bluuebunny/crossref_metadata_2025_split huggingface dataset:
Crankshaft Phenomenon in Patients Operated for Adolescent Idiopathic Scoliosis
Authors: Hrustic Asmir , Vujadinovic Aleksandar , Isakovic Eldar , Delic Jasmin 
Published: May 2015

Introduction Crankshaft phenomenon is determined as a loss of three-dimensional correction of the scoliosis curve, which occurs after posterior fusion in children who have not completely finished skeletal growth. Dubousset named this phenomenon when he noticed that the entire spine and torso gradually turn and deform anterior spine, which continues to grow and rake around the axis of the fusion mass. This is mostly seen in infantile and juvenile idiopathic scoliosis, however this also occur in adolescents who are immature at the time of the last fusion. Aim To analyze this phenomenon in adolescents who have not finished skeletal growth and were operated for idiopathic scoliosis. Material and Methods This retrospective–prospective study analyzed 48 randomly selected adolescents operated for idiopathic scoliosis in Clinic for Orthopaedic and Traumatology in Tuzla between 1996 and 2011. Patients operated only with a posterior stabilization and fusion were divided into two groups. One group consisted of adolescents with intensive growth (12 years for girls and 14 years for boys) and another group consisted of adolescents at final stage of skeletal growth (14 years for girls and 16 years for boys). We measured Cobb angle at standard X-rays performed in an upright posture immediately after the surgery and at the latest X-rays done at the end of skeletal growth at the age of 18 years. Results Increasing Cobb angle was noted in 53% of studied patients. In group A higher values of Cobb angle noted in 69.56% examinees and in 36% in group B. When we analyzed both groups Cobb angle increased from preoperative 19.6 degrees to postoperative 22 degrees (2.4 degrees—12.2%) ( r = 0.98), In group A preoperative Cobb angle increased from preoperative 20.6% degrees to postoperative 24 degrees (3.4 degrees—16.22%) ( r = 0.97), while in group B from 18.60 to 20 degrees (1.4 degrees—7.52%) ( r = 0.98). Conclusion Postoperative deformity progression of anterior column in adolescents operated for idiopathic scoliosis could be seen even if the stable fusion achieved. The risk for progression is higher in younger patients.
Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multicenter Matched and Unmatched Cohort Assessment with Minimum 2-Year Follow-Up
Authors: Smith Justin , Lafage Virginie , Shaffrey Christopher , Schwab Frank , Hostin Richard , Boachie-Adjei Oheneba , Akbarnia Behrooz , Klineberg Eric , Gupta Munish , Deviren Vedat , Hart Robert , Burton Douglas , Bess Shay , Ames Christopher 
Published: May 2015

Introduction Adults with spinal deformity typically present with pain and disability. Aim Our objective was to compare outcomes for operative (op) and nonoperative (nonop) treatment for ASD based on a prospective, multicenter patient population. Material and Methods This is a multicenter, prospective analysis of consecutive ASD patients electing for op or nonop care at enrollment. Inclusion criteria: age > 18 year and ASD. Propensity scores were used to match op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI-LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met with the criteria, including 286 op and 403 nonop, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS ( p < 0.001) and had worse deformity based on pelvic tilt, PI-LL, and C7SVA ( p ≤ 0.002). Before reaching minimum 2-year follow-up 38 nonop patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up all HRQL measures assessed significantly improved for op patients ( p < 0.001), but none of these measures improved significantly for nonop patients ( p ≥ 0.11). Total 97 matched op–nonop pairs were identified based on propensity scores. At last follow-up the 97 matched op patients had significant improvement in all HRQL measures assessed ( p < 0.001), but the 97 matched nonop patients lacked significant improvement in any of the HRQL measures ( p ≥ 0.20). Paired op–nonop analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed ( p < 0.001), except SF36 MCS ( p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, nonop treatment appears to at best maintain presenting levels of pain and disability.
Modified Posterior Vertebral Column Resection for the Treatment of Osteoporotic Fractures with Neurological Deficits in Elderly Patients
Authors: Enercan Meric , Erturer Erden , Kilic Mesut , Kahraman Sinan , Sanli Tunay , Ozturk Cagatay , Alanay Ahmet , Hamzaoglu Azmi 
Published: May 2015

Introduction The purpose of this retrospective study was to evaluate the results of spinal canal decompression and anterior column support via modified posterior vertebral column resection (PVCR) (Unilateral hemilaminectomy, pediculectomy, subtotal vertebrectomy) performed for eliminating the disadvantages of the anterior or combined A + P approaches, in the management of osteoporotic vertebral fractures with neurological deficits in elderly patients. Patients and Methods A total of 55 patients (40 females and 15 males) with more than 2 years of follow-up were included in this study. The fractures were in the thoracic spine in 16 patients, and thoracolumbar spine in 39 patients. Overall, 11 patients had ASIA grade C and 41 patients had ASIA grade D neurological deficits. Clinical and radiological outcome and complications were also evaluated. Surgical technique included placement of fenestrated titanium pedicle screws, followed by hemilaminectomy, unilateral pediculectomy, and decompression of the spinal canal by subtotal vertebrectomy, and support of anterior column by titanium cage. Contralateral facet joint fusion and grafting was made. Prophylactic vertebroplasties were made in one level above and one level below in all patients. Results Mean age was 74.2 years (range, 66–92), and mean follow-up was 43.5 months (range, 28–102). Mean operation time was 252 minutes (range, 160–340), and blood loss was 580 mL (range, 420–800). Mean preoperative local kyphosis angle was 18.5 degrees and improved to 4.2 degree after the operation and 4.8 degree at the final follow-up. Visual analog scale (VAS) score was eight before the operation and improved to two at final follow-up. Full neurological recovery was achieved in all patients. There were no pseudoarthroses. The major complication was adjacent segment fracture was made three patients (5.4%). The minor complications were superficial wound infections in five patients and dural tear in four patients (16.3%). Conclusion Treatment of osteoporotic vertebral fracture with neurological deficit is a challenging procedure in elderly patients. Modified PVCR provides effective decompression of neural structures. Contralateral intact lamina, pedicle, and cortex of the vertebra increase primary stability and provides more bony surface for fusion.
Prehab as an Alternative to Elective Spine Surgery
Authors: Urbonas Ryan , Hanscom David 
Published: May 2015

Introduction Hypothesis—A structured screening protocol including assessment of psychological well-being with subsequent self-directed physician supervised noninterventional treatment protocol can successfully avoid elective lumbar spine surgery while optimizing patient well-being. Background—Certain patients with chronic LBP without focal neurological deficits or significant instability or deformity may benefit from optimization of their psychological well-being before contemplating elective low-back surgery. In certain cases these interventions may actually ameliorate the patient symptoms to a degree that the originally planned surgery is no longer pursued while the patients experience a substantial improvement of their quality of life. Material and Methods From January 2012 onwards a routine protocol at the Swedish Neurosciences Institute required new patients presenting to our spine clinics to complete routine psychological testing for anxiety, depression, and irritability. All patients with abnormal scores in any of the categories were placed into a structured “prehab” program with a self-directed mental and physical health program. Only patients who had presented with degenerative lumbar disorders, such as central or foraminal spinal stenosis and mild degenerative spondylolisthesis that corresponded with their symptoms were considered candidates for surgery. Results During a required minimum 1-year follow-up of 25 patients selected for a formal “Prehab program” due to their abnormal psychological profiles we identified no cases of neurological decline, no conversions to surgery, and confirmed statistically significant improvement in patient-related outcomes scores (ODI, VAS, opiate index, and psychological wellness scores). Interestingly none of these patients required interventional spine management during our observation period while also increasing their functional activity profiles based on reported activity tolerances. Conclusion We identified two potential conclusions based on our early results: (1) Inclusion of psychological wellness testing including screening for anxiety, depression, and irritability may be a valuable adjuvant to routine other screening tests for elective lumbar spine surgery. (2) Emphasis on correction of abnormal psychological profiles in a formalized “Prehab program” may positively influence patients' subjective well-being to the point where surgical care may be delayed or not required anymore. Further investigation of a “mind body syndrome” in its spinal symptom manifestations may be warranted to optimize patient selection and treatment outcomes.
Transforaminal Epidural Injection for Cervical Disc Herniation: Clinical Outcomes
Authors: Vialle Emiliano , Guasque Joana , Vialle Luiz Roberto 
Published: May 2015

Introduction To investigate the effect and complications after transforaminal injection for cervical disc herniation. Material and Methods We retrospectively reviewed all the patients submitted to a fluoroscopic-guided transforaminal injection for radiculopathy caused by cervical disc herniation. During the past 7 years, 57 patients (39 females, 18 males, mean age 45.6 years) experiencing cervical radiculopathy underwent fluoroscopically guided nerve root infiltrations by posterolateral approach. The position of the needle was verified after injection of a small amount of contrast. Lidocaine 1% (0.5 mL) and a glucocorticosteroid (0.5 mL) were injected. Results The most treated root was C6 (31 procedures), 14 patients had injections at C7, 7 at C5, and 5 at C4. Eight patients (14%) had complications (three syncopes, three transient hoarseness, one worsening of symptoms, and one hematoma). 42.1% became asymptomatic after the procedure, therefore not requiring surgery. Around 57% needed surgery but it took at least 2 months to become symptomatic again. Conclusion Radicular block for cervical disc herniation is a safe way to avoid surgery. Some patients still need surgery but since they got better with the procedure, they can schedule it at a convenient date.
DISC (Degenerate-Disc Infection Study with Contaminant Control) Discussion on Methods, Interim Analysis, and the Pitfalls of not Sending Contaminant Control
Authors: Rao Prashanth J. , Reddy Rajesh , Fairhall Jacob , Coughlan Marc , Mews Peter , Scholsem Martin , Kohan Saeed , Davies Mark , Day Jerry , Phan Kevin , Thayaparan Ganesh , Scherman Daniel , Taylor Peter , Chau Christine , Salisbury Elizabeth , Lambie Neil , Mobbs Ralph J. 
Published: May 2015

Introduction Studies that implicate disc infection in the majority of patients with axial back/neck pain or leg/arm pain is potentially scandalous and irresponsible. The majority of these studies are underpowered and lack a contaminant arm, the current study is aimed to fulfil these basic criteria. Material and Methods A prospective case–control multicentric study (HREC 13/218) including cases discectomy for degenerative disc pathology and controls are patients undergoing discectomy for nondegenerate pathology. True disc positivity was inferred if the culture of disc was positive and the paraspinal tissue sample was negative. A total of 400 patients have been enrolled. In degenerative disc cases, 8.7% were true positive (disc +ve/paraspinal −ve) with paraspinal-positive samples in 38.4% on its own. In control cases there was 40% positive for disc culture together with paraspinal tissue. The organisms in disc or paraspinal culture were very similar with 85% having same organisms. On generalized linear model analysis of disc-culture positivity using binomial sets there were no statistical significant findings when comparing disc positivity to demography, type of surgery, modic changes or level of surgery. Conclusions (1) The true rate of disc culture positivity in the degenerative disc population is significantly lower than previous literature reports. (2) At the interim analysis stage, the DISC study heavily favors performing disc cultures strictly with a contaminant control.
Complications of the Anterior Approach to the Lumbar Spine
Authors: Griffiths-Jones William , Stokes Oliver , Chan Daniel , Budd H. 
Published: May 2015

Introduction Lumbar spine pathology, such as tumors and fractures, commonly affect vertebral bodies, making anterior access to the spine an important tool in the armamentarium of spinal surgeons. Furthermore, accessing the front of the spine via a posterior approach is associated with the potential for neural injury. Reports in the literature of high rates of complications, particularly vascular injury, has led to questions about the safety of the anterior lumbar approach. As a result, various recommendations have been made such as the used of “access” surgeons and ring retractor systems to reduce the complication rate. We present the complication rates from over 550 anterior approaches performed in Exeter, United Kingdom, by multiple surgeons over an 18-year period, without the use of an access surgeon or ring retractor system. Materials and Methods We retrospectively reviewed the notes of 567 consecutive patients having undergone an anterior approach to the lumbar spine for any procedure from 1996 to 2014. Information was collected from operation notes, anesthetic records, postoperative ward rounds, and clinic letters. Details were recorded on intraoperative blood loss and complications such as vascular injury and peritoneal opening as well as postoperative complications such as infection, DVT/PE, ileus, and hernias. Results There was an overall complication rate of 13.4%. The rate of vascular injury requiring suture repair was 3.2% and the rate requiring input from a vascular surgeon 0.8%. Conclusion We report a comprehensive and critical review of our practice over 18-years with a large series of consecutive patients undergoing anterior lumbar surgery for a wide range of pathology. This has been performed in a single center by multiple orthopedic spinal surgeons without the use of access surgeons or dedicated ring retractor systems. Our complication rates have been shown to be comparable to the existing literature demonstrating that in high volume centers the anterior approach to the lumbar spine is safe and effective for a multitude of applications.
Midterm Follow-Up of Cervical Disc Arthroplasty in Patients with Cervical Myelopathy
Authors: Berg Andrew , Tankel Jamie , Ansari Eanna , Killen Maire-Clare , Hernandez Miguel , Khan Shoaib , Bhatia Chandra , Friesem Tai 
Published: May 2015

Introduction Cervical myelopathy secondary to cord compression may require surgical decompression with the aim of surgery being to arrest the progression of myelopathy and associated symptoms. Theoretical concerns have been raised regarding the use of cervical disc arthroplasty (CDA) in patients with myelopathy due to the fear that continued motion may cause continuing microtrauma to the cord. As such there is a paucity of reported data. We report the clinical results of anterior cervical decompression and CDA in patients with cervical myelopathy at our institution. Patients and Methods Patients who had undergone one- or two-level anterior cervical decompression and CDA for myelopathy were identified from the authors' institution's database. Prospectively collected data including neck disability index (NDI), visual analogue scale (VAS) for neck and arm pain, patient reported activity level, and hospital anxiety and depression scale were reviewed. Statistical analysis was performed for significance. Results Demographics: 40 patients. Mean age at surgery 51.3 years (range, 35–75). Operated levels, 63: 17 one- and 23 two-level procedures. Seven patients had cord compression at both levels; 21 had myelomalacia at one level and 3 at two levels. The average duration of preoperative symptoms was 37.5 months. Mean follow-up was 3.2 years (range, 1–7.4 years). Surgery: Surgery was performed using four different implants; 28 PRESTIGE LP Cervical Disc System (Medtronic, Minnesota, United States), 24 NUNEC Cervical Arthroplasty System (RTI Surgical, Inc., Florida, United States), 10 Discocerv (Scient́x-Alphatec Spine, France), and one DISCOVER Cervical Arthroplasty Disc Replacement System (DePuy Spine, Inc., Massachusetts, United States). Overall, 34 procedures were performed at C5/6, 21 at C6/7, 7 at C4/5, and 1 at C3/4. Outcomes: Mean NDI improved from 47.7 to 33.96 ( p  < 0.01), VAS arm 6.4 to 3.8 ( p  < 0.01), VAS neck 6.5 to 3.3 ( p  < 0.01), depression 8.9 to 7.1 ( p = 0.01), and anxiety 9.4 to 7.8 ( p = 0.06). A total of 26 patients (65%) reported same or better activity level, 27 (68%) would be satisfied with their current condition for life. A total of 29 (73%) said they would have the treatment again. Conclusion We report the clinical results of anterior cervical decompression and CDA in 40 patients with cervical myelopathy, with follow-up up to 7.4 years. Statistically significant improvements were seen in NDI and VAS scores. The level of improvement or maintenance of activity level is likely a reflection of a general patient reported activity measure being used rather than a specific myelopathy scale. We believe our results support further investigation of CDA in myelopathy.
Comparison of Adjacent Segment Motion after Anterior Cervical Fusion Using Standalone Cage versus Total Disc Replacement Using Activ C
Authors: Kim Se-Hoon , Kim Bum-Joon , Choi Jong-Il , Ha Sung-Kon , Kim Sang-Dae , Lim Dong-Jun 
Published: May 2015

Introduction Anterior cervical discectomy and fusion (ACDF) has been a widely accepted procedure for treatment of cervical disc diseases. However, several reports about postfusion exacerbation of adjacent segments gave rise to development of motion preserving prosthesis. We present the retrospective analysis comparing total disc replacement (TDR) using Activ C (Aesculap, Germany) with ACDF using standalone cage. Materials and Methods From January 2010 to December 2012, among patients diagnosed of cervical disc diseases, patients who received either ACDF or TDR at single level were reviewed. Clinical outcome was assessed using visual analogue scale (VAS) of arm pain and neck pain. For all patients, lateral flexion and extension radiographs were taken at preoperative and 1 year after operation. The segmental range of motion (ROM) of operated level, rostral adjacent level, and caudal adjacent level were measured from plain dynamic radiographs using Cobb angle. Multilevel ACDF and hybrid method were not included in this series. Results A total of 40 patients (mean age 46.3 years) were reviewed. Fifteen patients were treated with TDR and the remaining 25 patients received ACDF. At the time of 1-year follow-up, the segmental ROM of operated level was significantly preserved in TDR group ( p = 0.017), whereas the motions of rostral and caudal adjacent levels were greater in ACDF group than TDR group (7.1 versus 6.6 degrees and 6.6 versus 5.1 degrees, respectively). However, the ROM of adjacent segments did not show statistical significance. Conclusions In the present study, we found that TDR using Activ C showed favorable motion preservation at the operated level. Radiologically, the ACDF group showed more increase of adjacent segment motion 1 year after surgery, which implies that TDR using Activ C may have advantages in preventing adjacent segmental diseases compared with ACDF.
Long-Term Results of Discover Single Level Total Cervical Disc Replacement: A Single Center Study of 100 Patients with a Minimum 4-Year Follow-Up
Authors: Rozankovic Marjan , Marasanov Sergej , Lupret Velimir , Vukic Miroslav 
Published: May 2015

Introduction Anterior cervical discectomy and fusion is still the “gold standard” for surgical treatment of patients with single-level cervical disc disease but in the past decade it has been challenged by total cervical disc replacement which offers several advantages over it. Materials and Methods A total of 100 patients with a single level cervical disc disease who fulfilled the inclusion and exclusion criteria were treated with total cervical disc replacement using Discover artificial cervical disc (DePuy Spine Inc., Raynham, Massachusetts) between May 2008 and September 2010. All patients were evaluated with pre- and postoperative serial radiographic studies (MRI, standard and functional cervical spine X-rays), and clinically. For clinical evaluation we used neck disability index (NDI), visual analog scale (VAS) for neck and arm pain and neurological status at 3, 6, 12, 24, and 48 months. Results The results of our study show that total cervical disc replacement using Discover provides excellent radiological and clinical outcomes in long-term follow-up during minimally 48 months. Patients showed significant improvement in clinical parameters, NDI and VAS (arm and neck) at follow-up visits. None of the patients developed adjacent disc disease. During the follow-up period in 15 of our patients heterotopic ossification occurred with complete loss of range of motion at the treated level (15%). Also we had one patient with the prosthesis migration at the 2-year follow-up visit who was reoperated. There were no other major surgery-related complications. Conclusion Discover total cervical disc replacement is according to our study safe and efficient method for surgical treatment of a single level cervical disc disease in selected patients with excellent outcome at long-term follow-up.