscles, and usually improved after surgery. The mean follow-up period was 27.05 ( ± 15.10) months. All the patients underwent an anterior cervical supramanubrial approach with microdiscectomy and fusion. Anterior cervical plate fixation was used in 9 of 19 cases (47.3%). In the rest of the cases, a stand-alone intervertebral device was placed. Conclusion An anterior cervical supramanubrial approach was easily accomplished in all patients. Motor deficit was the most common surgical indication.
Clinical and Functional Results of Patients with Surgically Treated Single Level Lumbar Disc Disease: Comparative Analysis of Patients with Disc Herniation, Stenosis of the Spinal Canal, and Lumbar Spondylolisthesis
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Conzatti Lucas Piccoli , Rizkalla Elisa Braun , Volquind Daniel 
Published: May 2015

Introduction Degenerative lumbar disc disease may occur in patients in different ways, according to their etiopathogeny, for instance, disc herniation, stenosis of the canal, and spondylolisthesis. The objective will be to evaluate the results of health-related quality of life measures in patients with surgically treated single-level degenerative disc disease. Patients and Methods A prospective study of 141 patients with a single level disc disease who had a 1-year postoperative follow-up. The indications for surgical treatment were algic syndrome refractory to clinical treatment and compatibility among the symptoms, neurological examination, and magnetic resonance imaging. The patients were evaluated preoperatively and 30 days, 6 months, and 1-year postoperatively with instruments validated for the evaluation of axial and radicular pain, functional capacity, quality of life, mood disorders, and satisfaction with the surgical treatment. The statistical analyses were conducted using the SPSS. Results A total of 92 patients with lumbar disc herniation (LDH), 13 with spondylolisthesis, and 36 with lumbar canal stenosis (LCS) were evaluated. The patients with LDH were presented to microdiscectomy and the others to decompression and arthrodesis. Preoperatively, the LDH group presented lower levels of axial pain compared with the others; the mean radicular pain during this period was different among the groups, higher in patients with LDH, followed by the patients with canal stenosis. One year postoperatively, no differences were observed in the levels of axial and radicular pain among the groups, nor in the functional capacity, quality of life, and depression and anxiety. Preoperatively, a deficit of force, sensitivity, myotatic reflexes, and Lasègue sign were most commonly found in patients with LDH, compared with the other groups. There was no statistically significant difference as to changes in the neurological examination among the groups in 1 year of follow-up. Dissatisfaction with the treatment was observed in 12.0% of the patients with LDH, 15.4% with spondylolisthesis, and 20.0% with LCS ( p = 0.508). Conclusion In 1 year of follow-up, the indicators of quality of life, functional capacity, residual pain, and changes in the neurological examination are similar among the patients with level 1 disc disease treated surgically.
Implications of Number of Fused Levels in the Outcome of Patients with Lumbar Degenerative Diseases
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , Merlin Luiz Henrique , Radaelli Lucas , Rizkalla Elisa Braun 
Published: May 2015

Introduction Patients with symptomatic lumbar degenerative disease can have one or more intervertebral disc involved according to several factors, such as age, smoking, weight, and profession. The objective of this study was to evaluate the outcome of patients with degenerative disease submitted to lumbar spinal fusion considering the number of levels fused. Patients and Methods Prospective comparative study in patients that were submitted to fusion of one (G1), two (G2), or three or more (G3) levels with a 6-month follow-up. The patients were evaluated preoperatively, at 30 days and 6 months postoperatively with the following validated instruments: NRS, ODI, HAD, and IDB. Comparisons among the groups were done with ANOVA and chi-square tests. The post hoc analyses were conducted with Bonferroni test. Results A total of 65 patients (G1 = 21; G2 = 25; and G3 = 19) were studied. The mean age was greater in G1 and lower in G3 ( p = 0.024). There was no difference among the groups regarding gender, previous surgery, evolution of the symptoms, and work compensation. The duration of surgery was longer, there was more bleeding and a greater incidence of postoperative complications ( p = 0.022) in G3 group ( p < 0.05). The intensity of pain was higher in G3 in the postoperative evaluation at 30 days, but that difference disappears postoperatively, within 6 months. There was no difference concerning hospital stay, transoperative complications, disability (ODI), depression and anxiety (HADS), and satisfaction among the groups ( p = 0.140). Conclusion There was no difference in relation to the pain, disability, depression and anxiety, and postoperative satisfaction among the groups. The patients with three or more fused levels were older and had higher rates of postoperative complications.
Comparison of Open Discectomy with Microendoscopic Discectomy in Lumbar Disc Herniations: Results of a Randomized Controlled Trial
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Chalá Fernanda 
Published: May 2015

Introduction Despite all of the technical refinements, surgical treatment of herniated discs still remains controversial. The objective of the current prospective randomized study was to compare the outcome of patients with persistent sciatica secondary to lumbar disc herniation treated with either open discectomy (OD) or microendoscopic discectomy (MED) technique. Patients and Methods We performed a prospective controlled randomized study of 40 patients with sciatica caused by lumbar disc herniations nonresponsive to conservative treatment who underwent OD or MED with a 24-month follow-up period. Pre- and postoperative neurological status, pain, and functional outcome were evaluated. Other studied variables were the duration of the procedure, blood loss, time of hospital stay, and time to return to work. Statistical analysis with a p value less than 0.005 was performed. Results The only statistically significant differences found were for size of the incision, length of hospital stay, and operative time. The former two were greater in the OD group ( p < 0.01 and p = 0.05, respectively), and the latter was greater in the MED group ( p < 0.01). Conclusion The few parameters that were found to be statistically significant between the groups did not affect the overall outcome. In the current series, the final clinical and neurological results were similarly satisfactory in both the OD and the MED groups.
Osteomyelitis and Destruction of the Atlas and Axis in a 4-Week-Old Infant: 4-Year Follow-Up
Authors: Banczerowski Peter , Czigléczki Gábor , Papp Zoltán 
Published: May 2015

Introduction Neonatal vertebral osteomyelitis is not an uncommon condition, but osteomyelitis simultaneously involving the atlas and the axis is distinctly unusual and no other infant case has been published so far in the literature. We present the case of an infant with retropharyngeal abscess, which led to the destruction of the C1–C2 vertebrae. Materials and Methods MRI examination revealed a multilocular abscess in the right mastoidal area penetrating to the cervical region and causing destruction of the C1 and C2 vertebrae, and an epidural abscess with signs of spinal cord compression at the level of the Th5–Th7 vertebrae. The retropharyngeal and thoracic abscesses were surgically removed and the therapy was completed with antibiotics. The child was placed in a custom-made fixation device for 8 weeks. Follow-up was performed with MRI, CT scans, and functional X-ray diagnostics. Results CT scans with 3D reconstruction demonstrated the absence of normal osseous structures at the craniospinal region, but undamaged ossification centers in the C3 vertebra and below. Functional X-ray diagnostics, performed in general anesthesia showed no significant instability of the cervical spine. Normal motor development and independent walking were allowed. During a 4-year long follow-up period, no signs of neurological impairment were observed, neck movements were limited but painless. It is assumed that the remnants of the bony elements of C1–C2 vertebrae and the massive interconnecting postinflammatory scar tissue make some degree of neck movements possible. His development was undisturbed, similar to his age group. Conclusion C1–C2 osteomyelitis is a very rare entity even in children. There is limited experience with treatment and rehabilitation, but the temporary immobilization of the neck, surgical debridement, antibiotic treatment, and continuous physiotherapy can be recommended. Close follow-up is required to check the reconstitution of affected bones and ligaments, any development of instability, and the necessity of surgical stabilization.
Incremental Cost-Effectiveness of Adult Spinal Deformity Surgery by Classification of Deformity
Authors: Robinson Chessie , Hostin Richard , McCarthy Ian , O'Brien Michael , Gupta Munish , Ames Christopher , Smith Justin , Lafage Virginie , Schwab Frank , Hart Robert , Klineberg Eric , Shaffrey Christopher 
Published: May 2015

Introduction We investigate the incremental cost-effectiveness of ASD surgery relative to nonsurgical treatment by classification of sagittal modifier using the SRS–Schwab classification. Methods This is a retrospective study of consecutive surgical and nonsurgical patients with ASD. Surgical data were from a single center observational data set, whereas nonsurgical data were from a prospective multicenter database. Hospital costs were collected from administrative data and QALYs were calculated from the SF-6D, each discounted at 3.5% annually. We analyzed the incremental cost-effectiveness ratios (ICERs) based on classification of sagittal modifier at baseline. The three modifier types considered were mild (SVA < 4 cm, PT < 20 degrees, PI–LL within 10 degrees), moderate (at least 1 of SVA 4–9.5 cm, PT 20–30 degrees; PI–LL 1020 degrees, and no severe modifiers); and severe (at least 1 of SVA > 9.5 cm, PT > 30 degrees, PI–LL > 20 degrees). The difference in QALYs between the surgical and nonsurgical cohorts at 2 years was projected through 5-year follow-up. 95% confidence intervals were calculated using nonparametric bootstrap methods. Results Two-year follow-up was available for 278 patients (168 surgical and 110 nonsurgical), predominantly female ( n = 245, 88%) with average age of 52 years (range, 18–81 years). Total surgical costs averaged $121,857, including readmissions. The 2-year ICER was least cost-effective for patients with severe sagittal modifiers at $424,978 and most cost-effective for patients with mild modifiers at $206,730. Projected through 5 years, the ICER among patients with severe sagittal modifiers was $151,689, reducing to $73,790 for patients with mild modifiers. Conclusion On the basis of the World Health Organization's suggested upper threshold for cost-effectiveness (three times GDP, or $140,000), ASD surgery appears cost-effective after a 5-year period for mild and moderate sagittal modifier types. Although average 5-year ICERs for severe modifier types are above this threshold, the threshold is included within the confidence interval, indicating the 5-year ICER is not statistically significantly higher than the threshold value. The ICER is expected to further decrease over extended follow-up.
Safety of Day Case Lumbar Decompressive Surgery in an NHS (Public) Hospital Setting
Authors: Hoggett Lee , Vadhva Mukta , Khatri Manoj 
Published: May 2015

Introduction This study is to assess the safety of day case lumbar decompressive surgery. Patients and Method: Retrospective study of 233 consecutive patients undergoing DCLDS who were identified from a prospective electronic database. Results Between January 2011 and April 2014, 131 open and 102 microscopic surgeries were done in patients with mean age of 46 (range, 16–88) years and male:female ratio of 136 (59%):97 (41%). Inclusion criteria were no known anesthetic reaction, ASA grade I or II, BMI < 35 mg/kg2, less than 30 minutes travel time, and responsible home care. Patients were discharged after clinical assessment with cauda equina advice and emergency contact number. A total of 215 (92%) procedures were single level, of which 188 (87%) unilateral and 27 (13%) were bilateral procedures. Overall, 18 (8%) procedures were multiple levels, of which 12 (67%) were unilateral and 6 (33%) were bilateral procedures. Majority, 107 (50%), 97 (45%) procedures were done at L5/S1 and L4/L5 levels, respectively, and rest 11 (5%) at higher level. The 7-day and 30-day representation figures were 7 (3%) and 15 (6.4%) that are as follows: pain ( n = 3), medication ( n = 2), wound issues ( n = 5), infection ( n = 2), headache ( n = 2), and VTE ( n = 1). Overall, 11 patients were sent home and 4 (1.7%) were admitted with two requiring further surgery, one revision discectomy and one wound washout. No cauda equina or compressive hematoma were encountered. Conclusion This study demonstrates that open and microscopic lumbar discectomy at single or multiple levels can be performed safely as a day case procedure. The representation rate to the ED can be potentially reduced by better advice and pain management.
New Classification System of Minimal Invasive Techniques based on the Location of the Pathologic Lesions in the Spinal Canal
Authors: Banczerowski Peter , Papp Zoltán , Veres Róbert , Vajda János 
Published: May 2015

Introduction Minimal invasive procedures in spine surgery to remove pathologies located in the spinal canal have undergone significant development in the recent times. These procedures have the common aim of avoiding biomechanical complications associated with some traditional destructive methods and improving efficacy. These new techniques prevent damage to crucial posterior stabilizers, and preserve structural integrity and stability of the spine. In this review, authors first provide a classification system of minimal invasive techniques based on the location of the pathologic lesion to be treated, to help the surgeon in selecting the appropriate procedure. Material and Methods A classification system was introduced, which pairs various intraspinal pathologic lesions, taking into account their location topography relative to the spinal cord, with the appropriate minimal invasive techniques. Classification of the different surgical methods is presented with the aim of helping the surgeon in selecting the appropriate minimal invasive procedure based on the location topography of the pathology in the spinal canal. This classification system can be applied in the daily routine of spine surgery. Results Lesions within the spinal canal may be segmental or longitudinal to the spinal levels, and axial or lateral relative to the spinal cord. The following four types of lesion locations are defined in the classification system: segmental-lateral, segmental-axial, longitudinal-axial, and longitudinal-lateral. Hemi–semi laminectomy (partial hemilaminectomy) and its variants are appropriate methods for the removal of various types of segmental-lateral located pathologies with preservation of dorsal spinal stability. Both unilateral and bilateral laminotomy for bilateral decompression can be used for the treatment of spinal stenosis, with good clinical outcomes. Foraminotomies with or without modifications are alternative surgical approaches for the treatment of segmental-lateral pathologies located in the neuroforamen. Split laminotomy and its variant, para split laminotomy are mainly recommended for the removal of longitudinal–axial located intraspinal lesions. Its “arch bone” modification enables the moderate enlargement of the spinal canal. Conclusion In summary, sufficient evidence is available for each minimal invasive techniques to be used as a clinically effective treatment option. Our classification system enables the surgeon to select and apply the appropriate minimal invasive technique and to remove the lesions located in the spinal canal. This overview of the minimal invasive techniques can be applied and recommended in the daily routine of spine surgery.
Extreme Lateral Interbody Fusion for Unilateral Symptomatic Vertical Foraminal Stenosis
Authors: Hofstetter Christoph P. , Alimi Marjan , Tsiouris Apostolos J. , Elowitz Eric , Härtl Roger 
Published: May 2015

Introduction Spinal deformity of the adult lumbar spine may occur de novo because of the degenerative disease or following decompressive surgery. Asymmetric loss of disc height may lead to unilateral vertical foraminal stenosis and radiculopathy. Aims/Objectives: This study aimed to investigate whether restoration of foraminal height at the symptomatic level using single-level extreme lateral interbody fusion (ELIF) may alleviate unilateral radicular pain. Methods In a retrospective cohort study, patients with single-level unilateral vertical foraminal stenosis (foraminal height < 15 mm) and corresponding unilateral radicular pain who underwent ELIF were included. Demographic and perioperative data were collected. Functional data (Visual Analogue Scale [VAS] for buttock, leg and back, as well as Oswestry Disability Index [ODI]) and radiographic measurements (bilateral foraminal height, disc height, segmental coronal Cobb angle, and regional lumbar lordosis) were collected preoperatively, postoperatively, and at the last follow-up. Results A total of 23 patients with a mean age of 66 years were included. The foraminal height of stenotic side was significantly increased by ELIF from the preoperative value of 11.0 to 18.1 mm postoperatively ( p < 0.001). The increase was durable at last follow-up of 11 ± 3.7 (SE) months (17.1 mm; p < 0.001). Preoperative VAS buttock and leg on the stenotic side, VAS back, and the ODI (7.3, 7.2, 6.5 and 48.0, respectively) were significantly improved postoperatively (1.5, 2.3, 3.3 and 25.4, respectively) and at the last follow-up (to 0.7, 1.1, 3.3 and 23.0). The postoperative FH on the stenotic side showed correlation with the VAS buttock and VAS leg on the stenotic side. In addition, at the last follow-up, FH on the stenotic side showed correlation with VAS leg on the stenotic side. Conclusion Single-level ELIF is an effective procedure for treatment of symptomatic unilateral vertical foraminal stenosis.