bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Results of Interspinous Dynamic Stabilization with STENOFIX Device
Authors: Zubovic A. 
Published: May 2014

Introduction The objective of our study was to evaluate the efficacy of STENOFIX interspinous dynamic stabilization device in different spinal conditions including discectomies and central and foraminal spinal stenoses, with minimum of 1 year of patient follow-up. Materials and Methods We performed a prospective case series on 64 patients over a period of 3 years who underwent spinal surgeries in our institutions with a minimum of 1 year follow-up. Spinal procedures included discectomies, one or two level Stenofix implant insertions for patients with central spinal stenosis and one or two level Stenofix implant insertions for patients with lateral recess foraminal stenosis. Pre- and postoperatively disability and pain scores were measured using the Oswestry Disability Index (ODI), visual analogue scale (VAS), SF 36 scores, and EQ-5D-3L scores in conjunction with radiographic evaluation of disc height and sagittal alignment. Results All follow-up patients demonstrated significant improvement in ODI, VAS, SF 36, and EQ-5D-3L pain scores in comparison to those of preoperation ( p < 0.05). We observed no significant difference in sagittal alignment post-interspinous dynamic stabilization with Stenofix implant. No complications such as implant loosening, immigration, and spinal process fracture were observed. Conclusion The STENOFIX implant demonstrates significant improvement in clinical outcomes when used as the treatment of choice in patients with central and/or lateral recess lumbar spinal stenosis, as well as when used as a supplement to discectomies. Disclosure of Interest None declared
Selectively Decompressive Nerve Root Surgery for Degenerative Lateral Lumbar Spinal Canal Stenosis in Elderly Patients
Authors: Zhou H. , Cao D. , Feng S. , Ning G. , Zhang C. , Hao Y. , Liu Y. , Zheng Y. , Ma X. , Wang P. 
Published: May 2014

Introduction A literature review demonstrated conflicting results with different lumbar spine surgery techniques for LSS in the elderly. Materials and Methods From 2004 to 2011, a total of 183 consecutive patients at least 65 years old with degenerative LSS underwent decompressive surgery. Patients were divided into two groups: open decompression (Group A, 85 patients) and selective decompression (Group B, 98 patients). All patients were followed for at least 1 year and clinical outcomes were assessed using Visual Analog Scale pain scores (VAS), Oswestry Disability Index (ODI), and MacNab criteria preoperatively, 6 months postoperatively, and at the final follow-up. Results A total of 161 patients met the study criteria. The two groups were similar in age, sex, involved levels, preoperative neurologic status distribution, and comorbidities. The mean follow-up period was 22.3 ± 6.7 months (Group A) versus 23.0 ± 7.1 months (Group B) ( p > 0.05). Operation time, blood loss, and duration of hospitalization were significantly lower in the selective decompression group. The clinical outcomes (VAS, ODI) were maintained preoperatively, 6 months postoperatively, and at the final follow-up. Mean VAS scores were 7.4 ± 1.7 versus 7.9 ± 1.8; 4.0 ± 2.0 versus 2.6 ± 1.4; and 2.9 ± 1.3 versus 2.5 ± 1.5, respectively. Mean ODI scores were 60.3% ± 11.0% versus 65.1% ± 11.5%; 39.6% ± 8.7% versus 33.0% ± 8.5%; and 42.5% ± 10.8% versus 31.2% ± 8.8%, respectively. Sixty-seven patients (83.8%) versus 74 patients (91.4%) had good to excellent results 6 months postoperatively and 62 patients (77.5%) versus 72 patients (88.9%) had good to excellent results at the final follow-up. There were no surgery-related complications and no deaths among the patients at the last follow-up. Conclusion Compared with the open decompression group, selective decompression provided satisfactory clinical outcomes with significant reductions in operation time, blood loss, and duration of hospitalization. Selective decompression of the nerve root canal under direct vision was a safe and effective alternative to microsurgical procedures for elderly patients with LSS. Disclosure of Interest None declared
Artificial Disc Replacement versus Fusion in the Cervical Spine: A Systematic Review of Systematic Reviews
Authors: Aneiba K. Muftah , Tashani O. A. 
Published: May 2014

Introduction Artificial disc replacement versus fusion in the cervical spine: A systematic review of systematic reviews. Materials and Methods A combination of the following keywords was used in the search for systematic reviews: ( total disk replacement, prosthesis, implantation, diskectomy, arthroplasty) and ( cervical vertebrae, cervical spine, spine) and ( pain, disability, quality of life) and ( systematic reviews, reviews, meta-analysis) . These keywords were used as MESH headings where appropriate. The search was conducted on August 18, 2013, by a Cochrane-trained academic librarian. The following databases were searched: [Medline via Ovid, Embase, Cochrane Database of Systematic Reviews, Google scholar]. Manual search of reviews and discussion articles and case studies were also attempted by the two authors. The authors screened the results of the search independently according to pre-designed eligibility criteria. For the article to be selected for further consideration it has to be a systematic review and/or meta-analysis of randomized controlled trials that attempted to compare between the two interventions at the cervical region. Results The electronic search produced 881 hits of which 145 were duplicates. Initial screening of the abstracts resulted in selection of 68 articles for further evaluation. Five more articles were identified through manual search. The final judgment of the two reviewers was to include 10 systematic reviews and/or meta-analyses in this overview. The number of randomized trials reviewed by the selected reviews varies from 2 to 27. Other discrepancies between the reviews included: the follow up period, the outcomes considered and reporting of heterogeneity or publication bias of the included studies. Eight reviews and meta-analyses concluded that overall C-ADR is more effective and probably superior to ACDF specifically in neurological success, low rate of secondary operation and most pain outcomes. One meta-analysis concluded that ACDF is associated with shorter operative time and less blood loss compared with C-ADR. However, a Cochrane review critically evaluated the differences between the clinical outcomes of the two interventions and while confirmed that C-ADR superiority may be statistically significant in many of these outcomes, the differences between C-ADR and ACDF is small. This was also evident in all meta-analyses evaluated here. Conclusion C-ADR may be superior, or at least equivalent, to ACDF in most clinical and patients’ outcomes but the effect size of the difference is small and more time and research is needed to reach a definitive conclusion. A robust systematic reviewing is also recommended. Disclosure of Interest K. Aneiba: Conflict with research supported by Trimedica/Poinnner O. Tashani: None declared
The New Dynamic Interlaminar Device for the Treatment of Early and Late Lumbar Degenerative Problems
Authors: Darwono A. B. 
Published: May 2014

Introduction The ultimate Clinical goal of Dynamic Stabilization using motion preservation Devices is to relieve Pain and to improve the function of the spinal motion segment (SMS). Essentially it should preserve and restore physiologic motion, while maintaining the balance and stability of the SMS by controlling motion and unloading the disk and or the facet joint. Since the Degenerative cascade cannot be stopped, so the Key is: 1. Try to treat in the early stage with Dynamic stabilization or 2. Try to treat in the late stage with decompression and Dynamic stabilization. Materials and Methods Three years nonrandomized prospective follow-up study of dynamic stabilization using IntraSpine for the treatment of early and late degenerative cases. Follow-up: 2 weeks, 1, 2, 3, and 6 months after surgery. The dynamic stabilization using IntraSpine was performed by single surgeon. Assessment by dynamic X-ray, MRI, Ct-scan, and VAS before and after surgery. Results In 3 years, 67 cases of 23 males and 44 females, average age 56.9 (27 - 85 years old), were treated using IntraSpine. The variation levels of dynamic stabilization are related to the degenerative levels, from 1 to 5 levels, and from L1-2, until L5-S1. The skin incision is from 3 to 10 cm, the surgical time for 1 level with decompression is 45 to 4 hours for 4 to 5 levels. After 6 months, the result is excellent: VAS from average 8.3 to 1.2, dynamic X-ray stable, patient can do normal daily activity. Discussion The fundamental feature in the design of the new device IntraSpine is related to the anatomical reconstruction of the SMS and regarding the overturned anvil the anterior part (nose) of the device should be placed in between the laminae (Middle Column of Roy Camille) to control the load distribution and to achieve the “Sagital Balance” The interlaminar area is closer to the axis of instantaneous rotation of the SMS. The Complex Fascia Supraspinatus (CFS) is used as Natural Connector for this system, while the connector of pedicle system is metal connector. The IntraSpine is made of Medical Grade Silicone 65 shore coated by a pure PET sleeve Conclusion This report shows a good result of IntraSpine and match with the goals of Dynamic stabilization: 1. Stabilize the Segmental Instability, 2. Maintain the Sagittal Balance, and 3. Restore the physiologic movement of SMS. Disclosure of Interest None declared
Clinical, Radiological, and Safety Results of the Carbon Composite Cage (OSTAPEK) in Anterior Cervical Diskectomy and Fusion (ACDF): Retrospective Analysis of 54 Cases
Authors: Carrabs G. , Sessa G. , Oliva G. , Pipola A. M. , Silvestro A. , Sica G. 
Published: May 2014

Introduction Anterior cervical microdiskectomy and fusion with an intervertebral cage is a widely accepted procedure for the treatment of herniated cervical disc. Traditional titanium or simple plastic implant materials can limit implant performance below optimal needs: in some indications, legacy materials can be too stiff, in others not strong enough. Spinal implants constructs should not be so stiff that over time the implant works against bone's natural renewal. The Osta-Pek composite biomaterial satisfies the needs of cervical arthrodesis with motion preservation and because of the intrinsic radiolucency permits a simple and reliable radiological follow-up. Materials and Methods We operated on 54 patients (24 males and 30 females) with a mean age of 56.7 years (ranging from 26 to 65 years) at our institution. The mean follow-up was 6 months. We evaluated patients with to end points: clinical outcome (according to Odom criteria) and radiological “fusion” (fusion rate and motility). Results A total 75 cage in Osta-Pek were implanted in 32 single-level and 22 two-level procedures (one patient in two-level group had an Osta-Pek cage at one level and a Mobi-C prosthesis). Six months after surgery, there was radiographic evidence of fusion in 92% (69/75) of implants. According to Odom criteria, all patients experienced good to excellent functional recovery with preservation of cervical motility. There was any space disc collapse/pseudoarthrosis phenomenon. We experienced complications related to anterior cervical microdiskectomy in 6/54 (11%) of patients including 4 cases of transitory vocal cord paresis, 1 case of Bernard-Horner syndrome, 1 case of subfascial hematoma, and 2 cases of crashed cage during arthrodesis (evacuated in the first 24 hours). Conclusion The clinical and radiological results suggest that the carbon composite Osta-Pek frame cages are safe and effective alternative to autologous bone graft and other type of cages after anterior cervical discectomy for treatment of degenerative cervical disease Disclosure of Interest None declared References Han KW, Kim JS, Kim KH, Cho YW, Lee IC, Bae SD. Anterior cervical interbody fusion with the carbon composite Osta-Pek frame cage in degenerative cervical diseases. J Korean Neurosurg Soc 2005;37(6):422–426 Jagannathan J, Shaffrey CI, Oskouian RJ, et al. Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar. J Neurosurg Spine 2008;8(5):420–428 Jacobs W, Willems PC, Kruyt M, et al. Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine 2011;36(14):E950–E960
Classification of Chronic Back Muscle Degeneration after Spinal Surgery, and Its Relationship to Low Back Pain
Authors: Ohtori S. , Orita S. , Yamauchi K. , Miyagi M. , Sakuma Y. , Kubota G. , Oikawa Y. , Inage K. , Sainoh T. , Sato J. , Suzuki M. , Fujimoto K. , Takahashi K. 
Published: May 2014

Introduction Back muscle injury and degeneration often occurs after posterior lumbar surgery, and back muscle degeneration may be a cause of back pain after surgery. However, the relationship between back muscle degeneration and back pain remains controversial. In the current study, we aimed to classify back muscle degeneration using MRI and investigate its relationship with back pain after surgery. Materials and Methods A total of 84 patients (average age: 65.1 years, 38 men, 46 women) with lumbar spinal stenosis underwent only posterior decompression surgery. MRI (1.5 T) was evaluated before and more than a year after surgery in all patients. Muscle on MRI was classified into three categories: low intensity in T1-weighted image, high in T2-weighted image (type 1), high in both T1- and T2-weighted images (type 2), and low in both T1- and T2-weighted images (type 3). The proportion of types and their relationship with back pain (visual analog scale: VAS) was evaluated. Results MRI revealed muscle degeneration in all patients after surgery (type 1: 6%, type 2: 82%, and type 3: 12%). Type 2 was significantly frequent as compared with types 1 and 3 ( p < 0.01). Low back pain before surgery (average: VAS 7.5) significantly improved after surgery (average: VAS 2.0) ( p < 0.01). Low back pain was not associated with any muscle degeneration MRI types after surgery ( p > 0.05). Conclusion The current study showed the pathology of back muscle degeneration was various after posterior lumbar surgery. Type 2 (fatty change) was most frequent, and some patients were classified into type 3 (scar change), and type 1 (inflammation or water-like change). Modic classification is used for bone marrow change, and type 1 is associated with inflammation and back pain. However, no type of back muscle degeneration was correlated with back pain after surgery. Disclosure of Interest None declared
Lumbar Spinal Canal Stenosis: Expression and Functional Investigations on a Library of Different Chondroitin Sulphate Molecules in Normal and Hypertrophic Ligamentum Flavum
Authors: Lee H. C. , Loo W. L. , Yip G. 
Published: May 2014

Introduction The hypertrophy of the ligamentum flavum is known to be related to degenerative changes that are secondary to the aging process or mechanical instability. However, there has been no study to investigate the effect of chondroitin sulfate on hypertrophy of the ligamentum flavum. We aim to investigate the role of chondroitin sulfate on hypertrophy of the ligamentum flavum in lumbar spinal stenosis compared with that of lumbar disc herniation. Materials and Methods The concentrations of chondroitin sulfate were analyzed in the surgically obtained ligamentum flavum specimens from lumbar spinal stenosis ( n = 34; mean age 65 years) and disc herniation ( n = 24; mean age = 39.7 years) by immunohistochemical evaluation. The staining intensity and percentage of cells stained were recorded and these figures were converted into a weighted average intensity (WAI). The immunoreactivity score (IRS) was then calculated by multiplying WAI with TPS (total percentage of cells stained). The thickness of the ligamentum flavum was measured with axial T1-weighted magnetic resonance imaging. The biochemical and radiologic results were compared for these two conditions. Results A total of 94% (34/36) of specimens in the lumbar spinal stenosis had a IRS >50 as compared with 72% (16/22) in lumbar disc herniation; this difference is statistically significant ( p = 0.011). The mean thickness of the ligamentum flavum was 3.96 mm (range, 2.67-5.75 mm) in lumbar spinal stenosis and 2.59 mm (range, 1.41-4.17 mm) in lumbar disc herniation; the difference between lumbar spinal stenosis and disc hernation was statistically significant ( p < 0.05). Conclusion The current results suggest that higher expression of chondroitin sulfate might be related to the development of hypertrophy of the ligamentum flavum in lumbar spinal stenosis. Disclosure of Interest None declared
Minimally Invasive Laminectomy for Lumbar Spinal Stenosis in Patients with and without Preoperative Spondylolisthesis: Clinical Outcome and Reoperation Rate
Authors: Alimi M. , Hofstetter C. P. , Pyo S. Y. , Paulo D. , Hartl R. 
Published: May 2014

Introduction Surgical decompression is the intervention of choice for lumbar spinal stenosis (LSS) when nonoperative treatment has failed. Standard open laminectomy is an effective procedure. Minimally invasive laminectomy through tubular retractors is an alternative procedure. The aim of our cohort study was to evaluate the clinical and radiographic outcome of this procedure in LSS patients with or without preoperative spondylolisthesis. Materials and Methods Patients with LSS without spondylolisthesis and with stable spondylolisthesis who underwent MIS tubular laminectomy between 2004 and 2011 were included. Demographic, perioperative, and radiographic data were collected. Clinical outcome was evaluated by Oswestry disability index (ODI) and visual analog scale (VAS) scores, as well as by MacNab criteria. Results In a total of 110 patients, preoperative spondylolisthesis at the level of spinal stenosis was present in 52.5%. ODI and VAS pain scores at a mean follow-up of 28.8 months revealed a median improvement of 16% in ODI, 2.75 in VAS back, and 3 in VAS leg scores, compared with the preoperative baseline ( p < 0.0001). The reoperation rate requiring fusion was 3.5%. Patients with and without preoperative spondylolisthesis had no significant differences in their clinical outcome or the reoperation rate. Conclusion MIS laminectomy is an effective procedure for treatment of LSS. Reoperation rates for instability are lower than reported after open laminectomy. Functional improvement is similar in patients with and without preoperative spondylolisthesis. This procedure can be a viable alternative to open laminectomy. Routine fusion may not be indicated in all patients with LSS and spondylolisthesis. Disclosure of Interest None declared
Spinal Abscess after Epidural Catheter Insertion: A Case Report
Authors: Velnar T. , Bunc G. , Ravnik J. 
Published: May 2014

Introduction Epidural anesthesia has become a common practice for treatment of acute surgical pain and to relieve chronic pain syndromes. Despite its many qualities, potential risks have been described. Spinal epidural abscess is one of its most perilous complications. Materials and Methods A 72-year-old patient was treated due to lung cancer. After the operation, the pain was worsening progressively for many months. As a pain relieving measure, an epidural catheter was inserted into the upper thoracic spinal canal. In the reconvalescent period, progressive weakness of lower extremities suddenly developed and advanced rapidly into paraplegia. There was no fever observed by the patient. Results At admission, hypoesthesia from the upper thoracic level and anesthesia from the lower thoracic level was observed, accompanied with paraplegia. Muscle tone was appropriate and Babinski sign was present bilaterally. MRI revealed epidural fluid formation at the posterior aspect of the spinal canal with an intense compression of the cord at levels Th1 to Th4. An immediate operation followed during which a wide decompression of the spinal cord with complete evacuation of the abscess was performed. In the epidural fluid collection, the tip of the epidural catheter was found. Appropriate antibiotic therapy was started instantly. From the abscess, Staphylococcus epidermidiswas isolated. Postoperative CT scan revealed sufficient decompression of the spinal cord. Unfortunately, initially promising recovery was complicated with pneumonia and lung cancer progression that led to the death of the patient. Conclusion Although rare, the epidural abscess is a dangerous complication, resulting in high morbidity and mortality despite rapid surgical and postoperative interventions. Clinical signs and symptoms may be confusing and may point to other forms of pathology. The importance of very strict sterile procedures during catheter insertion and removal or close monitoring of patients with inserted catheters cannot be overemphasized. Disclosure of Interest None declared References Stäbler A, Reiser MF. Imaging of spinal infection. Radiol Clin North Am 2001;39(1):115–135 Tompkins M, Panuncialman I, Lucas P, Palumbo M. Spinal epidural abscess. J Emerg Med 2010;39(3):384–390 Ugarriza LF, Porras LF, Lorenzana LM, Rodríguez-Sánchez JA, García-Yagüe LM, Cabezudo JM. Brucellar spinal epidural abscesses. Analysis of eleven cases. Br J Neurosurg 2005;19(3):235–240 von Albert HH. [Lumbalgia, lumboischialgia. 2: Instrumental diagnosis, differential diagnosis]. Fortschr Med 1990;108(18):363–364
Lumbar Interbody Fusion Rates with Actifuse, i-FACTOR, and Vitoss BA Synthetic Bone Grafts
Authors: Berg A. James , Tankel J. A. , Jensen C. D. , Irwin A. , Purushothaman B. , Reddy G. Raj , Friesem T. 
Published: May 2014

Introduction One surgical treatment modality for the management of degenerative disc disease causing back and/or leg pain is interbody fusion. Nonunion is associated with poor outcomes. The gold standard bone graft for augmenting and achieving fusion is iliac crest autograft but significant donor morbidity is associated with its harvest. Allografts require processing, to prevent transmission of infections, which impairs their osteogenic and osteoinductive properties. An alternative synthetic bone graft that avoids the morbidity of autograft is safe, and provides reliable fusion and is therefore desired. In our institution, we have used three synthetic bone grafts, Actifuse (Baxter, USA), i-FACTOR (Cerapedics, USA) and Vitoss BA (Stryker, USA), which all report to be bioactive and to enhance bone fusion in transforaminal lumbar interbody fusion (TLIF) procedures. They were all used in combination with morselized local autograft. Materials and Methods Patients undergoing TLIF surgery with one of the mentioned bone grafts were identified from hospital records. Postoperative radiographs were reviewed by an independent blinded radiologist for evidence of spanning trabeculae on orthogonal radiographs. Results A total of 40 patients (55 levels) were included. The number of patients, operated levels, follow-up, and cumulative and overall fusion rates for each bone graft group are demonstrated in Table 1. Conclusion Patients who underwent TLIF with a mixture of i-FACTOR combined morselized local autograft had a higher rate of fusion with a similar mean follow-up and higher cumulative fusion rates over the period studied than Actifuse and Vitoss BA. The smaller patient numbers in the Actifuse and Vitoss BA groups does limit comparisons. Disclosure of Interest None declared