bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dorsal and Lumbar Posterior Fixation by Minimally Invasive and Traditional Open Techniques: Comparison of Safety and Efficacy
Authors: Carla Reizinho , Casimiro Miguel , Luis Ana , José Cabral 
Published: May 2015

Introduction The use of minimally invasive techniques for spinal stabilization (MISS) is now widespread because of the theoretical advantage of lesser surgical aggression. However, there is no definitive evidence of its real advantage comparing to traditional open surgery (TOS). In this study, the authors compare both techniques according to safety and efficacy for the treatment of spinal instability. Patients and Methods This is a retrospective cohort study analyzing the records of the patients submitted to posterior dorsal or lumbar stabilization by MISS or TOS as treatment of instability because of trauma, infection, or tumor in a single center in the last 5 years (2009–2013). We compared both techniques according to efficacy (postoperative pain and deformity correction) and safety (accuracy of screw insertion, surgical and length of surgical time and hospital stay, complication occurrence Đ mortality, infection, neurological deterioration, instrumentation failure). Statistical analysis was performed with SPSS(R)17.0 surgeon preference dictated the technique chosen for each case. Results A total of 69 patients were treated, with a median follow-up of 21.6 ± 15 months. The populations (MISS/TOS) were not significantly different in the following: age, general medical status (ASA score), instability score (TLICS and SINS), osteoporosis incidence, lesion location, type of pathology, previous neurological state, or nonfusion risk factors. There was no statistical difference in postoperative pain ( p = 0.715) and immediate and late deformity correction ( p = 0.577 and p = 0.689). Screw insertion accuracy was significantly less in TOC ( p = 0.001) leading to more cases of revision surgery. Surgical time was not significantly different ( p = 0.08). Hospital stay was significantly shorter in MISS. Complication incidence was rare, but postoperative infection and neurological worsening was more frequent in TOS. Conclusion MISS is as effective as TOS and significantly safer than the later in what concerns to screw insertion accuracy and need for revision surgery. It does not take more OR time; and the length of stay at the hospital is shorter.
Utility of the Ultrasound in the Diagnose of Posterior Ligamentous Complex Injury of Thoracic and Lumbar Spine Fractures
Authors: Ilabaca Francisco , Lecaros Javier , Urzúa Alejandro , Ballesteros Vicente , Azócar Patricio , Arancibia Germán , Azolas Cristián , Lukoviek Andrés , Bustos Rubén , Góngora Carlos , Arriagada Víctor 
Published: May 2015

Introduction In posterior ligamentous complex injury (PLC), surgery is indicated in the treatment algorithms of thoracic and lumbar fractures. That is why its research is of a great importance, taking into consideration the magnetic resonance imaging (MRI), as historical “gold standard.” As the MRI is not always available or at times it is contraindicated, the use of ultrasound is proposed. Our purpose is to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasound to diagnose PLC injuries in thoracic and lumbar fractures. Patients and Methods A protocol is designed before the start of the study, being approved by the Ethics Committee, deciding to perform an ultrasound to all of the patients with PLC admitted with fractured thoracic and lumbar spine, between April 2013 and July 2014. Patients with neurological and life-threatening risks were excluded. The ultrasound and MRI reports were performed by different radiologists without knowledge of the results of other studies. The result of the MRI is considered “gold standard,” and in case of operated patients, there were intraoperative findings. Data were analyzed with STATA 12. Results A total amount of 56 patients were recruited, with 7 cases of PLC injuries according to our “gold standard.” The ultrasound as diagnostic tool obtained the following results: sensitivity 0.9999 (95% CI, 0.59–1), specificity 0.9608 (95% CI, 0.8603–0.9966), PPV 0.7778 (95% CI, 0.4427–0.9465), and NPV 0.9999 (95% CI, 0.9131–1). Conclusion The ultrasound would be useful to diagnose the PLC injuries in thoracic and lumbar fractures.
Effects of Fusion and Conservative Treatment on Disc Degeneration and Rates of Subsequent Surgery after Thoracolumbar Fracture
Authors: D'Oro Anthony , Buser Zorica , Cohen Jeremiah , Smith Lance , Spoonamore Mark , Wang Jeffrey 
Published: May 2015

Introduction Studies have shown that lumbar fusion may lead to increased degeneration at the adjacent level. However, the issue of further degeneration around the fusion area is controversial. There is debate whether it is the natural history of progressive degeneration or increased stress from the fusion which causes the further degeneration. Goal of our study was to compare the incidence of progressive degeneration and need for subsequent surgery between patients who were treated nonsurgically or with fusion for a thoracic or lumbar level fracture. Material and Methods The commercially available PearlDiver database and insurance billing codes were used to identify 3,699 patients diagnosed with thoracic fracture and 5,016 patients diagnosed with lumbar fracture in 2007. For both the thoracic and lumbar fracture cohorts, patients were divided into subgroups based on procedural codes: those who underwent fusion surgery and those who were treated nonsurgically. Each of those subgroups was further divided into patients who were diagnosed with intervertebral disc degeneration within1, 2, and 3 years from their initial treatment, and of those patients, how many had a follow-up surgery. We used chi-squared statistical analysis to compare incidences of disc degeneration and follow-up surgery between the fusion and nonsurgical groups. Results Of the 3,699 patients diagnosed with thoracic fracture, 3,215 (86.9%) were treated nonsurgically and 117 (3.2%) underwent thoracic fusion surgery within 90 days. Within 3 years, 147 patients from the nonsurgical subgroup and fewer than 11 from the fusion subgroup were diagnosed with thoracic disc degeneration. From the nonsurgical subgroup, 11 (0.3%) patients underwent a thoracic surgery related to disc degeneration, compared with zero from the fusion group ( p > 0.05). From 5,016 patients diagnosed with lumbar fracture, 4,371 (87.1%) were treated nonsurgically and 150 (3.0%) underwent lumbar fusion. Within 3 years, 503 (11.5%) patients from the nonsurgical and 35 (23.3%) from the fusion subgroup were diagnosed with lumbar disc degeneration ( p < 0.05). From the nonsurgical subgroup, 42 went on to have lumbar surgery related to disc degeneration, compared with fewer than 11 from the fusion subgroup (exact number suppressed because of the privacy limitations). Conclusion In the thoracic region, fusion surgery as treatment for thoracic fracture does not appear to increase the likelihood of disc denegation and future surgery compared with conservative treatments. On the contrary, in the lumbar region, initial fusion surgery appears to increase the incidence of disc degeneration and future surgeries, as well as nonsurgical procedures.
Pregnancy after Lumbar Total Disc Replacement
Authors: Owusu Anthony , Zigler Jack , Ohnmeiss Donna , Guyer Richard 
Published: May 2015

Introduction There is much literature addressing back pain and pregnancy, often attributing the pain to changing loads and stresses on the spine. There is much less information available on pregnancy after lumbar spinal surgery. Many women considering surgery or who have undergone surgery are of child-bearing age. They may have concerns about the safety of pregnancy after surgery. This may be particularly true of procedures performed through an anterior approach, such as lumbar total disc replacement (TDR). The purpose of this study was to evaluate the course of back pain and safety of pregnancy after lumbar TDR. Patients and Methods From a single center, 18 patients were identified who became pregnant after lumbar TDR surgery. Data were recorded from clinic records and mailed questionnaires. Questionnaire data were collected for 15 of 18 patients, although not all patients responded to all questions. For the remaining three patients, as much data as possible were collected from charts. The mean patient age at the time of surgery was 28.2 years, ranging from 25 to 35 years. The majority of patients (77.8%) had a single level operation with L5–S1 being the most common. Results Information related to back pain during pregnancy was available for 16 patients. Eight (50%) reported no increase in back pain during pregnancy, while the remaining eight did report increased back pain. Among the eight patients with increased back pain, it resolved postdelivery in all but one. There were no pregnancy-related complications. The mean time from surgery to delivery was 38.7 months (range, 9–102 months). Of the 15 patients for whom delivery method information was available, 10 (66.7%) had caesarian delivery while 5 (33.3%) had vaginal delivery. Of the 15 patients, 13 carried to term. The remaining two patients delivered twins prematurely. The mean birth weight was 7.4 pounds with the exception of the two sets of twins who had a mean weight of 4.4 pounds (range, 3.9–4.9 pounds). Three patients experienced two pregnancies post-TDR. Data for the first pregnancy are included earlier. In all the three patients, the second pregnancy was carried to term; one had a cesarean delivery, and the other two had vaginal delivery. One of the three had increased back pain during pregnancy which resolved after delivery. Conclusion Although based on a small patient sample, this study found that pregnancy after lumbar TDR surgery followed a typical course with no spine-related complications. The percentage of women delivering via cesarean delivery was greater than the 32.8% reported in the Center for Disease Control and Prevention's National Center for Health Statistics for 2012. It is hoped that this study may provide reassurance to women who were pregnant after TDR surgery that they should not be unduly concern about the safety of pregnancy and delivery because of their spine surgery.
Does anterior Column Reconstruction Works in the Surgical Management of Tuberculosis of the Spine?
Authors: Akinjolire Akinwande , Ukunda Frederick 
Published: May 2015

Introduction Drug therapy still remains the main stay in the treatment of TB spine. However, surgery is indicated in some patients. According to the MRC guidelines, radical ventral debridement, fusion, and the reconstruction of the spinal column remain the gold standard of surgical treatment for tuberculous spondylitis as popularized by Hodgson and his coworkers as the “Hong Kong” procedure. The lack of resources such as theater time, and the dual impact of HIV disease and TB pandemic led to the development of other surgical management techniques. Thus, the anterior debridement and anterior column reconstruction has evolved as a method of surgical intervention. The aim of this study is to report on the adequacy and outcome of patients treated with this surgical technique. Patients and Methods This is a retrospective study of 54 TB spine patients (25 males and 29 females) who had anterior decompression and interbody fusion over a 3-year period (from 2012 to 2014). The indications for surgery were essentially the same as for 360 degrees decompression and fusion. The average age of our patients was 38.6 years and the disease was thoracic in 49 cases and thoracolumbar in only 5 cases. Except for six cases of single vertebral body involvement, all of our cases have two contiguous vertebral bodies involvement and required a four-body fusion. In four cases, we used fibular strut graft, while the titanium mesh cage with a mixture of allograft and autograft (the cut rib) was used in majority of the cases. The mean follow-up period was 13 months (ranging from 6 to 30 months). Results The average preoperative kyphosis was 30 degrees; this improved to an average of 21 degrees postoperatively but falls to 27 degrees on the last follow-up (overall 10% improvement in the kyphosis angle). The mean Frankel neurology grading at the last follow-up was D (improvement from B to E). No loosening or breakage of implants occurs and no graft/mesh displacement recorded. Conclusion Early results of the anterior decompression and interbody fusion indicates that the method is adequate and the outcome gratifying. We therefore conclude that the procedure is an effective and adequate surgical technique for treating TB spine, but with possible risk of major complications.
Is there a Regional Difference in Morphology Interpretation of A3/A4 Fractures among Different Cultures?
Authors: Schroeder Gregory , Kepler Christopher , Dvorak Marcel , Chapman Jens , Fehlings Michael , Aarabi Bizhan , Rajasekaran Shanmuganathan , Kandziora Frank , Schnake Klaus , Bellabarba Carlo , Vialle Luiz , Reinhold Maximilian , Oner Cumhur , Vaccaro Alexander 
Published: May 2015

Introduction The AOSpine Thoracolumbar Spine Injury Classification System was recently published, but before establishing a treatment algorithm to accompany the classification, further investigation on the cause of current regional treatment variations is required. The objective of this study is to determine if the ability of a surgeon to correctly classify A3 (burst fractures with a single endplate involved) and A4 (burst fractures with both end plates involved) fractures were affected by either the region or the experience of the surgeon. Material and Methods A survey was sent to 100 AOSpine members from all six AO regions of the world (North America, South America, Europe, Africa, Asia, and the Middle East) that had no prior knowledge of the new AOSpine Thoracolumbar Spine Injury Classification System. Respondents were asked to classify 25 cases, including 6 thoracolumbar burst fractures (A3 or A4). The current analysis focuses on the effect of region and experience on surgeons' ability to properly classify these controversial fractures. Results All 100 surveyed surgeons completed the survey, and no significant regional variability in the ability to correctly classify burst fractures was identified ( p > 0.50). Further analysis demonstrated that no region predisposed surgeons increasing the severity of burst fractures. Similarly, experience did not affect surgeons' ability to correctly classify burst fracture ( p > 0.21). Conclusion Regional variation in the treatment of thoracolumbar burst fractures (A3 and A4) is not because of the differing radiographic interpretation of the fractures.
AOSpine Subaxial Cervical Spine Injury Classification System
Authors: Vaccaro Alexander , Kepler Christopher , Koerner John , Dvorak Marcel , Chapman Jens , Fehlings Michael , Aarabi Bizhan , Rajasekaran Shanmuganathan , Schroeder Gregory , Kandziora Frank , Schnake Klaus , Bellabarba Carlo , Vialle Luiz , Reinhold Maximilian , Oner Cumhur 
Published: May 2015

Introduction The purpose of this project is to describe a morphology-based subaxial cervical traumatic injury classification system. Similar to the effort put toward the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra and interobserver reliability to be used for clinical and research purposes. Material and Methods A subaxial cervical spine injury classification system was developed using a consensus process. All investigators were required to successfully grade 10 cases to demonstrate comprehension of the system before grading 30 additional cases on two occasions, 1 month apart. Kappa coefficients ( κ) were calculated for interobserver and intraobserver reliability. Results The classification system is based on the following three injury types: compression injuries (A), tension band injuries (B), and translational injuries (C), with additional descriptions for facet injuries, as well as patient-specific modifiers and neurologic status. Interobserver and intraobserver reliability was substantial for all injury subtypes ( κ = 0.64 and 0.75, respectively). Conclusion The AOSpine subaxial cervical spine injury classification system demonstrated substantial reliability in this initial assessment, and could be a valuable tool for patient care and for research purposes.
Evaluation of Use of Video Telescopic Operating Microscope with Operative Microscope in Cervical Spine Surgery
Authors: Younus Aftab 
Published: May 2015

Introduction In cervical spine surgery, it is essential to use the magnification, however, the surgical operating microscope can be expensive, cumbersome, and difficult to set up. Whereas the use of no magnification may lead to failure in removing the disc completely with no improvement of the patient condition. VITOM is an exoscope, which is used in place of operation microscope. It is easy to use and it gives same size magnification as operation microscope. This is a prospective cohort study form July 2013 to February 2014 at Helen Joseph Hospital. This study aims to evaluate the efficacy of video telescope operating microscope (VITOM) as an alternative to operative microscope (OM) in cervical spinal surgery. Patients and Methods Patients undergoing spinal surgery were enrolled in a prospective cohort study between July 2013 to February 2014 at Helen Joseph Hospital. The age, sex, and operation-matched patients undergoing surgery using the standard OM served as the control group. During surgery, the VITOM system was used in place of the OM in 20 patients. Operative time, length of postoperative hospital stay, and intraoperative complications were assessed. Results A total of 10 patients were studied in two equal cohorts of 10 patients each. Within each cohort, patients underwent single-level and two-level cervical spine surgery. There were no significant differences in age or sex between cohorts. There were no statistically significant differences in mean operative room time for single-level decompressions and two-level decompressions. Postoperative length of hospital stay averaged 4 days for the VITOM group versus 5 days for the traditional OM group. Subjectively, surgeon opinion was the quality of image was much higher as compared with operating microscope. Conclusion The VITOM system provides as good a result as compared with operating microscope. However, there was no statically difference in the duration of patient stay in hospital and length of operation and interoperative complications. However, VITOM provide good visualization and better picture quality because of the high-resolution image. It is convenient also for teaching the purpose as well.
Influence of Clinical and Histopathological Parameters in the Management of Metastatic Disease of the Spine Secondary to Lung Cancer: A Systematic Review
Authors: Batista Nuno , Fisher Charles 
Published: May 2015

Background Determining optimal treatment of metastatic disease of the spine is difficult. Decision making revolves around neurological status, stability, and patient factors; histology the most important as specifically linked to life expectancy. Traditionally, limited life expectancy eliminated surgery as an option, but with minimally invasive techniques this paradigm is changing. Metastatic lung cancer generally has poor life expectancy and most patients are not offered surgery; but are there some patients with lung cancer who would benefit from surgery? Recently, molecular sequencing has led to better specificity than the traditional small cell, non-small cell (NSCLC) dichotomy and thus betters prediction of life expectancy. The purpose of this study is to identify histopathological and clinical parameters related to life expectancy that would help guide optimal surgical decision making for metastatic disease of the spine secondary to lung cancer. Methods A systematic review was conducted to answer the following questions: Q1. Determine the current survival patterns in the lung Ca population. Q2. Identify prognostic factors influencing survival and outcome in patients with lung Ca. Results A total of 20 studies met the preset inclusion criteria. All included studies were retrospective series with a level of evidence of IV. The overall survival of patients with metastatic lung carcinoma is poor ranging from 5 to 17.8 months. Included studies consistently showed a better prognosis for patients with adenocarcinoma. The presence of EGFR mutation was also associated with a mild increase in life expectancy compared with the other histological subtypes. Conclusion Although life expectancy in patients with metastatic lung Ca is still in general not good, a subset of patients with adenocarcinoma and patients with EGFR mutations seem to have a better overall survival. Previously identified clinical and imagiological prognostic factors are still valid, but histology and specific mutations should be factored in the decision making when dealing with patients with lung Ca and MESSC.
Are MAGEC Rods a Contraindication to MRI: An In-Vitro Study Evaluating the Effect of MRI on Rod Growth, Temperature, and Image Interpretation
Authors: Budd Henry , Hutton Mike , Stokes Oliver , Clarke Andrew , Fulford Jon , Meakin Jude 
Published: May 2015

Introduction The management of early-onset pediatric deformity has been revolutionized by the development of adjustable growing rods. These rods contain a rare-earth magnet that rotates when triggered by an externally applied magnetic field resulting in rod elongation. This patient group includes those with underlying neuromuscular conditions who occasionally require further MRI of the neuraxis during development and, given the magnetic properties of the rod, they are conventionally contraindicated for this imaging modality once implanted. We have investigated the behavior of the MAGEC (Ellipse Technology) rod to determine whether MRI adversely affects the elongation properties of the rod or indeed directly causes any detrimental consequences, including rod elongation, shortening, heating, or significant artifact to outline implications for this patient group. Materials and Methods We designed an in-vitro experiment using two MAGEC rods secured in an MRI compatible restraint system to investigate MRI behavior of magnetic growing rods during scanning. We used a 1.5T Philips MRI and a restraint system designed to secure the rods within this environment. Repeated gradient echo multiscan sequence MRI of the neuraxis was performed to evaluate whether the rods elongated, contracted, or rotated during scanning, while we used MRI compatible heat-sensors attached to the outer housing of the rods to assess temperature changes. We also assessed the ability of the rods to lengthen after completion of the MRI and a phantom model to evaluate the amount of artifact induced by the rare-earth magnet. Results During repeated MRI of the neuraxis, the MAGEC rod mechanism was not triggered; however, the rods did rotate to bring the internal rare-earth magnet in line with the surrounding electromagnetic field, while only small forces were generated causing rod movement within the restraint system. The ability of the rods to lengthen after MRI was not enhanced or impaired and no significant heating effect on the external rod housing was demonstrated. The assessment of imaging with a phantom model did reveal a significant degree of artifact up to 30 cm because of the presence of the magnet within the electromagnetic field and, therefore, only MRI of the head and cervical spine could be interpreted with normal placement of MAGEC rods within the pediatric patient. Conclusion This study demonstrated that there are no detrimental effects of MRI on the MAGEC rod. In addition, while the degree of the artifact demonstrated prohibits imaging of the thoracolumbar spine, the MRI images of the head and cervical spine remain unimpaired. Finally, we did not demonstrate any significant force acting on the rod by the electromagnetic field that would cause implant dislodgement or loosening during MRI.