bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Age in Sagittal Spinal and Spinopelvic Alignment in a Brazilian Asymptomatic Sample
Authors: Barsotti Carlos Eduardo , Pratali Raphael , dos Santos Francisco Prado , Oliveira Carlos Eduardo , Nogueira Monica Paschoal 
Published: May 2015

Introduction The anatomical relationship between elements of the spinopelvic linear chain does not appear to be uniform across different ethnic and population groups, based on measurements of radiographic parameters presented in the literature in populations with different origins. These studies have demonstrated variability in spinal and pelvic parameters among the groups studied, which makes it important to know their normative values, specific for a population. Such knowledge enables surgeons to individualize treatment goals for deformities in a specific adult population. The aim of this study was to present normal values of sagittal spinal and spinopelvic parameters in a Brazilian population sample and analyze the effect of age on these parameters. Materials and Methods This is a prospective observational study involving asymptomatic volunteers in a Brazilian population sample. The volunteers that accepted to participate had obtained total spine radiography in addition to collecting demographic data, including age and sex. The radiographic parameters evaluated were: Sagittal vertical axis (EVS), T1-spinopelvic inclination (T1-SPI), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and thoracic kyphosis (TK). We also consider the mismatch between the PI and the LL (PI-LL). These radiographic parameters were compared between the age groups of volunteers, divided into three groups: 18 to 39, 40 to 59, and older than 60 years. Results In total, 167 asymptomatic volunteers were enrolled, 105 women and 62 men with a mean age of 45.8 years (range, 18–74). In regards to the age group, 54 volunteers had 18 to 39, 79 had 40 to 59, and 34 had older than 60 years of age. The mean values of radiographic parameters in the total sample were: SVA −11.77 mm, T1-SPI- 5.47 degrees, IP: 46.93 degrees, PT: 13.77 degrees, SS: 33.05 degrees, LL: 54.53 degrees, PI-LL: −6.98 degrees, and TK: 40.54 degrees. Comparing the values regarding age, it was observed that higher the age of individuals is, occurs a statistically significant increase in the values of SVA, PT, T1-SPI, and PI-LL ( p < 0.001, < 0.001, 0.001, and 0.004, respectively). Conclusion The study presented normal values of sagittal spine and spinopelvic parameters in a sample of a Brazilian population, and also showed that there is an increase in anterior tilt of the trunk and a larger pelvic retroversion directly proportional to the increase in age of the individuals.
Successful Correction of Sagittal Imbalance can be Calculated on the Basis of Pelvic Incidence and Age
Authors: Cecchinato Riccardo , Damilano Marco , Ismael Maryem , Langella Francesco , Lamartina Claudio , Berjano Pedro 
Published: May 2015

Introduction Sagittal imbalance is an independent predictor of outcome in adult degenerative spinal deformity. Restoration of sagittal spinopelvic parameters correlates with a better postoperative outcome. Several methods of preoperative calculation for sagittal correction have been proposed, most of them geometrical. A nongeometrical method, based on data of spinopelvic relationships in normal subjects, that uses the patient's pelvic incidence and age to calculate target lumbar lordosis and thoracic kyphosis is proposed. The goal of this study is to describe and validate this nongeometrical method in terms of sensitivity and specificity to predict satisfactory spinopelvic alignment. Materials and Methods A retrospective cohort study of patients operated for sagittal imbalance with pedicle subtraction osteotomies (PSO). Two calculation algorithms (method a: LL = −[32.56 + PI × 0.54], method b: LL = −[PI + 10 degrees]); in both TK = PI/r (see text for definitions) obtain theoretical lumbar lordosis (LL) and thoracic kyphosis (TK) solely based on pelvic incidence and age, for surgical planning. The sample is categorized according to two parameters: planning goals (LL and TK) achieved or not and satisfactory alignment (SVA < 50 mm and PT < 20 degrees) achieved or not. Two × two tables are built and odds ratio, sensitivity and specificity and PPV/NPV are calculated for each planning method. Different levels of tolerance for undercorrection are analyzed to refine the use of the method. Results Of the 50 patients included in the study, 23 presented satisfactory alignment postoperatively. With a tolerance of hypocorrection of 10 degrees (LL) and 30 degrees (TK), correction target was achieved in 23 patients according to method a (S = 0.89, Sp = 0.87%, OR = 53.33 [95% CI: 9.677–293.931]; p < 0.001), 23 patients according to method b (S = 0.93, Sp = 0.91, OR = 131.25 [95% CI:17–1013]; p < 0.001). The best prediction of satisfactory alignment was obtained with method b and tolerance 0 degrees (LL) and 10 degrees (TK). All patients with complete correction of LL (both methods) achieved good alignment. Overall, 22 of the 24 (91%) patients with less than 10 degrees of undercorrection of LL (method b) achieved good alignment. Conclusion Calculation of the target lordosis based only in the value of PI and age is a reliable method that can predict good outcomes in terms of alignment. The rule LL = −(PI + 10 degrees) is an easy to calculate and very effective method of planning for lumbar lordosis and good alignment can be expected with high confidence when the final lordosis is within 10 degree of undercorrection. Including TK in surgical planning can improve the results in terms of restoration of the less known “spinopelvic balance” parameter.
New Instrumentation Technique for Growing Rod
Authors: Aydinli Ufuk , Kara Kursat , Yaray Osman , Mutlu Muren 
Published: May 2015

Introduction The spine is a key factor in the growth of thorax, abdomen, and pelvis. By the age of 5 years, the spine reaches 50% of its adult length. Therefore, spinal fusion in a 5-year-old child can result in about 12.5 cm loss of spinal growth. Disruption of the growth of the spine due to fusion performed in the treatment of early-onset scoliosis leads to thoracic insufficiency syndrome. The ideal technique should maintain the correction of the deformity, allow continued spinal growth, should not require postoperative immobilization, and also should have low complication rates. There are several growing rod techniques which have been defined but none of them fulfill all of these conditions. The aim of this article is to define a new modification on the growing rod technique. Patients and Methods Ten children have been operated in authors' institution, at an average age of 8 (range, 4–9) years. The surgical technique involved short segment instrumentation applied on the convex side of the apex of the deformity. Pedicle screws or hooks were used at stable anchor levels of the concave side of the deformity. Two rods, one proximal and one distal, were fixed to anchor sites and connected by a domino connector. After distracting the concave side, a transverse connector was used between the short segment and the long one, and this connector was compressed to maintain a translational force on the apex of the deformity. The frequency of lengthening procedure is 6 to 9 months. Results The average follow-up was 11 months. The average preoperative coronal plane curve was 46 degree and corrected to 13 degree showing 74% scoliosis correction after index surgery. Conclusion The main goal of the treatment of early-onset spinal deformities in children is to correct the deformity while maintaining the growth of the spine. All the described techniques up to now have been based on distraction of the concave side and the compression of the convex side of the deformity at stable vertebrae. The technique defined in this study, distracts the concave side while applying a translational force at the apex of the deformity by a transverse connector. The authors believe that this new technique will maintain more effective correction. Other advantages include less surgical dissection so less likely to cause a spontaneous fusion of the spine, shorter operation time, and low risk of surgery-associated complications. Long-term outcomes of the treatment by this new technique should be investigated by the mean spinal growth, and the correction of the spinal deformity.
Does the Position of the Aorta Change with the Altered Body Position in Ankylosing Spondylitis Patients with Thoracolumbar Kyphosis? A Magnetic Resonance Imaging Investigation
Authors: Qian Bang-Ping , Qu Zhe , Ji Ming-liang , Zhu Zezhang , Liu Zhen , Wang Bin , Sun Xu , Zhu Feng , Yu Yang , Qiu Yong 
Published: May 2015

Introduction Lumbar spine osteotomy has been widely adopted to correct thoracolumbar kyphosis in ankylosing spondylitis (AS) patients; however, catastrophic aortic complications may occur during the insertion of pedicle screws or the performance of osteotomy. To prevent these iatrogenic complications, it is essential to have a clear understanding of the spatial relationship between the aorta and the spine. Previous study reported that the aorta is positioned more anteromedially relative to the spine in AS patients with thoracolumbar kyphosis when compared with normal subjects. However, patients in the aforementioned study were performed computed tomographic scans in the supine position, which was different from the prone position adopted in surgery. To the best of our knowledge, no report has been published to investigate the difference in the position of the aorta relative to the vertebrae between supine and prone positions in AS patients with fixed thoracolumbar kyphosis. The objective of this study is to explore the differences in the anatomic position of the aorta relative to the spine between supine and prone positions in AS patients with thoracolumbar kyphosis. Patients and Methods From March 2013 to June 2014, 20 AS patients (19 males, 1 female) with thoracolumbar kyphosis with a mean age of 30.9 years (range, 19–46 years) were recruited into this study. Each patient received an axial MRI scan from T9 to L3 in both the supine and prone positions. The left pedicle-aorta (LtP-Ao) angle and LtP-Ao distance were measured at each level. Radiographs were analyzed to measure the global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), and the apex of the kyphotic curve was also recorded. The paired sample t-test was used to compare these parameters between different positions. Results At T9 to L3 levels, no significant difference was noted in LtP-Ao distances (43.84 vs. 44.58 mm; p = 0.054) and LtP-Ao angles (0.67 vs. 0.03 degrees; p = 0.058) for AS patients between supine and prone positions. The correlation analysis also revealed no significant correlation between shifting of the LtP-Ao angle and GK, TK, and LL at T9 to L3 levels in the prone position. Conclusion There is no significant change of the relative position between aorta and spine at T9 to L3 levels when patients change from supine to prone position. The result of this study suggested that in advanced stage of AS, the chronic inflammation may result in the firm adhesion between the aorta and anterior longitudinal ligament. Moreover, due to the reduced mobility and limited range of motion, the aorta is more vulnerable to be injured when the misplacement of pedicle screws and the stretching of the aorta occurs during surgery. Therefore, surgeons must keep this condition in mind to avoid catastrophic aortic complications.
Standalone Anterior Lumbar Interbody Fusion for Spondylolisthesis
Authors: Ghent Finn , Rao Prashanth , Keegan Lee , Reddy Rajesh , Mobbs Ralph J. 
Published: May 2015

Introduction Debate continues over the optimal approach for fusion of isthmic and degenerative spondylolisthesis. We favor anterior lumbar interbody fusion (ALIF) as it permits liberal discectomy and placement of a large, lordotic device which restores disc height and sagittal balance, reduces listhesis, and indirectly decompresses exiting nerve roots. There are only a few articles in the literature looking at the degree of reduction and the durability over time in patients undergoing ALIF with spondylolisthesis. Material and Methods We studied the initial degree of reduction achieved, and the durability of this reduction over time when ALIF was used for patients with isthmic and degenerative spondylolisthesis. Analysis of prospectively collected radiographic data was conducted. All patients with lumbar spondylolisthesis who underwent standalone ALIF between 2009 and 2013 by a single surgeon (R. J. M.) were included. Radiological analysis of slip percentage and disc height on preoperative, postoperative, and latest follow-up imaging was performed with Surgimap Spine software. Demographic factors, surgical data and radiological results were compared. Results Average patient age was 64.5 years (range, 37–84) with 16 females, 15 males. There were 36 levels treated with 20 at L4/5, 15 at L5/S1, and one at L3/4. Mean listhesis was 16% which immediately postoperatively reduced to 2.3%, but at latest follow-up had recurred to 58% of the original value. An average disc height increase of 184% was observed postoperatively. Analysis of these measurements showed a high degree of inter- and intraclass correlation. Mean follow-up was 17 months. BMI correlated with immediate postoperative reduction ( p = 0.004), as did posterior disc height ( p = 0.04). The overall radiological fusion rate was 91%. Three patients required subsequent posterior instrumentation, which will be discussed. Conclusion ALIF achieves disc height restoration and indirect listhesis reduction in isthmic and degenerative spondylolisthesis. Although this reduction may regress over time, we found it remained reduced by approximately 50% at latest follow-up. Around 10% of patients required further strengthening by posterior pedicle screw fixation. Standalone ALIF without posterior pedicle screw fixation is successful in the majority of patients with spondylolisthesis.
The Implications of Limited Decompression and Fusion or Decompression Alone Compared to Full Correction in Adult Deformity Surgery
Authors: Hawryluk Gregory , Berven Sigurd , Chou Dean 
Published: May 2015

Introduction Some patients request limited surgery instead of full deformity correction and stabilization because of the perceived lower morbidity, risk, and magnitude of surgery. This study is an attempt to evaluate outcomes in patient who select limited fusion/decompression compared with patients who elect to undergo complete deformity correction/stabilization. Materials and Methods We performed a retrospective review of consecutive adult spinal deformity patients treated over a 6 year period who had minimum 1 year of follow-up in the practice of a single spinal surgeon. Patients with cervical or pathological deformity were excluded. Some patients chose only to undergo partial corrections or decompression alone. We compared demographic data of patients choosing among these three options and additionally compared intraoperative blood loss, length of surgery, and length of stay. We also examined the early and late complication rate as well as the number of subsequent spinal surgeries. We additionally compared perioperative change in quality of life measures (ODI, VAS, and SF36v2). Results A total of 103 patients were identified, out of which 59 patients underwent full correction while 24 underwent partial correction and 20 underwent decompression alone. Full correction was achieved in 54 of the 59 patients (91.5%). Patients choosing full correction were significantly younger than those undergoing less than full correction ( p < 0.0001). Attempted full correction was associated with significantly longer length of stay ( p = 0.016), longer surgical duration ( p < 0.0001), and greater volume of intraoperative blood loss ( p = 0.002). There was no clear relationship between extent of surgery and rate of early complications. Late complication and reoperation rates increased as the extent of the initial surgery increased however these differences were not significant. Only 26.2% of patients provided quality of life data. Those undergoing full correction had greatest improvement in ODI, VAS, SF36v2 physical and mental scores, particularly when full correction was achieved. No statistical differences in quality of life measures were detected although type II error is probable. Conclusion Although full deformity correction is more resource intensive and associated with a higher reoperative rate, our results suggest that achieving full deformity correction may achieve the greatest improvement in quality of life measures. A low response rate on quality of life measure surveys limits the strength of our conclusions.
The Presence of Preoperative Cervical Deformity in Adult Spinal Deformity Patients is a Strong Predictor of Inferior Outcomes and Failure to Reach MCID at 2-Year Follow-Up: Analysis of 235 Patients
Authors: Ames Christopher , Passias Peter , Soroceanu Alex , Boniello Anthony , Scheer Justin , Schwab Frank , Shaffrey Christopher , Kim Han Jo , Protopsaltis Themistocles , Mundis Gregory , Gupta Munish , Klineberg Eric , Lafage Virginie , Smith Justin 
Published: May 2015

Introduction A high prevalence of cervical deformity (CD) has been identified among adult spinal deformity (ASD) patients undergoing surgical treatment. The clinical impact of this is uncertain. This study aims to quantify the difference in patient-reported outcomes among ASD patients based on presence of CD before treatment. Material and Methods Retrospective review of a multicenter prospective database of surgical ASD patients with 2-year follow-up. CD was defined as: C2C7 SVA > 4 cm, cervical kyphosis (CK) C2C7angle > 0. Univariate testing was performed using t-tests, or tests of proportion. Multivariate models determined impact of preoperative CD on health-related quality of life (HRQL) scores (SF-36, ODI, and SRS) and obtaining minimally clinically important difference (MCID) at 2 years. Results A total of 235 patients met the criteria, of which 65 with preoperative C2C7 SVA > 4 cm, 57 with CK. Patients with and without CD saw improvements in 2-year HRQL scores ( p < 0.001). Overall, patients with preoperative CD had inferior postoperative HRQL and were less likely to achieve MCID for HRQL at 2-years. Those with preoperative SVA > 4 cm had worse ODI, PCS, SRS activity, appearance, pain, and total, and were less likely to meet MCID for ODI, PCS, SRS activity, and pain scores (odds ratio 0.39 for ODI CI 0.19:0.81 p < 0.05), (0.34 for PCS CI 0.16:0.72 p < 0.05), (0.29 CI 0.14:0.62 p < 0.05 SRS activity) (0.41 CI 0.20:0.86 p < 0.05 SRS pain). Similarly, patients with CK had inferior 2-year HRQL scores. Patients without any CD were four times more likely to reach 2-year SRS activity MCID (OR 0.40 CI 0.19:0.86 p < 0.05). Conclusion Despite experiencing significant improvements in HRQL scores, preoperative CD in ASD patients is a strong predictor of inferior outcomes and failure to reach MCID at 2-year follow-up. This information will help surgeons educate patients at risk for inferior outcomes and direct future research to improve patient outcomes.
Effectiveness and Safety of Convex Derotation in Thoracic Adolescent Idiopathic Scoliosis
Authors: Oggiano Leonardo , La Rosa Guido 
Published: May 2015

Introduction Concave derotation is the traditional correction maneuver in adolescent idiopathic scoliosis surgery. However, the positioning of thoracic pedicle screws at the concave side of the curve can be quite challenging, because of the small pedicle size and the wide variation in its morphological characteristics, due to the vertebral dystrophy observed in scoliotic patients. Then, to reduce risks of neural damages and ensure the same strength of derotation maneuver, a convex derotation through an all-level pedicle screws convex instrumentation can be performed. We report perioperative and 1-year results in a consecutive series of patients treated by convex derotation through an all-level pedicle screws convex instrumentation. Materials and Methods From January 2013 to January 2014, we surgically treated 24 consecutive patients (18 female patients and 6 male patients, mean age 13 years) affected by thoracic adolescent idiopathic scoliosis (Lenke Type 1, 19 patients, and Lenke Type 2, 5 patients). Mean preoperative Cobb angle was 56 ± 6 degrees in Lenke Type 1 group and 51 ± 4 degrees plus 32 ± 3 degrees in Lenke Type 2 group. We performed a posterior access only in patients using polyaxial pedicle screws at each level on the convex side and two sublaminar acrylic loops (universal clamps) at the upper instrumented vertebra, to reduce the stiffness of the construct. Derotation maneuver was performed on the convex prebent rod. In all cases, motor-evoked potential monitoring was used. Mean follow-up time was 15 months. Results The average percentage of coronal correction was 76 ± 5% (mean postoperative Cobb angle 15 ± 4 degrees), with no neurological complications. Regarding the postoperative kyphosis, we observed a slight decrease in mean values compared with preoperative measurements (mean reduction of thoracic kyphosis 5 ± 2 degrees). At 1-year follow-up, no changes in coronal or sagittal plane were observed. The mean operative time was 210 ± 30 minutes, with a mean blood loss of approximately 500 ± 100 mL. Using the free-hand technique, the mean time of pedicle screws positioning in the thoracic area on the convex side was approximately 2 ± 1 minutes from T6 to T12 and approximately 4 ± 1 minutes from T3 to T5. Whenever included in the area of arthrodesis, T2 was usually instrumented with the universal clamps. Instead, T1 has never been included in the arthrodesis area. Conclusion This case-series study shows the effectiveness and safety of convex derotation in Lenke Type 1 and 2 scoliosis. The coronal correction obtained with this technique is comparable to that obtained with the traditional concave derotation. Other advantages are short operative time, low intraoperative blood loss, and, mostly, a reduced risk of neurological complications.