bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Strategies Surgical Complications in Scoliosis Surgery in Children with Mielomeningocele
Authors: Costa Marcelo , Weissmann Karen , Mora Samuel , Huaiquilaf Carlos , Cristian Correa 
Published: May 2015

Introduction/Aim Over the years, we have changed strategies regarding scoliosis surgery in myelomeningocele. We compare complication incidence in our previous and current cases. Materials and Methods Medical files of patients with spinal dysgraphia who underwent surgery for neuromuscular scoliosis because of the myelomeningocele were recovered and analyzed. Between 2002 and 2007 (group A), we found 32 patients but 18 with complete records and between 2010 and 2013 (group B) other 10 patients. Group A had 72% women, aged 3 to 25 (average, 11.7 years); and group B had 80% woman, 11 to 15 years of age (average, 13.5 years). We have changed our policies in the last 3 years in neuroprophylaxis, use of urinary catheter, anti-biotherapy, use of hemostatic during surgery, surgical approach, muscle flaps, skin management, use of drains, and others. Results Surgical approaches were anterior, posterior, or both in group A and posterior only in group B. Surgical time averaged 5 hours, in both the groups. Intraoperatory bleeding was 1,445 mL in group A and 1,996 mL in group B. Postoperative intensive care unit stay ranged between 1 to 30 days and 3 to 5 days in groups A and B, respectively, and mechanical ventilation was used between 24 to 72 hours in anterior approaches only. Total hospitalization time averaged 24 days (maximum 62 days) in group A and 10 days (maximum 15 days) in group B. Overall, two incidental durotomies were repaired intraoperatively in group A. Postoperatively, the most common complication was infection, one superficial and four deep ones. One patient presented hypokalemia and edematous syndrome in group A. In group B, one screw was malpositioned and required replacement, one patient had a wound dehiscence, and one deep infection that required implant removal. One patient had a severe screw pullout after a wall fell over her during the 2010 earthquake. In the long term, two patients presented screw loosening, one hardware failure, one screw pullout, and one nonunion in group A. In group B, one patient's screw inners became loose and needed replacement. Discussion We studied correlation between long- and short-term complications, surgical time and blood loss, and found less complications and shorter hospital stays in group B. We discuss the different techniques and strategies currently in use for these patients. Conclusion Scoliosis surgery in patients with spinal dysgraphia has a high incidence of complications, in our series (25%). New strategies have developed in recent years to decrease them.
Analysis of Results and Complications in Patients with Scheuermann Disease Treated with Posterior Fixation
Authors: Tavolaro Trombetta Celeste , Legarreta Carlos , Rosito Gabriel , Escalada Maria , Reviriego Juan , Lutzky Lazaro , Krekun Walter , Medina Sebastian , Cirillo Juan 
Published: May 2015

Introduction The selection of fusion levels in thoracic kyphosis been controversial, the incidence of juvenile kyphosis ranges from 1 to 8% being more common in males. Patients and Methods This study is a retrospective study case series type, level of evidence IV. We evaluated 15 patients with Scheuermann disease treated with posterior transpedicular fixation and osteotomies. Overall, two cases were excluded for not meeting the minimum monitoring time 2 years. The average age at time of surgery was 16.2 years. Patients were evaluated clinically and radiologically pre- and postsurgery to assess results and determine common factors of complications. Results In the series studied found that the percentage correction achieved was 49%, with a loss of correction 3 degrees at follow-up, the incidence of PJK was 23%, two of three patients presented the following factors in common: apex above T5, cervical hyperlordosis, SVA more than 4 cm, increased pelvic incidence, stiffness deformity, proximal fixation with hooks above T3, in the third case ended with pedicle screws. Conclusion Transpedicular fixation system and posterior spinal osteotomy is effective for the treatment of kyphosis by Scheuermann disease; the power of this type of correction techniques may arise in the pediatric population increased incidence of proximal junction kyphosis in patients with highest apex, curve stiffer, cervical hyperlordosis, and lower percentage of correction.
Cross-Sectional Study Evaluating Nonoperative and Surgical Treatment for Lumbar Degenerative Spondylolisthesis
Authors: Corredor Santos José Alfredo , Meves Robert , Silber Caffaro Maria Fernanda , Astur Nelson , Góes Medéa de Mendonça Rodrigo , Flores de Araujo Fernando 
Published: May 2015

Introduction Nonoperative treatment is the first prerogative for patients with degenerative spondylolisthesis without neurological deficit. In cases where persistent pain or neurological deficit becomes prevalent, surgery becomes an option. In this cross-sectional study, we evaluated clinical and functional results of patients with lumbar degenerative spondylolisthesis treated nonoperatively or surgically. Patients and Methods Patients with degenerative spondylolisthesis treated either nonoperatively or surgically from 2004 to 2014 were selected from databases and a cross-sectional evaluation was applied. Outcome measures included back and leg visual analog scales (VAS), Fischgrund criteria, short form-36 (SF-36) physical function, and the modified oswestry disability index (ODI). Results Of the 85 patients who met the inclusion criteria, we evaluated 43 in total: 20 with nonoperative treatment and 23 with surgical treatment. Baseline characteristics were similar without significant differences. The mean follow-up time was 43 months (range, 10–72 months) for nonsurgically and 36 months (range, 6–80 months) for surgically treated groups. The surgical group displayed better scores in back VAS (8 vs. 4), leg VAS (6 vs. 3), SF-36 physical function (35 vs. 77), and ODI (46 vs. 17). On the basis of the Fischgrund criteria, only 10% of patients reported excellent or good health post nonoperative treatment versus 83% for those treated surgically. Conclusion Symptomatic patients with lumbar degenerative spondylolisthesis treated surgically obtained better clinical and functional scores than patients treated nonoperatively. The limitations of the study do not permit statistical analysis and hence further review is necessary to draw firm conclusions.
Cauda Equina Syndrome in Patients with Lumbar Disc Herniation: Postoperative Results of a Series of 10 Cases
Authors: Urzúa Alejandro , Lecaros Javier , Zamorano Juan Jose , Mandiola Sergio , Munjin Aleksandar , Medina Fabián , Ilabaca Francisco 
Published: May 2015

Introduction The Cauda Equina Syndrome (CES) is a rare clinical entity with potentially devastating consequences. Usually, patients complain concealed history of back pain and acute presentation of red flags, as severe back pain, sensory alteration in saddle or genital tract, and bladder, bowel, or sexual dysfunction. Early surgical decompression is mandatory to reduce neurological sequels. The objective of this study is to describe the clinical picture and postoperative results of patients with CES. Materials and Methods Data of 10 patients diagnosed with CES because of lumbar disc herniation (LDH) between 1994 and 2013 were collected. All of them were studied with magnetic resonance imaging or computed tomography and subsequently submitted to emergency decompressive surgery with a postoperative follow-up from 5 months to 3 years. Results The patients had an average age of 38 years (range: 19–58 years), on a male/female ratio of 8/2. Overall, 70% reported no medical history, while the remaining 30% were diabetic. Nine patients had presented a massive primary LDH and one patient was secondary to a posttraumatic LDH. All the patients had neurologic compromise ASIA D at hospital admission, but in the postoperative, 50% improved to ASIA E. The main sequel was sphincter dysfunction, present in the 50% of the patients. Conclusion Unlike what was previously reported, the majority of the patients presented immediate improvement in relation to radicular pain and motor recovery. The literature describes neurologic sequels in those patients with chronic low back pain and/or late consultation. Although our series is small, it gives us valuable information about this pathology.
Evolution of Neurological Complications in Spine Deformities Surgery in Children
Authors: Godoy Miguel Angel , Tello Carlos A. , Francheri Ida Alejandra , Noel Mariano A. , Galaretto Eduardo , Remondino Rodrigo G. , Bersusky Ernesto 
Published: May 2015

Study Design This study is a retrospective descriptive study, and Evidence Level IV. Objective This study aims to assess the evolution of neurological complications because of kyphosis or scoliosis surgery in children. Introduction Neurological complications after deformities surgery although not very frequent could be evolved in terrific outcomes. These can come after simple approach, instrumentation, and because of correction techniques through direct or indirect mechanism. Modern surgeries techniques count with neurophysiology monitoring. Nonetheless, radicular and spinal cord injury may arise. Patients and Methods Nine patients who suffered neurological complication during kyphosis and/or scoliosis deformity surgery from May 2003 to June 2013 at the Garrahan Pediatric Hospital Spine Department. Results Etiologies observed were as follows: four idiopathic scoliosis (44.4%), two congenital scoliosis (22.2%), one associated with neurofibromatosis type I (11%), one idiopathic kyphosis (11%), and one myofibrosarcomatosis post laminectomy surgery (11%). The mean follow-up was 4.3 years (range, 0.6–10.5 years). We performed posterior only instrumented fusion in seven cases (77.7%) and two double approach instrumented fusions (22.3%). Five patients presented intraoperative neurological changes (55.5%). All the patients needed at least a second surgical intervention to solve the spine deformity. The topographic classification of the neurological injury was as follows: one patient with radicular injury (11.1%); eight patients with spinal cord injury (88.8%), six of those presented bilateral paresis (75%) and two patients (25%) presented monoparesis. The patient with radicular injury remained asymptomatic after the second-staged surgery; three patients remained with minimum secuelas (ASIA D) and three patients, with major disability secuelas (ASIA C), all patients preserved aptitude to stroll. Four patients (44.4%) who presented disorders in the sphincters control during the immediate postoperatory, only two patients stayed with neurogenic bladder. Conclusion Early detection of a neurological complication, its etiological diagnosis, and surgical resolution improve neurological outcome of the patient, avoiding or reducing its severity sequel.
Immature Skeleton Thoracolumbar Fractures
Authors: Cabrera Jorge , Sanchez Felix 
Published: May 2015

Introduction Lesions in children have increased in the general population; yet, thoracolumbar fractures in childhood are uncommon. Very few studies in immature skeleton patient's thoracolumbar fractures have been made. Patients and Methods A nonexperimental, transversal, and retrospective research was performed, having patients aged between 0 and 18 years' old, who had presented thoracolumbar fracture and needed medical–chirurgical treatment, throughout a period of time between 2006 and 2013 in two traumatology hospitals, being both third level attention hospitals. Evidence level III. Results A total of 100 patients who met the inclusion criteria were used for this study. The most affected age group was the young–adolescent group, prevailing male patients in a 2:1 relation. The most affected zone was the thoracolumbar union, and 89 were treated with surgery, 41 patients presented associated lessons. Conclusion The main cause was falls, it was found a poorly described cause (PPAF), which affected the 7% of the series. There is no predominant lesion type as there is in adults. Ligament injuries do heal up in children aged 11 years or less. A 36% of the cases presented multiple fractures. Overall, 22.47% of operated patients were treated with fixation without arthrodesis and a single posterior boarding as surgical management in 92%. Neurological recovery percentage was 8%.
With the Foot to the Neck
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Salgado Castillo Santiago 
Published: May 2015

Introduction The surgical resolution of a cervical spine fracture dislocation is well known; however, there are certain difficulties when the right instrumentation is not available at the right time. We present an alternative solution for a cervical injury with complete medullary involvement. Patient and Methods: A patient, 45 years old, suffered a fall from a height (tree), arriving at the emergency service with tetraplegia. Imaging study reveals a C6–C7 fracture dislocation. Orthopedic reduction was performed and stabilization occurs in the first 6 hours postaccident. It is reduced manually and stabilized with a compact foot H-plate 2.7. Results The surgical and neurological evolution of the patient was favorable. Currently, the patient is autonomous, has sphincter control, and walks with a cane. Conclusion The management of upper cervical spine fractures presents an interesting challenge given the complexity and possible complications derived from these injuries. Their management is not usually difficult if the proper equipment is available. We present a possible solution when the correct spinal instrumentation is not available that can help solve such injuries with favorable results.
Anterior Percutaneous Fixation of Odontoid Fractures
Authors: De Jongh Enrique , Rubinos Rene , Fleites Ernesto , Santos Carlos , Rodriguez Norberys , Betancourt Josue 
Published: May 2015

Introduction In some fractures of the odontoid process of the axis, the gold standard is anterior transaxial fixation if there is slight or none displacement. To minimize the damage of an opened surgery, we developed anterior percutaneous approaches. Patients and Methods From 1995 to 2014, 10 patients with traumatic fractures of the odontoid process of axis classified as type II and type III (according Anderson and Alonzo classification) underwent surgery. The anterior approaches fixation were performed using 1 cm incision. Cannulated instruments and screws were necessary to fix the odontoid process. In all patients, surgery was image guided. Results In eight patients (80%) the only one symptom when admitted was cervical pain without neurological deficit. Two patients (20%) also presented also quadriplegia. The unique complication concerning surgery was retropharyngeal pain in all patients during 2 or 3 days. In later evaluations, consolidation of the fracture was confirmed in all patients (100%). One patient admitted with quadriplegia improved. The other one never improved spontaneous ventilation and died 8 months later (10%). Conclusions The knowledge and development of some percutaneous techniques can be employed in patients with fractures of the dens of the axis. The use of cannulated screws and instruments is mandatory to perform the operation. This kind of surgery must be always under imaging guidance.
Facet Joint Capsular Laxity in Degenerative Lumbar Spondylolisthesis Associated with the Increased Expression of Fractalkine (CX3CL1)/CX3CR1 Chemokine
Authors: Ha Kee-Yong , Oh In-Soo 
Published: May 2015

Introduction CX3CL1 and its receptor (CX3CR1) are part of a chemokine system involved in leukocyte recruitment and adhesion in chronic inflammatory disease. From previous study, the CX3CL1 and CX3CR1 activity has been investigated in ligamentum flavum, synovial membrane, and intervertebral discs, but not with the facet joint capsule-related issue. The purpose of this study is to investigate the following: (1) The role of fractalkine (CX3CL1)/CX3CR1 chemokine on facet joint capsular laxity in degenerative lumbar spondylolisthesis (DLS); (2) Correlation between expression of CX3CL1/CX3CR1 chemokine and degree of slippage by lumbar spondylolisthesis. Method The mRNA concentrations of CX3CL1/CX3CR1 chemokine were analyzed in the surgically obtained facet joint capsule specimens from grade 1 spondylolisthesis ( n = 12), grade 2 spondylolisthesis ( n = 12), and more than grade 3 spondylolisthesis ( n = 11) by real-time PCR. Grade 1 to 3 is being decided on degree of slippage which is, less than 5 mm, between 5 to 10 mm, and more than 10 mm. The localization of CX3CL1/CX3CR1 chemokine within the facet joint capsule was determined using immunohistochemical study. Plasma level of soluble fractalkine (sFKN) was measured by enzyme-linked immunosorbent assay (ELISA), respectively. Result The cells that shows higher CX3CL1/CX3CR1 chemokine expression ratio in the facet joint capsule are observed in tissues acquired from patients with higher degree of slippage by lumbar spondylolisthesis ( p = 0.000, 0.000). In ELISA, the plasma levels of sFKN was significantly higher in the group with more severe degree of slippage ( p = 0.002). There was greater CX3CL1/CX3CR1 expression in higher grade spondylolisthesis as quantified by RT–PCR ( p = 0.000, 0.003). Degree of slippage in patients with DLS were significantly correlated with serum CX3CL1 level ( R2 = 0.451, p = 0.000) and with mRNA expression of CX3CL1/CX3CR1 ( R2 = 0.360, p = 0.000) ( R2 = 0.205, p = 0.006). Conclusion This study identified for the first time that increases in CX3CL1 and CX3CR1 expressing cells are significantly related to facet joint capsular laxity, which may provide new conceptual and therapeutic approaches for treating spinal spondylolisthesis.
Biomechanical Stability of Transverse Connectors in the Setting of a Thoracic Pedicle Subtraction Osteotomy
Authors: Kang Daniel , Lehman Ronald , Wagner Scott 
Published: May 2015

Introduction The biomechanical effect of augmentation of a longitudinal constructs with one or two transverse connectors (TC) after a thoracic pedicle subtraction osteotomy (PSO) has not been evaluated previously. Previous investigations have suggested the role of transverse connectors for long segment thoracic constructs in enhancing torsional rigidity. We set out to evaluate the biomechanical contribution of TC to the stability of a long-segment pedicle screw–rod construct after a thoracic PSO. Methods Seven human cadaveric thoracic spines were prepared and instrumented from T4 to T10 with bilateral pedicle screws/rods and a PSO was performed at T7. Intact range of motion (ROM) testing was performed with nondestructive loading and analyzed by loading modality (axial rotation, flexion/extension, and lateral bending). ROM analysis was performed in the unaugmented construct, the construct augmented with one TC, and the construct augmented with two TC. No outside funding sources were utilized for this study. The authors have no potential conflicts of interest to report. Results Following PSO and an unaugmented longitudinal pedicle screw–rod construct, T4–T10 (overall construct) and T6–T8 (PSO site). ROM was significantly reduced in all planes of motion compared with intact condition ( p < 0.05). Augmentation of longitudinal construct with either one or two TC did not significantly increase construct stability in flexion-extension or lateral bending compared with the unaugmented construct ( p > 0.05). In contrast, during axial rotation, global ROM was significantly reduced by 43% and by 48% at T6–T8 following addition of two TC ( p < 0.05). One TC did not significantly reduce torsional ROM. Conclusions Two transverse connectors significantly improved torsional rigidity of the entire construct and at the PSO site, with no differences in stability for flexion-extension and lateral bending, or with the addition of only one transverse connector. In the setting of a PSO and long segment pedicle screw–rod construct, augmentation with at least two transverse connectors should be considered to improve torsional rigidity.
Comparison of Dynamic Stability of Lumbosacral Fixation using L5/S1 Pedicle Screws between with and without a Transverse Connector: A Finite Element Analysis Study
Authors: Kumano Yoh 
Published: May 2015

Introduction Fixation failure and pseudoarthrosis at the lumbosacral junction continue to be a big problem for spine surgeons. The poor bone quality of the sacrum, relative displacement between a screw and a screw head of a polyaxial screw and between a screw head and a rod and the substantial biomechanical forces at the lumbosacral junction are major risk factors for the high rates of instrumentation failure. It has already been believed that a transverse connector is necessary to achieve lumbosacral fusion. The purpose of our study is to investigate the dynamic stability of lumbosacral fixation using L5/S1 pedicle screws and a transverse connector with CT/finite element analysis quantitatively. Material and Methods CT Dicom data including L4, L5, and pelvis was obtained from the patient who had kyphoscoliotic spine and prepared for the correction surgery. The data were changed to the biomechanical model for analysis. On the computer, four pedicle screws (6 × 40 mm) were applied to L5 and S1 (PS) of the model. In addition to PS, a transverse connector was applied to bilateral rods (PS–TR). The flexion, extension, bending, and rotation force was loaded on L4 and the displacement of L5 was calculated with finite element analysis. The larger displacement was defined as the lower stability. The software of finite element analysis was MechincalFinder7.0EE. Results As to flexion, the displacement of L5 was reduced to 82% (PS–TR) compared with PS. As to extension, the displacement of L5 was reduced to 85% (PS–TR) compared with PS. As to right bending, the displacement of L5 was reduced to 77% (PS–TR) compared with PS. As to right rotation, the displacement of L5 was reduced to 13% (PS–TR) compared with PS. Conclusion As to flexion, extension, bending, and rotation, PS–TR tended to have higher stability than PS. As to rotation, the displacement of L5 (PS) is remarkably larger than that of PS–TR and it indicates that as to L5/S1 pedicle screw fixation, a transverse connector plays a significant role for lumbosacral stability and L5/S1 pedicle screw fixation without a transverse connector may be one reason for the higher rate of pseudoarthrosis.