bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expandable PEEK Spacers for Interbody Distraction in the Lumbar Spine
Authors: Alimi M. , Shin B. , Macielak M. , Hofstetter C. P. , Njoku I. , Tsiouris A. J. , Elowitz E. , Hartl R. 
Published: May 2014

Introduction StaXx XD is an expandable PEEK wafer implant that has been used in the treatment of lumbar degenerative disease. PEEK implants have been successfully used as interbody devices. There have been little studies evaluating the outcome of expandable PEEK devices. The aim of the current study was to determine the clinical effectiveness and radiographic outcome of expandable PEEK cages for interbody fusion. Materials and Methods This was a retrospective study of 49 consecutive patients who underwent lumbar interbody fusion with implantation of expandable PEEK cages in combination with posterior instrumentation using pedicle screw-rod constructs primarily for degenerative disorders. The patient's clinical outcomes were evaluated using the visual analog scale (VAS) and the Oswestry disability index (ODI). In addition, disc height, foraminal height, listhesis, local disc angle, lumbar lordosis, and graft subsidence were evaluated on pre-op, post-op, and on latest follow-op imaging. Results A total of 16 patients (32.6%) had undergone previous surgery at the index level. From pre-op to an average follow-up of 19.3 months, there was significant improvement in VAS back (6.42 vs. 3.11, p < 0.001), VAS buttock (4.66 vs. 1.97, p = 0.002), VAS leg (4.55 vs. 1.96, p < 0.001), and ODI (21.7 vs. 12.1, p < 0.001) scores. In addition, there was significant increase in the average disc height (6.49 vs. 8.18 mm, p = 0.037) and foraminal height (15.6 vs. 18.53, p = 0.0001), and there was a significant reduction in the amount of listhesis (5.13 vs. 3.15, p = 0.005). The increase in average local disc angle and overall lumbar lordosis was not significant. Subsidence of 0.66 mm (7.4%) was observed at the latest follow-up ( p = 0.35). Conclusion Our mid-term results indicate that in situ expandable PEEK spacers for lumbar interbody distraction can effectively and durably restore the disc height and foraminal height and are associated with significant improvement in the clinical outcome. Disclosure of Interest None declared
Minimally Invasive Foraminotomy through Tubular Retractors via a Contralateral Approach in Patients with Unilateral Radiculopathy
Authors: Alimi M. , Njoku I. , Cong G. T. , Pyo S. Y. , Hofstetter C. P. , Grunert P. , Hartl R. 
Published: May 2014

Introduction Radiculopathy caused by foraminal nerve root compression is a common pathology of the lumbar spine. Surgical decompression through conventional open foraminotomy is the treatment of choice when surgery indicated. Minimally invasive tubular foraminotomy through a contralateral approach is a potentially effective treatment approach. The aim of this retrospective cohort study was to evaluate the efficacy and benefits of this approach for treatment of radiculopathy. Materials and Methods Patients with unilateral lower extremity radiculopathy, who underwent minimally invasive lumbar foraminotomy through tubular retractors via a contralateral approach between 2010 and 2012 were included. Oswestry disability index (ODI) and the visual analogue scale (VAS) for back, and leg pain were evaluated preoperatively, postoperatively, and at the latest follow-up. Functional outcome was evaluated using MacNab's criteria. Results For the total of 32 patients, postoperatively there was significant improvement in the ODI ( p = 0.006), VAS back pain ( p < 0.0001), and VAS leg pain on the pathology and the approach side ( p = 0.004, p = 0.021, respectively). At follow-up of 12.3 ± 1.7 months, there was also significant improvement in the ODI ( p < 0.0001), VAS back pain ( p = 0.001), and VAS leg pain on the pathology and the approach side ( p < 0.0001, p = 0.001, respectively). The functional outcome was excellent and good in 95.2%. One patient required fusion (3.1%). Conclusion A minimally invasive, facet-sparing contralateral approach is an effective technique for treatment of radiculopathy due to foraminal compression. It also allows for decompression of lumbar spinal stenosis and bilateral lateral recess decompression without the need for a fusion. Disclosure of Interest None declared
Prevention of Cement Leakage during Kyphoplasty by using the Eggshell Technique
Authors: Lo H. 
Published: May 2014

Introduction The most common complication of osteoporotic is vertebral compression in aged people. Pain and disability pose major problems in these patients. To restore the vertebral height for driving physical stiffness, and loading bearing toward normal limited, kyphoplasty and vertebroplasty with variable filling materials (PMMA, CPC, etc.) have been used for the treatment. For decreasing the rate of PMMA leakage, we performed kyphoplasty with eggshell technique in different characteristics of vertebral wall. Materials and Methods Twenty symptomatic vertebral fractures were enrolled. Visual analogue scale (VAS), the oswestry disability index (ODI), and vertebral wall injury score were assessed. The vertebral height loss and changes of kyphotic angle were also recorded by plain X-ray. Three-dimensional CT will be arranged for evaluating the condition of deficiency vertebral wall and central body collapse if needed. After creating cavity by percutaneous bipedicular balloon device, PMMA was injected into weak wall site according the preoperative evaluation or intraoperative finding. The balloon was once again introduced into the created cavity and inflated to achieve the PMMA shield (eggshell method). Outcome, PMMA leakage condition, X-ray, and CT were reviewed postoperatively. Results Symptomatic cement extravasation-related complications or leakage on X-ray were not observed in follow-up. Only one adjacent compression fracture has happened in 1 month. Improvement in vertebral height and the mean kyphotic angle was also noted. The mean VAS and ODI decreased significantly from preoperation to postoperation ( p < 0.05). The vertebral wall injury score reviews also told us that the eggshell technique is fit for multiple conditions of wall injury. Conclusion It is always concerned for the leakage of PMMA during spine surgery. There are many options of new implant for decreasing the rate of leakage. Greene introduces the eggshell technique since 2007. According to our experiences of kyphoplasty with this eggshell technique, the technique is a safe and significantly functional works for decreasing the leakage of PMMA and pain scale in various wall injury conditions. Disclosure of Interest None declared Reference Greene DL, Isaac R, Neuwirth M, Bitan FD. The eggshell technique for prevention of cement leakage during kyphoplasty. J Spinal Disord Tech 2007;20(3):229–232
Treatment of Refractory Low Back Pain Caused by Degenerative Spine Disease with Minimally Invasive Techniques
Authors: Tyulikov K. Vladimirovich , Korostelev K. , Manukovsky V. , Litvinenko V. , Badalov V. 
Published: May 2014

Introduction Puncture techniques—nucleoplasty and radio frequency denervation—have recently been widely used for the treatment of pain syndrome caused by intervertebral disc protrusion. The purpose of the study was to assess the effectiveness of nucleoplasty and radio frequency denervation of intervertebral joints as advanced minimally invasive surgical techniques for alleviating pain in the case of intervertebral disc disease, spondylarthrosis, and other vertebroneurologic diseases accompanying degenerative disc disease. Materials and Methods All patients had a history of pain syndrome for not less than 3 months and were followed up after undergoing minimally invasive procedures for 1 year. To assess the effectiveness, the visual analogue scale and treatment satisfaction scale were used. A total of 81 patients, aged between 30 and 57 years, underwent nucleoplasty and radio frequency denervation. Of the 81 patients, 70 patients of control group were treated therapeutically. Results No complications were noted. At 12-month follow-up all operated patients showed the decrease of pain syndrome intensity according to the visual analogue scale ( p < 0.0001), and treatment satisfaction scores were higher compared with patients treated therapeutically ( p < 0.001). Conclusion Minimally invasive electrosurgical techniques appeared to be safe and effective in the treatment of carefully selected patients suffering from low back pain and leg pain caused by a degenerative-dystrophic process. Nucleoplasty technique is more effective in younger patients. Procedures performed at several levels also result in marked clinical improvement. Primary advantages of these techniques were their safety and efficacy, minimal invasiveness, and the absence of a peridural scar. They do not complicate further microsurgical intervention. Disclosure of Interest None declared
Research of Compare Unilateral Fixation with Bilateral Fixation MIS-TILF Technique
Authors: Liang Y. 
Published: May 2014

Introduction Unilateral fixation MIS-TLIF has less trauma, fewer scar, and shorter operation time than standard bilateral fixation MIS-TLIF. But the debatement of fixation on biomechanical strength and clinical effects is not stopped. So, in our research, we tried to confirm safety and effectivity of unilateral fixation MIS-TLIF. Materials and Methods Our research retrospectively reviewed 17 cases undergoing unilateral fixation MIS-TLIF in Ruijin Hospital during August 2010 to March 2012, and chose 21 cases undergoing bilateral fixation MIS-TLIF randomly during that period as control group. The operation time, intraoperative blood volume, duration of hospital stay, and complications were recorded in both the two groups. Preoperative and postoperative ODI scores were compared between both the two groups and the statistical differences of ODI score at final follow-up was compared. Especially in cases having low back pain/leg pain, pre- and postoperative VAS scores were compared between the two groups and the statistical differences of VAS score at final follow-up was compared. Also, radiation exposure dose and time in both groups were compared; X-ray and 2D CT image reconstruction were used to evaluate whether bony infusion or not. Results The average follow-up was 24.2 months. All cases achieved bony infusion confirmed by radiography. The intraoperative blood loss volume in unilateral fixation group was 25.50 ± 15.20 mL, whereas which was 43.30 ± 8.25 mL in bilateral fixation group. The duration of hospital stay was 5 days in unilateral fixation group, whereas 7.9 days in bilateral fixation group. At the aspect of complications, one case suffered in unilateral fixation group (one case of dural laceration) and two cases suffered in bilateral fixation group (one case of dural laceration, one case of incision infection). The preoperative ODI score was 77.23 ± 12.40 and the final follow-up ODI score was 12.34 ± 9.34 in unilateral fixation group; the preoperative VAS score for low back pain/leg pain cases was 6.3 ± 2.1 and the final follow-up VAS score was 2.3 ± 1.1. The preoperative ODI score was 79.14 ± 9.21 and the final follow-up ODI score was 13.34 ± 11.28 in bilateral fixation group; the preoperative VAS score for low back pain/leg pain cases was 5.4 ± 2.3 and the final follow-up VAS score was 2.4 ± 1.2. Radiation exposure dose and time were significantly lower in unilateral fixation group than that in bilateral fixation group. There was a significant statistical difference between the two groups in intraoperative blood loss, duration of hospital stay, and radiation exposure dose, but no statistical difference was confirmed at the aspect of function score, pain score, and complications. Conclusion Unilateral fixation MIS-TLIF is similar to bilateral fixation MIS-TLIF in clinical effectivity and safety. Unilateral fixation MIS-TLIF has obvious advantage in intraoperative blood loss, duration of hospital stay, and radiation exposure. Disclosure of Interest None declared
Correlation of Lateral Stenosis in MRI with Symptoms, Walking Capacity, and EMG Findings in Patients with Surgically Confirmed Lateral Lumbar Spinal Canal Stenosis
Authors: Kuittinen P. , Sipola P. , Aalto T. Juhani , Määttä S. , Parviainen A. , Saari T. , Sinikallio S. , Savolainen S. , Turunen V. , Kröger H. , Airaksinen O. , Leinonen V. 
Published: May 2014

Introduction The aim of this study is to evaluate the clinical significance of lateral lumbar spinal canal stenosis (LLSCS), found by magnetic resonance imaging (MRI), through correlating the imaging findings with patient symptoms, walking capacity and electromyographic (EMG) measurements. Materials and Methods A total of 80 patients with symptoms of LSS severe enough to indicate operative treatment were studied with MRI. Of these patients, subjects with distinct lateral LSS were included. Accordingly, 140 roots in 14 patients (mean age, 58 years; range, 48-76 years; male, 43%) were evaluated. In MR images, the entrance and midzones of the lateral lumbar nerve root canal were graded as normal, narrowed but not compressed, or compressed. In quantitative analysis, the minimal widths of the lateral recess and midzone area were measured. Clinical symptoms were recorded with the oswestry disability index (ODI), overall visual analogue scale (VAS), specific low back pain (LBP; NRS-11), specific leg pain (LP NRS-11), beck depression inventory (BDI), and walking distance in the treadmill test. Lumbar paraspinal (L2-S1) and lower limb needle EMG studies were performed. The findings were classified root by root as 1 = normal, 2 = abnormal. The associations between radiological, EMG, and clinical findings were tested with each other. Results LLSCS was confirmed in all patients during surgery. EMG findings were normal in 92 roots and abnormal in 48 roots. All of the patients had at least one abnormal nerve root finding. Severity of the midzone stenosis in MRI correlated with abnormal EMG findings ( p = 0.015). Patients with abnormal EMG had also higher scores in the VAS (41.9 ± 25.7 vs. 31.5 ± 18.1; p = 0.018), NRS leg pain (7.5 ± 1.5 vs. 6.3 ± 2.1; p = 0.000), and BDI (9.8 ± 3.8 vs. 8.0 ± 3.9; p = 0.014). However, no statistically significant correlations between MRI findings and clinical symptoms or walking capacity were found. Conclusion MRI findings correlated with abnormal EMG, indicating that a lateral stenosis seen by MRI is a clinically significant finding. However, no relationships between the MRI findings and symptoms or walking capacity were found, suggesting their multifactorial etiology. MRI and EMG may be useful in the workup of patients with suspected LLSCS. Disclosure of Interest None declared
New Development in VCFs Treatment: Vesselplasty, Vessel-Lock, and SrHA Cement
Authors: Darwono A. B. 
Published: May 2014

Introduction Vertebroplasty and kyphoplasty are used to treat VCFs with a risk of certain cement leakage. Regarding cement leakage the new technique vesselplasty use a nonstretchable PET container to prevent leakage of the injected cement and then left as an implant body expander. Instead of PMMA, the new SrHA cement (osteoinductive and osteoconductive with less 65°C heat production) is to be used. To treat a complex case (osteoporotic VCFs, multiple stenosis, and kyphotic and degenerative scoliosis), the new innovative vessel-lock system is used. The purpose of this study is to review the theory, surgical techniques, 5 years results using this new technique and compare the effect of SrHA and PMMA cement in osteoporotic bone. Materials and Methods A nonrandomized prospective study to treat VCFs using vesselplasty with PMMA and SrHA cement. This new technique, the Vessel-X system is a percutaneous nonfusion technique to stabilize, restore VCFs, and prevent leakage risk of cement. Instead of previously creating a void inside the vertebral body to be filled with BFMs, this system allows the delivery of a nonstretchable bone filler container (BFC) into the vertebral body in deflated configuration, then inflated by injecting viscous BFMs into the BFC, and left as an implant body expander. The volume of the injected BFMs is controlled by a controllable cement delivery (CCD) injector system with extension tube. The pressure inside the BFC is created by the resistance of the polyethylene terephthalate (PET) container which is related to the amount of layers (1 or 2 layers), the pore size 100 µm, and the container size. The optimum pressure need to lift the end plate is the amount of pressure to counteract the resistance of surrounding bone density (fresh or old fractures, young or elderly patients), and related to the amount of BFMs to be injected with pressure into a certain size of BFC. When the pressure is over the surrounding bone resistance, the BFMs stars to penetrate the pores and interdigitate, thus stabilizing the BFC to the surrounding bone. Compare the effect of SrHA and PMMA using X-ray and CT scan: just after treatment, 3 months and 6 months after treatment. Results A total of 250 cases consist of 298 VCFs (VT3-VL 5) that have been treated using this new technique included 178 PMMA and 120 SrHA cases is reported also the five preliminary report of vessel-lock system. Conclusion The vesselplasty is a new technique to treat osteoporotic vertebral fractures using BFC system. This technique allows the stabilization and restoration of vertebral body height of VCFs, with the advantage in controlling the volume of the injected BFMs, also the pressure inside BFC, and preventing the leakage of BFMs. SrHA cement is superior compared with PMMA in the elderly cases. The vessel lock could be the solving of difficult cases. But there is still a continuum of osteoporotic problems that should be treated with a specific medical treatment. Disclosure of Interest None declared
Chronicity of Back Pain: Predisposing Factor of Normal Age-Related Axonal Degeneration
Authors: Chen Jun 
Published: May 2014

Back pain is extremely common in clinical setting. In the history, back pain has been believed to be seldom associated with clearly identifiable tissue damage or anatomical defect, but it is rather a normal part of life and aging.1 Back pain is also considered to have multifactorial etiology involving biological (age, sex, and genetic), psychosocial (stress), and environmental (food, toxins, infection, and trauma) factors. More recent epidemiological investigation has revealed that cooccurring pain sites in the body are linearly increased with age, suggesting important roles of age in pain. In this report, I will highlight the roles of normal age-related axonal degeneration in the nervous system that may predispose to the chronicity of pain in general and of back pain in specific conditions. First, across the lifespan, aging process results in development of polyneuropathies along the whole somatosensory system characterized by damage of both large myelinated and unmyelinated C fibers. The age-related polyneuropathies are a predisposing factor to chronicity of mechanical pain hypersensitivity (hyperalgesia and allodynia) under both inflammatory and nerve injury conditions. For example, in aged rats, mechanical pain hypersensitivity lasts much longer relative to young cohorts in a rat model of experimental inflammatory pain as well as in a rat model of radiculopathy caused by chronic compression of dorsal root ganglia/dorsal roots by placing a steel rod into intervertebral foramen. Second, age-related polyneuropathies are initiated by myelin breakdown that is likely to be caused by decline of NGF receptors and myelin proteins, subsequently leading to axonal degeneration and loss of sensory receptors. Third, age-related polyneuropathies that are characterized by myelin breakdown and axonal degeneration are accompanied by activations of both astrocytes and microglial cells in the central somatosensory system. Together, myelin breakdown and axonal degeneration in the nervous system are common features of aged spinal cord that are likely to be a predisposing factor to chronicity of back pain due to widespread neuropathies and angiopathies which normally supply the spine. Targeting and unraveling the pathogenesis of age-related myelin breakdown and axonal degeneration would shed new light on the underlying mechanisms of chronic back pain in specific and chronic pain in general. Acknowledgments The article is supported by grants (2011CB504100, 2013BAI04B04, and 81171049). I am grateful to Fang Xie and Han Fu for performing the experiments and to our team members for collaborations. Disclosure of Interest None declared Reference Fordyce WE. Back Pain in Workplace. Seattle, WA: IASP Press; 1995
Pathological End Plate Alterations in Disc Degeneration
Authors: Lotz Jeffrey C. 
Published: May 2014

Discogenic pain accounts for approximately 40% of chronic low back pain cases, affecting 1 to 2 million adults between age 45 and 64 years in the United States. The putative pain generator in discogenic pain patients is usually considered intrinsic to the disc. Crock defined internal disc disruption as damage of internal disc structures while the external shape remains essentially normal, and no nerve root compression is present. However, the vertebral end plate is also a source of pain. It is the weak link during spinal compression, can sustain damage at loads well below those that cause disc herniation or vertebral fracture, and is innervated comparable to the outer annulus. Further evidence of the clinical importance of the vertebral end plate is the association between vertebral marrow abnormalities and discogenic pain. Data from multiple independent studies suggest that Modic Types I and II adjacent to the end plate are among the most specific of all MRI observations for predicting concordant discography-induced pain. In one prospective study, moderate-to-severe Modic Types I or II end plate abnormalities correlated 100% of the time with positive concordant pain at the adjacent disc. Recently, increased end plate innervation has also been reported for end plates with Modic changes. End plates serve as the interface between rigid vertebral bodies and pliant intervertebral discs. Because the lumbar spine carries significant forces and discs do not have a dedicated blood supply, end plates must balance conflicting requirements of being strong to prevent vertebral fracture and porous to facilitate transport between disc cells and vertebral capillaries. Consequently, end plates are particularly susceptible to damage, which can increase communication between proinflammatory disc constituents and vascularized vertebral bone marrow. End plate damage regions can be sites of reactive bone marrow lesions that include proliferating nerves, which are susceptible to chemical sensitization and mechanical stimulation. While several lines of evidence indicate that innervated end plate damage can be a source of chronic low back pain, its role in patients is likely underappreciated because innervated damage is poorly visualized with diagnostic imaging. This literature review summarizes end plate biophysical function and aspects of pathologic degeneration that can lead to vertebrogenic pain. Disclosure of Interest Consultant for Relievant MedSystems Consultant for Nocimed, LLC