bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cauda Equina Syndrome (CES) Secondary to Lumbar Disc Herniation: Retrospective Clinical Study in 13 Cases with in Progression Symptoms
Authors: Marotta Nicola , Maiola Vincenza , Gregori Fabrizio , Landi Alessandro , Delfini Roberto 
Published: May 2015

Introduction A compression of nerve roots of cauda equina (CE) is responsible for cauda equina syndrome (CES). The nine pairs of CE nerve roots provide motor and sensory innervation to the lower extremity muscles, the pelvic floor, and the bowel and bladder sphincters. CES caused by a massive herniated lumbar disc, has rarely been described in literature. We report 13 cases of massive lumbar disc herniation causing CES which underwent surgical intervention after 48 hours or more from the trauma. Material and Methods Between September 2010 and June 2014, 13 cases of CES by lumbar disc herniation were treated in our department. In eight patients the herniated disc level was L4–L5, in one patient was L3–L4, and in four cases was L5–S1. The patients admitted to our hospital had lumbosciatic pain and worsening progressive: motor weakness (seven cases), hypoesthesia to lower limbs (nine cases), sexual dysfunction (two cases), hypo/areflexia (five cases). All the patients before surgery referred sphincter disorders (SD). The surgery was performed in a range from 48 hours to 8 days by the onset of symptomatology. Magnetic resonance imaging (MRI) of the lumbosacral region was performed in all cases before surgery; other postsurgical studies include electromyography (EMG), urodynamic study, RigiScan, and GSA. Results The MRI examinations showed a herniated lumbar disc determining a compression on CE. Of 13 patients, 11 had a complete recovery of sphincter disturbances and 8 had a recovery of neurological symptoms in the first day after surgery. Eight patients were discharged in the 3rd day after surgery and had a complete clinical recovery after 1 month from surgery. Conclusion CES is characterized by the following symptoms: low back pain, saddle anesthesia, hypo/areflexia, motor weakness or sensory disturbances to lower limbs, sphincter disorders, and sexual disorders. We classified CES according to the onset of symptoms in an acute (symptoms occur within 24 hours) and an in progression form (more than 24 hours). According to the clinical features CES can be classified in a complete (sphincter disorders plus at least four other criteria) and an incomplete form (sphincter disorders and three or less symptoms). Our study is aimed to elaborate a score to better define the preoperative symptomatology and give a prognostic evaluation about neurological recovery. In our experience, despite the fact that surgery has been performed at least 48 hours after the symptoms occurred, we had a complete neurological recovery in 10 out of 13 cases. In case of in progression CES, the surgical intervention, even if it is not performed within 12 hours, can allow a complete neurological recovery, depending on the severity of the clinical features at the time of surgery.
Adjacent Segment Degeneration after Cervical Disc Surgery: Comparison of One-Level Cervical Disc Arthroplasty versus Anterior Cervical Interbody Fusion: 7-Year Radiological Follow-Up
Authors: Szollosi Balazs , Klemencsics Istvan , Lazáry Áron 
Published: May 2015

Introduction Cervical disc arthroplasty and anterior cervical interbody fusion provide the same clinical result in the surgical treatment of degenerative disc disease. The main theoretical advantage of motion preservation is its preventive effect on the adjacent disc degeneration. The aim of our study was to compare the radiological results at the 7-year follow-up after disc replacement and after fusion. Patients and Methods Since January 2006 to December 2007, 17 patients underwent one-level cervical disc arthroplasty (group A), and 17 patients were operated with one-level interbody fusion (group B). ROM of the adjacent segment, dimensions of the adjacent intervertebral disc space, ROM and alignment of the whole cervical spine, and presence of heterotopic ossification were evaluated preoperatively and at 7-year follow-up. All the measurements were done by independent radiologist on the digital anteroposterior, lateral, and flexion/extension X-rays. Results The adjacent disc height decreased in both groups, but the decrease was more significant in the fusion group. Mean disc height was 4.13 mm (preoperative) and 4.03 mm (postoperative) in group A, and 4.02 mm (preoperative) and 3.83 mm (postoperative) in group B. The sagittal ROM of the adjacent segment was higher in the arthroplasty group (group A: 10.89 degrees, group B: 9.5 degrees). The cervical lordosis was significantly higher in the fusion group (group A: 11.81 degrees, group B: 18.59 degrees, p < 0.05). In the arthroplasty group, the mean ROM of the operated level was 11.4 degrees preoperatively and 11.12 degrees postoperatively ( p > 0.05). A total of 64.7% of the patients had any sign of heterotopic ossification. Conclusion The segment of the prosthesis ultimately showed preservation of the preoperative motion. The decrease of the intervertebral disc height, and the ROM (flexion/extension) in the adjacent segments was more significant in the fusion group, so the disc degeneration process seems to be faster after fusion than arthroplasty. The restoration of the lordosis is more effective with fusion than arthroplasty. The early experience is promising but long-term follow-up studies are required to prove the theoretical advantages of the arthroplasty in the prevention of the adjacent segment degeneration.
Long-Term Results after Cervical Disc Replacement using Bryan Prosthesis
Authors: Amro Nahed , Badke Andreas , Jarrar Dina , Schätz Christoph 
Published: May 2015

Study Design Retrospective clinical study. Objective To study the outcome of cervical disc replacement with a Bryan prosthesis in 60 to 91 months follow-up duration through analyzing the motion of index segments and associated heterotopic ossification (HO), and adjacent segment degeneration using their motion, patient satisfaction, and pain as indicators. Summary of Background Data Cervical disc replacement is considered to be equivalent if not superior to discectomy and fusion because it allows for decompression while maintaining segmental motion and has the potential to minimize adjacent segment disease. However, long-term results of motion and degeneration of adjacent segments after cervical disc replacement are rare. Methods Data of 47 patients with cervical disc prolapse, treated with cervical disc replacement with a Bryan disc between January 28, 2002 and October 31, 2003 in the orthopädische Klinik Markröningen, Germany were analyzed. Cobb angles of the exchanged segment, and the adjacent segments were measured on pre- and postoperative radiographic pictures. The grade of heterotopic ossification was examined. The postoperational functionality of the cervical spine was examined via active range of motion. Patients' satisfaction and pain were assessed using; the neck disability index (NDI), Odom criteria, and visual analog scale (VAS). Results At follow-up no postoperative complications or revision were recorded. No HO formation was present in 34 patients (72.3%), grade I and grade III HO was present in 10 patients (21.3%) five of each grade. Segmental fusion (grade IV) was observed in three patients (6.4%). Most patients showed improved motion and high satisfaction. Mean NDI was 12.3% (SD = 13.12). Mean VAS score was 1.8 (SD = 2.1). Using Odom criteria all patients were classified as a clinical success. Conclusions Preserving stability (as a nonresorbable stable place holder) and the goals of decompression, cervical disc replacement preserved motion, and decreased related degeneration clinically and radiologically.
Improvement in Disc Height after Lumbar Arthroplasty with Mobidisc and Minimum 3 Years of Follow-Up
Authors: Vujadinovic Aleksandar , Hrustic Asmir , Dakheel Aldakheel Dakheel 
Published: May 2015

Introduction Degenerative disc disease (DDD) is one of the most common reasons for low back pain in active population. During process of degeneration disc loose water content that leads diminishing of disc height. Disc degeneration is characterized by loosening of water content. These leads to diminishing of disc height, higher stress to facet joints and narrowing neural foramina. The aim of this study is to evaluate improvement in disc height after total lumbar arthroplasty at L4–L5 and L5–S1 segments with a Mobidisc prosthesis. Patients and Methods We analyzed 63 patients in which Mobidisc lumbar prosthesis were implanted at L4–L5 and L5–S1 segments during period of January 2008 to January 2011 in Civil Hospital in Strasbourg, France. Full standing X-rays have been done preoperatively and postoperatively after 6 weeks, 3, 6, 12, and 36 months. X-rays were digitalized and measurement were performed by using Spineview software. Measurement was statistically significance at p < 0.05. Results The mean follow-up was 44 months; 45 females and 18 males were analyzed with average 41.3 year of age. Prosthesis was implanted at L4–L5 in 19 cases and at L5–S1 in 44 cases. Preoperative anterior disc height at L4–L5 was significantly improved, from 6.30 to 9.03 mm (2.73 mm) postoperatively ( p < 0.01). Posterior disc height at same level was also improved, from 2.82 mm preoperatively to 3.90 mm postoperatively (1.08 mm) ( p < 0.05). At level L5–S1 anterior and posterior disc height were improved as well. From 4.99 mm to 7.53 mm (2.54 mm) ( p < 0.05) and from 2.52 mm to 4.66 mm (2.14 mm), respectively, ( p < 0.05). Conclusion During lumbar disc arthroplasty the size of prosthesis may have a significant role in a final postoperative result. Oversize prosthesis may produce too much distraction to posterior ligaments and muscles of lumbar spine. On the other hand, too small implants will not reduce stress enough on facet joints nor will adequately open neural foramina. In both cases, this would probably result in painful syndromes of lumbar spine.
Sacroiliac Joint Syndrome 10 Years after Lumbar Arthroplasty: The Importance of Spinopelvic Alignment
Authors: Ciarpaglini Riccardo , Maestretti Gianluca 
Published: May 2015

Introduction Sagittal balance is an independent predictor of outcomes in spinal care and several authors focused their attention on the lumbar lordosis restoration as the key point to prevent secondary sacroiliac joint dysfunction (SIJD) after fusion. On the other hand, lumbar disc arthroplasty allows preservation of motion avoiding increased stress on the spinopelvic junction and preventing iatrogenic sagittal imbalance. Methods We analyze the incidence of a secondary SIJD and the spinopelvic alignment on a series of 31 consecutive lumbar disc prosthesis with a 10-year follow-up. Results Sagittal balance assessment showed no significant variation of preoperative spinopelvic parameters. Four patients (12%) presented a symptomatic SIJD. Only two of them required a percutaneous SIJ fixation. Both of them presented a fused L5–S1 prosthesis. Conclusions Very few studies are focused on the topic of SIJ deterioration after lumbar arthroplasty and, at the best of our knowledge, the present article is the first with such a long follow-up. After 10 years of the surgery 12% of our patients presented a symptomatic SIJ dysfunction, less than the percentage reported in the literature after lumbosacral fusion. The low rate of SIJD 10 years after lumbar arthroplasty might be explained by the preservation of the spinopelvic balance.
Early Results of Magnetically Controlled Growing Rods in the Management of Early-Onset Scoliosis
Authors: La Rosa Guido , Ruzzini Laura , Oggiano Leonardo 
Published: May 2015

Introduction To present a series of nine patients with early-onset scoliosis (EOS) managed with magnetically controlled growing rods (Ellipse TM MAGEC System). Material and Methods We implanted magnetically controlled growing rods in nine patients affected by early-onset scoliosis. Scoliosis and Kyphosis angles, T1–T12, and T1–S1 distances were evaluated preoperatively, postoperatively, and at the last follow-up. A visual analogue scale score was used to evaluate pain during outpatient rod distraction procedures. The mean follow-up is 24.5 months. All patients attended distractions of the magnetic rod through an external remote control every 3 months. Results The mean Cobb angle value was 66.3 ± 17.6 degrees (range, 45–100 degrees) preoperatively and 30 ± 13.8 degrees (range, 15–59 degrees) at the latest follow-up. The mean T1–S1 length value was 27.2 ± 5.7 cm (range, 16–34.8 cm) preoperatively and 33.2 ± 4 cm (range, 26.5–39 cm) at the latest follow-up. The mean T1–T12 length value was 16.3 ± 2.9 cm (range, 10–19 cm) preoperatively and 20.9 ± 2.9 cm (range, 15.5–23.5 cm) at the latest follow-up. The average monthly T1–T12 height increase was 0.8 mm while the average monthly T1–S1 increase was 0.9 mm. Two patients experienced a rod breakage and one patient had a pullout of the apical hooks. Conclusion Although implant-related complications could occur, magnetically controlled growing rods can be effectively used in patients with EOS. This spinal instrumentation can overcome many of the complications related with the traditional growing rods implants. This procedure can be effectively used in outpatient settings, minimizing surgical scarring, and psychological distress due to multiple surgeries needed in the traditional growing rods system, improving quality of life, and saving health care costs.
XLIF-Related Postoperative Events versus Psoas Muscle Dimension and Ratio: A Possible Preoperative Evaluation Factor
Authors: Buric Josip 
Published: May 2015

Introduction Advanced intraoperative neuromonitoring (IONM) is used to attenuate postoperative complications and side effects of extreme lateral interbody fusion (XLIF). Specific factors relate to the presence of postoperative injury are not well understood. This study aims to identify intraoperative variables with correlations to new postoperative anterior thigh/groin sensory changes. Patients and Methods A total of 29 patients with various degenerative lumbar conditions were treated with XLIF at a single institution. Mean age was 59 years, 69% were females, and 21% had undergone previous lumbar surgery. A total of 47 levels (mean 1.6, range 1–3) were treated with XLIF. Supplemental pedicle screw and rod fixation was used in 24 patients (83%). Dynamically evoked electromyography was used in all cases. Analysis of baseline demographic and treatment variables were performed at a per patient basis ( n = 29), whereas analysis of intraoperative variables were performed at a per levels treated basis ( n = 47). Results Within 24 hours postoperative, 10 (34%) patients experienced anterior thigh/groin sensory changes (4 reported pain only, 5 reported pain plus other sensory changes, and 1 paresthesia without pain). Symptom resolution occurred at 1 month postoperative for four patients, at 3 months postoperative for two patients. At 3 months postoperative, six patients had complete symptom resolution, three patients had symptom improvements, and one patient had no change in perioperative symptoms. Psoas dimension in the lateral–latero direction were significantly smaller for patients with postoperative sensory changes ( p = 0.025), and similarly, patients with postoperative sensory changes had a significantly higher ratio of psoas muscle in the anterior–posterior to lateral–latero directions ( p = 0.026). Conclusion In addition to IONM, MRI evaluation of psoas shape, position, and dimension may be of help in preoperative planning of a safe XLIF access and eventually, predict those cases with higher risk of approach-related postoperative events.
Comparative Analysis about Efficacy, Security, and Manageability of Gelified Hemostatic Matrix in Bleeding Control during Thoracic and Lumbar Spine Surgery: Floseal versus Surgiflo
Authors: Gregori Fabrizio , Landi Alessandro , Marotta Nicola , Delfini Roberto 
Published: May 2015

Introduction An accurate hemostasis in surgical practice is as important as reduced the dimensions of the operating field are. The need of an optimal, atraumatic hemostasis has become impelling in neurosurgery. Gelified hemostatic matrix has been employed very often because of their simple and safe use. This prospective study is aimed to comparatively evaluate two different hemostatics, Floseal and Surgiflo, in the bleeding control during spine surgery, considering their efficacy, security, and ease of use. Material and Methods From January 2012 to December 2013, 149 patients were recruited for this study. Inclusion criteria were: age between 25 and 80 years, diagnosis of arthrosic or traumatic pathology of lumbar or thoracolumbar spine, persistent bleeding not responding to standard hemostatic techniques. All patients required laminectomy or laminoartrectomy, with exposure of the perivertebral venous plexus. Aim of our study was to reach a complete stop of the bleeding in the operatory field after the application of hemostatic gel. All patients have been evaluated during the follow-up period with clinical and neurological examination after the intervention. All patients underwent a CT scan 3 months after the intervention. Results We included 149 patients in our study: 98 men and 51 women. A total of 92 patients were affected by a degenerative condition, 57 by traumatic pathology. A total of 42 patients assumed anticoagulant and/or antiaggregant therapy preoperatively. In all cases, a massive bleeding originated from the epidural venous plexus. Floseal was used in 86 cases, Surgiflo in 63. A complete hemostasis was achieved in all patients in a time included between 3 minute 30 second and 7 minute (Floseal 5 minute 35 second ± 52 second, Surgiflo 5 minute 32 second ± 54 second). Statistical analysis did not show any association between coagulation time and hemostatic, age, sex, pathology treated. A previous therapy with antiaggregants and/or anticoagulants determined a slight increase in time of hemostasis without any statistical difference. The clinical and radiological follow-up showed no evidence of postsurgical hematomas. Conclusion Comparative analysis of the two products did not show any relevant difference in terms of efficacy and ease of use, showing their effectiveness in the bleeding control. Their use has been valid even in patients who made use of antiaggregant/anticoagulant drugs preoperatively. Both Floseal and Surgiflo can be considered a valid instrument in controlling bleedings in thoracic and lumbar spine surgery.
C2 Subfacetal Body Screw in Posterior Atlantoaxial Fixation (Goel–Harm Technique) to Avoid the Vertebral Artery
Authors: Sushil Patkar 
Published: May 2015

Introduction Axis (C2) pedicle/pars screw fixation has a definite risk of injury to the vertebral artery. An alternative trajectory 3 mm below the midpoint of the C2 facet surface, directed, downwards and medially into the C2 body, bypasses the vertebral artery altogether, and still offers adequate bone stock for rigid fixation of the C2 vertebra. Material and Methods Overall, 65 patients, 40 males and 25 females, aged 12 to 82 years, underwent posterior C1–C2 fixation from February 2007 to June 2014. Reducible atlantoaxial instability due to trauma (35), rheumatoid arthritis (20), and infection (tuberculosis) (10), magnetic resonance imaging (MRI), dynamic lateral X-rays of craniovertebral junction (CVJ), 3D CT scan of the craniovertebral region along with dynamic study and CT angiography. The entry point for the C2 screw was 2 to 3 mm below the midpoint of superior facet of the C2 which is also the midpoint C1–C2 joint and directed 10–to 15 degrees medially and downwards into the body of the axis. The same 3-mm drill bit was used incrementally till a depth of 5 mm and, 3.5 mm and 18 to 24mm length self-tapping screw with polyaxial head was used in most cases. Results No case of intraoperative vertebral artery injury. No patient required per operative blood transfusion. Follow-up visits were scheduled at 2, 6 to 8 weeks, and 3 months. Dynamic X-ray imaging was done in all patients at 6 to 8 weeks before discontinuing the collar and after 3 months since the operation. All patients followed up for 3 months. Telephonic follow-up of 30 patients was available for 24 months, 12 patients for 6 months, and remaining 7 patients have not reported and are not contactable after the 3 month visit. One postoperative mortality due to myocardial infarction on 7th day. Seven patients complained of occipital numbness and paresthesia which was not disturbing and responded to reassurance and supportive medication (pregabalin). Two patients had superficial wound infection which responded to appropriate antibiotics. There was no case of implant failure or loss of rigidity of fixation up to 3 months. Conclusion The new entry point offers rigid fixation and avoids the vertebral artery altogether nullifying the chance of arterial injury. Divergent screws (bridge vs. tension band construct) have a greater pull out strength. The new technique of C2 screw fixation allows rigid immobilization of the C1–C2 joint without any risk of vertebral artery injury.
Observation of Intraoperative Visual Evoked Potential Monitoring during Prostrate Spinal Surgery
Authors: Cui Zhiming , Bao Guofeng 
Published: May 2015

Introduction In order to provide the theoretical basis and practical guidance of eye protection during the prone spinal surgery under the general anesthesia, visual evoked potential (VEP) was monitored before and after surgery. Patients and Methods A total of 82 patients were involved in our study and grouped into three groups, S, M, and L groups, respectively, according to the operation time. The P100's latency and amplitude changes and the visual function of preoperative, postanesthetic, and postoperative spots were analyzed to understand their relationship. Results (1) The waveforms of VEP in 78 cases were monitored stably and repeatedly and the other four cases failed. (2) Difference of P100's latency and amplitude at preoperative, postanesthetic time was not statistically significant in all groups. (3) Postoperatively, difference of P100's latency was statistically significant in M and L groups, and no statistically significant difference was observed in S and M groups. Difference in P100's amplitude was statistically significant in all groups. (4) Recovery time of P100's latency has statistically significant differences in all three groups. (5) Two patients in the L group had conjunctival edema, pupillary light reflex obstacles, and visual acuity descending. After receiving positive symptomatic treatment, symptoms disappeared and vision recovered. Conclusion VEP can provide the stable and on-time electrophysiological conductive evidence needed to judge the optical pathway function. The operator should pay close attention to the change in VEP and visual performance if prone spinal surgery continues for more than 4 hours.