bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical Lordosis Increases with Age in Adult Spinal Deformity: A Cross-Sectional Study of Nonoperative Patients
Authors: Kim Han Jo , Scheer Justin , Lafage Virginie , Smith Justin , Shaffrey Christopher , Schwab Frank , Mundis Gregory , Klineberg Eric , Gupta Munish , Cunningham Matthew , Hart Robert , Burton Douglas , Bess Shay , Ames Christopher 
Published: May 2015

Introduction It is theorized that with age and degeneration, the cervical spine becomes progressively more kyphotic; however, there are no studies which support these conclusions. We performed a radiographic analysis of patients with adult spinal deformity (ASD) and hypothesized that cervical lordosis would decrease with aging. Patients and Methods The nonoperative arm of a prospective multicenter database of patients with ASD was analyzed. Inclusion criteria were patients > 18 years old meeting any one of the following criteria: Coronal Cobb > 20 degrees, C7-S1 sagittal vertical axis (SVA) > 5 cm, pelvic tilt (PT) > 25 degrees, or thoracic kyphosis (TK) > 60 degrees, and the patients who did not undergo surgery. Nonidiopathic causes of scoliosis, history of spine surgery, and age < 18 years were excluded. Coronal and sagittal radiographic parameters were collected with particular interest to cervical sagittal parameters. Curves were classified into Schwab type. Age groups were separated into group 1: < 40 years, group 2: 41 to 60 years, and group 3: > 60 years. Statistical analysis was performed with Wilcoxon rank sum test for continuous variables with a p value < 0.05 as significant. Results Of the 491 patients in the database, 373 met inclusion criteria for the study and 269 had complete radiographic data for analysis. With increasing age, there were an overall slight increase in body mass index and a statistically significant increase in the Charlson Comorbidity Index. There were no differences in Schwab curve type prevalence between groups. The mean cervical lordosis (CL) increased with age (1.6 ± 10.6, 7.1 ± 13.3, and 11.8 ± 13.2 in groups 1, 2, and 3, respectively, p = 0.04,< 0.01, and < 0.01. Interestingly, there was a corresponding increase in T1 slope between groups 1, 2, and 3 without an increase in thoracic kyphosis. Meanwhile, the C2–7 SVA remained the same (3.0 ± 1.2, 2.7 ± 1.6, and 2.7 ± 1.8, groups 1, 2, and 3, respectively, p = 0.17, 0.88, 0.32). With increasing age, there was a decrease in lumbar lordosis (LL), increase in PT, and increase in SVA. Conclusion CL actually increases with age in nonoperative ASD patients while the thoracic kyphosis remained the same. The LL decreased whereas the PT and SVA increased. The types of curve distributions were similar between all the age groups.
Elderly Patients Older than 75 Years Undergoing Reconstructive Spinal Deformity Surgery Have Significantly Improved Health-Related Quality of Life Measures versus those Managed Nonoperatively Despite High Surgical Complication Rate
Authors: Sciubba Daniel , Scheer Justin , Smith Justin , Klineberg Eric , Gupta Munish , Mundis Gregory , Protopsaltis Themistocles , Lafage Virginie , Kim Han Jo , Koskim Tyler , Kebaish Khaled , Shaffrey Christopher , Bess Shay , Hart Robert , Schwab Frank , Ames Christopher 
Published: May 2015

Introduction Elderly patients with adult spinal deformity (ASD) often report worse health-related quality of life (HRQOL) than younger patients. Increasing age is associated with increased surgical morbidity. The objective of this study was to compare the outcomes of patients with ASD older than 75 years managed operatively (OP) and nonoperatively (NONOP). Materials and Methods A retrospective review of a multicenter prospective ASD database was conducted. Inclusion criteria included age ≥ 75 years, ASD. Demographics, comorbidities, radiographs, complications, and HRQOL measures collected included pain with visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 (SF-36), and Scoliosis Research Society-22 (SRS22) at baseline, 1 and 2 years. Results A total of 32 patients met criteria (OP: 17, NONOP: 15), all had a minimum 2-year clinical and radiographic follow-up. Of the 32 patients, 13 were at least 80 years of age. There were no significant differences between OP and NONOP for age, BMI, and Charlson Comorbidity Index ( p > 0.05 for all). OP had worse baseline ODI, PCS, SRS Activity, Appearance, and Total than NONOP ( p < 0.05 for all). There were no significant differences in any baseline radiographic parameters. OP had significant improvement in LL, C7SVA, PI–LL, ODI, PCS, and all SRS subdomains except mental compared with pre-op ( p < 0.05 for all). OP had significantly higher 2-year SRS appearance and satisfaction ( p < 0.05) than NONOP. There were no significant differences between baseline and 2-year HRQOL for NONOP ( p > 0.05). Of the 17 OP patients, 10 (58.8%) had at least one complication with a total of 27 complications including a 64.7% rate of PJK and a 35.3% rate of reoperation. Conclusion Elderly patients ≥ 75 years undergoing ASD surgery had significantly improved HRQOL and radiographic measures over baseline at 2 years compared with a similar nonoperative cohort, despite substantial operative morbidity. This data may be used for preoperative patient counseling in this high-risk elderly population.
Preoperative Cervical Hyperlordosis and C2–T3 Angle are Correlated to Increased Risk of Post-Op Sagittal Spinal Pelvic Malalignment in Adult Spinal Deformity Patients at 2-Year Follow-Up
Authors: Passias Peter , Yang Sun , Soroceanu Alex , Scheer Justin , Schwab Frank , Shaffrey Christopher , Kim Han Jo , Protopsaltis Themistocles , Mundis Gregory , Gupta Munish , Klineberg Eric , Lafage Virginie , Smith Justin , Ames Christopher 
Published: May 2015

Introduction Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment and achieving optimal TL alignment in ASD surgery is unclear. This study assesses the relationship between preoperative cervical spinal parameters and global alignment following thoracolumbar ASD surgery at 2-year follow-up. Patients and Methods Using a multicenter prospective database of surgical patients with ASD, we included patients with 2-year follow-up and cervical X-rays. SRS-Schwab sagittal modifiers (PT, GA, and PI–LL) were assessed at 2-year postoperative as either normal (0) or abnormal (“ + ” or “ + +”). Patients were classified in the aligned group (AG) or maligned group (MG) if all the three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2–C7 SVA > 4 cm, C2–C7 SVA < 4 cm, cervical kyphosis (CL > 0), cervical lordosis (CL < 0), any deformity (C2C7 SVA > 4 cm or CL > 0), and both CD (C2C7 SVA > 4 cm and CL > 0). Univariate testing was performed using t test or chi-square test, looking at the following pre-op parameters: CD, C2–C7 SVA, C2–T3 SVA, CL, T1S, T1S–CL, C2–T3 angle, LL, TK, PT, C7–S1 SVA, and PI–LL. Results A total of 184 patients met initial inclusion criteria with 70 in the AG and 34 in MG. Pre-op, patients in the MG had a higher cervical lordosis (11.7 vs. 4.9, p = 0.03), higher C2–T3 angle (13.59 vs. 4.9 p = 0.01), and higher PT ( p < 0.0001), higher SVA ( p < 0.0001), and higher PI–LL ( p < 0.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both the groups: MG and AG. There was no statistically significant difference in the amount of improvement over 2 years on the ODI or the SF-36 PCS. Conclusion Patients with 2-year sagittal TL malalignment also have preoperative sagittal TL malalignment and concomitant cervical hyperlordosis as a compensatory mechanism to maintain horizontal gaze. Cervical radiographs suggestive of cervical hyperlordosis should be followed up with complete standing radiographs to asses for sagittal TL malalignment.
Impact of Ethnicity on Adult Spinal Deformity Surgical Outcomes: An Analysis of Japanese and North American Databases
Authors: Lafage Virginie , Matsumoto Morio , Hosogane Naobumi , Smith Justin , Protopsaltis Themistocles , Yamato Yu , Matsuyama Yukihiro , Taneichi Hiroshi , Liu Shian , Ferrero Emmanuelle , Shaffrey Christopher , Schwab Frank , Ames Christopher 
Published: May 2015

Introduction Adult spinal deformity (ASD) research and treatment has continued to evolve and grow globally. International studies are now frequently presented at the SRS, but surgeons are unsure of the data comparisons and global relevance of conclusions across ethnicities. We compared HRQOL and radiographs between two countries (United States and Japan) to help define the effect of geographic variation. Materials and Methods Retrospective, multicenter case series of 337 operative patients with ASD with baseline radiographs and ODI from 11 sites across USA ( n = 235) and Japan (JPN, n = 102). Patients were compared preoperatively and postoperatively in ODI, ODI need for improvement (ODIni, using age/ethnic normative values), and radiographs. Regression was used to define thresholds for disability: USA ODI 41.9, JPN ODI 33.7. Results Differences in age (USA 55 years, JPN 65 years, p < 0.001) and primary cases (USA 59%, JPN 98%, p < 0.001) existed at baseline (BL), but not gender (USA 84%, JPN 84%). BL ODIni was significantly higher in JPN, without a difference in BL ODI. JPN was significantly more deformed at BL (Table). At 2-year follow-up, both cohorts improved significantly ( p < 0.05), however, JPN had significantly higher ODIni without a difference in 2-year ODI (Table). Both cohorts improved significantly radiographically ( p < 0.05); however, JPN was more malaligned (Table). Applying thresholds of deformity, 46% United States ( n = 54) were disabled compared with 60% JPN ( n = 36; p = 0.014). Conclusion Despite having a greater deformity at BL, there were no significant differences in BL ODI. Although both the groups improved in ODI and alignment, JPN cohort still had higher offset from the normative age-/ethnicity-matched values and more spino-pelvic malalignment at 2 years—for the same ODI, JPN patients may be masking a greater disability than represented by the score. When population-specific thresholds of disability were applied, JPN patients had a large percentage over the threshold, revealing that 60% were still with lower scores at 2 years. The ethnicity of a patient should be considered when interpreting ODI and comparing surgical outcomes for ASD using standard metrics.
Vitamin D deficiency and its Relation with Adolescent Idiopathic Scoliosis
Authors: Batista Rodrigo , Martins Delio , Hayashi Lilian , Terreri Maria , Lazaretti-Castro Marise , Wajchenberg Marcelo , Puertas Eduardo 
Published: May 2015

Introduction Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine occurring in up to 4% of children between 10 and 18 years of age. AIS is considered multifactorial, and probably genetics play an important role in its genesis. Family history may present several individuals affected. Classical progression risk factors such as curve magnitude, remaining growth potential, and skeletal maturity help us to identify which curves are likely to worsen. Scientists have tried to link the AIS to vitamin D receptor gene (VDRG) polymorphism. Approximately 90% of the daily recommended intake of vitamin D should be provided by sunlight through a process housed in the skin, the 10% remaining (around 400 IU) must be ingested. After hydroxylation processes hosted by the liver and kidneys, calcitriol (1,25OHVitD—active form) will play an important role in bone homeostasis and muscle strength. Vitamin D levels are considered insufficient under 30 ng/mL and deficient when lower than 20 ng/mL. Recently, bone mineral density has been studied and included as a potential explanation to the developing of skeletal deformities and its progression. Benefits of vitamin D include adequate management of muscle and bone quality, and this hormone could be implicated on AIS development. This study had the objective of comparing vitamin D serum levels of children being treated for AIS in our institution to those of normal individuals. Patients and Methods Patient recruitment was undertaken along 2013 from the outpatient clinics of Spine Pathology of the Department of Orthopedics. Children younger than 10 or older than 18 years, and those carrying neurologic or muscular disorders, congenital deformities, or genetic syndromes were excluded. Calcium, phosphorus, creatine, urea, and human parathyroid hormone dosage were taken to rule out renal or parathyroid dysfunctions. Patients were measured and weighted, and 25-OHVitD levels were determined through electrochemiluminescence by an automated test after an 8-hour fasting, during Brazilian Spring. The results were compared with a paired group composed of healthy individuals. Results The majority of the patients in both groups are nonblack females. In group 1 (controls), all children were eutrophic according to their body mass index and 63.3% showed abnormal vitamin D levels. Group 2 presented 12.7% incidence of malnutrition, and only 9% presented normal vitamin D level. Statistical analysis through unpaired t tests found relevant difference ( p < 0.001) between the means of vitamin D levels of the two groups. Conclusions There is a significant difference of vitamin D levels between patients with AIS and normal individuals. However, more studies are necessary to establish a cause–consequence relation between low vitamin D levels and AIS.
Protocol to Anticipate the Possibility and the Risk of the Anterior Approach to the Cervicothoracic Junction
Authors: Falavigna Asdrubal , Righesso Orlando , Volquind Daniel , Teles Alisson Roberto 
Published: May 2015

Introduction Several authors have previously described their radiological methods to identify in which cases the anterior approach could be performed and when the manubriotomy was needed; nevertheless, the reproducibility of the technique was not straightforward, several different measurements were described and analyzed, without considering the vascular anatomy and the relationship of the inclination of the vertebrae above the lesion to the manubrium was not taken into account. The purpose of this study was to present a straightforward preoperative protocol to define the possibility and the risk of the anterior approach to the cervicothoracic junction (CTJ). Patients and Methods A prospective cohort study of 19 consecutive patients who underwent an anterior approach in cervicothoracic surgery. Radiographic evaluation of the patients was performed with magnetic resonance imaging to study the disease features and to address the feasibility of the anterior approach through knowledge of the vascular anatomy. Computed tomography with sagittal reconstructions images including the manubrium was done to apply the “surgeons' view line.” This line is parallel to the inferior plateau of the superior healthy vertebrae or the vertebrae above the herniated intervertebral disc and the decision concerning the feasibility and need for manubriotomy depends on the correlation between this line and the great vessels and the manubrium, respectively. Results A preoperative planning of the need for manubriotomy was correct in all cases. Manubriotomy was never performed in C7 corpectomy or C7–T1 discectomy cases, nevertheless manubriotomy was needed in half the cases when the T1 corpectomy was the lowest level to be resected ( n = 8), and in four cases, the lowest level to be approached was T2 ( n = 5). The mean surgical time, bleeding volume, postoperative pain intensity, and length of hospital stay were less in the cervicotomy group when compared with the manubriotomy group. Conclusion Using the “surgeons' view line” and its correlation with the manubrium, the need for manubriotomy can be predicted without compromising decompression and reconstruction. The statistical differences observed in the surgical variables between the manubriotomy and cervicotomy cases justified the usefulness of the preoperative evaluation of the need for manubriotomy to perform surgical planning and give the patient and family realistic expectations about the surgery.
Anterior Cervical Interbody Fusion with Hydroxyapatite Graft: Clinical and Radiological Analysis of Graft Breakage
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , Volquind Daniel 
Published: May 2015

Introduction The most common complication related to the use of hydroxyapatite (HA) grafts for cervical anterior fusion is graft breakage. However, the implication of graft breakage in terms of loss of graft height, cervical alignment, plate migration, and clinical outcomes has not been adequately evaluated. The objective of this study is to evaluate the efficacy of HA grafts in combination with cervical plates in terms of fusion, restoration, and maintenance of cervical lordosis and to compare clinical and radiologic outcomes of patients who experienced graft breakage with patients who did not. Patients and Methods A prospective study of 40 patients who underwent anterior cervical fusion in which HA graft and plate systems were used. The chemical analysis of the implants showed 65% HA and 35% tricalcium phosphate and other ionic constituents found in bone mineral, such as carbonate, sodium, and magnesium ions. Preoperative assessments included clinical examinations, plain radiography, and magnetic resonance imaging. Postoperative assessments included clinical examinations, use of analgesics, and plain radiography. Flexion-extension radiography and computerized tomography scanning with sagittal and coronal reconstructions were also performed at the last visit. Results At the final follow-up evaluation, 80% of patients had an excellent clinical outcome, 15% had a good outcome, and 5% had a fair outcome based on Odom classification. All patients achieved lordotic alignment in the immediate postoperative period. Graft breakage was observed in 25% of cases. Patients who experienced HA block breakage have a 21 times greater chance of having an intervertebral height loss greater than 2 mm, a 4.9 times greater likelihood of undergoing loss of cervical alignment exceeding 3 degrees, and are 12.4 times more likely to present migration of the plates when compared with patients who had normal HA grafts. Conclusion Despite the positive clinical results observed in this study, breakage of HA grafts was a common complication occurring in 25% of patients. Graft breakage was associated with strut height loss of more than 2 mm, loss of cervical alignment exceeding 3 degrees, and a higher rate of plate migration. These changes related to the HA graft breakage demonstrate the necessity to continue searching for better grafting methods to perform cervical interbody fusion.
Clinical Outcomes and Considerations of the Lumbar Interbody Fusion Technique for Lumbar Disk Disease in Adolescents
Authors: Kuh Sung-Uk , Kim Kyung-Hyun , Kang Moo-Sung , Ryu Dal-Sung , Lee Won-Chul 
Published: May 2015

Introduction The posterior lumbar interbody fusion (PLIF) technique is a commonly used surgical method for wide indications such as degeneration or trauma. Although it is rarely required for lumbar disc disease in younger patients, there are a few children and adolescents who are indicated for PLIF for other reasons such as congenital severe stenosis with or without lumbar instability that requires wide decompression, or severe bony spurs that need to be removed. In such cases, different pathophysiology and outcomes are expected compared with adult patients. Patients and Methods We retrospectively reviewed data of 23 patients who underwent PLIF techniques when less than 20 years old. Clinical and radiographic outcomes were assessed during a mean 36.4-month follow-up period. The indications of PLIF, success of fusion, complications, and visual analogue scale (VAS) scores were analyzed. Results Radiographs of all patients taken 6 months after the surgery showed fusion. Clinical outcome was also satisfactory, with improvement of VAS score from 7.7 preoperatively to 2.3 at 6 months after surgery. Only one patient had reoperation because of the adjacent segment disease. Conclusions For adolescent patients with severe bony spur, massive central disc rupture, or severe spondylolisthesis, PLIF surgery has good surgical outcomes with few complications.
Surgical Treatment of Lumbar Degenerative Problems with CD HORIZON BalanC Spinal System
Authors: Enercan Meric , Gokcen Bahadir , Sanli Tunay , Popovski Neron , Kahraman Sinan , Erturer Erden , Ozturk Cagatay , Hamzaoglu Azmi 
Published: May 2015

Introduction Adjacent segment degeneration (ASD) is a common (34%) problem following posterior spinal fusions which may deteriorate functional outcomes in long-term follow-up. CD HORIZON BalanC rod has a dynamic portion made of silicone and polyetheretherketone (PEEK) aiming motion preservation, and fusion portion is entirely made of PEEK. The aim of this study is to evaluate the efficacy of CD HORIZON BalanC Spinal System in the treatment of multilevel lumbar degenerative disease and to identify fusion and ASD rates with MRI and 3D CT scan for both adjacent (AL) and dynamic (DL) levels with clinical outcomes. Patients and Methods A total of 30 patients (18 F and 12 M) mean age 47.3 years (range, 26–65 years) with 50 levels of TLIF with more than 2-year follow-up were reviewed. TLIF were single level in 12 patients, 2 levels in 16 patients and 3 levels in 2 patients. Pre-op, post-op AP/L X-rays were measured for pelvic and sagittal parameters. Disc angles, ROM, anterior disc height (ADH), and posterior disc height (PDH) were measured for AL and DL. Disc and facet degenerations for AL and DL were evaluated with MRI and 3D CT scan at the end of 2-year follow-up. Clinical evaluation was done with ODI and VAS. Results Mean follow-up was 26.3 months (range, 24–38 months). Av instrumented levels was 3.33 (range, 2–5) and av. fused levels was 1.66 (range, 1–3). TLIF were at L5–S1 in 23 patients, L4–L5 in 20 patients, L3–L4 in 6 patients, and L2–L3 in 1 patient. Pre-op LL was restored to 42.7 and 49.3 degrees. There were no significant differences in ADH, PDH, and disc angles between pre-op and follow-up for AL and DL ( p > 0.05). Pre-op AL av. ROM of 5.85 degrees changed to 6.57 degrees. Pre-op DL av. ROM of 6.72 degrees was decreased to 5.07 degrees with a limitation of 24.6% post-op. There were no significant changes in terms of disc and facet degeneration grades for both AL and DL at final follow-up ( p > 0.05). 3D CT evaluation revealed solid fusions for all TLIF levels. Mean of 43.51% ODI was improved to 18.93 and pre-op VAS score 7.2 was improved to 2.2. Conclusion In lumbar spinal fusion surgeries performed with CD HORIZON BalanC Spinal system, MRI and 3D CT scan studies at the end of 2-year follow-up did not show any significant deterioration in terms of disc and facet degeneration for AL and DL. Dynamic portion of the rod limits ROM by 24.6% at dynamic level. Dynamic portion seems to be effective in preventing ASD at the end of 2-year follow-up.