bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Acute Lumbar Back Pain: An Algorithm
Authors: Melcher Carolin , Wegener Bernd , Kanz Karl Georg , Jansson Volkmar , Birkenmaier Christof 
Published: May 2015

Introduction Low back pain imposes a considerable social and economic burden as one of the most serious public health issues in the developed nations and is one of the most common reasons for presentation to primary health-care providers, outpatient, or A&E departments. Currently, point prevalence of acute low back pain adds up to 40%, 1-year prevalence exceeds 70%, and life time prevalence equates 80%. Despite these certainties, the complex set of problems generating low back pain is still not satisfactorily understood. In addition, the complexity of diagnoses and treatment of lumbar pain syndrome provokes insecurity and restraint, especially in younger clinicians when faced with a patient suffering from acute back pain. To counter these problems—alleviating the operational sequences in A&Es, outpatient departments, and health-care centers and minimizing the risk of mis- or underdiagnosis of life-threatening internistic disease patterns, respectively, spinal emergencies—this algorithm has been originated. Material and Methods The algorithm is based upon the clinical guidelines of the national and international scientific associations in Europe, North America, and overseas as well as on experienced data in the daily work of the spine specialists at Ludwig-Maximilians-University Munich Campus Großhadern und Innenstadt. Hereby, consistency with the guidelines and recommendations of the literature, on one hand, and feasibility in the course of action in daily life with as much practical relevance as possible, on the other hand, were the main goals. Results In synopsis, an algorithm was formed which evaluates the crucial differential diagnosis of lumbar back pain according to their clinical relevance and targets a plot of action in reasonable diagnostic and therapeutic steps. By distinct yes–no decisions within the scope of history taken together with instructions according to clinical, laboratory, and radiological investigational steps, even clinicians without long-time experience in spine surgery should be able to handle patients with acute low back pain in any situation according to the guidelines and treatment needed. Conclusion The designated aim in developing this algorithm was to render assistance to colleagues of primary health-care providers, outpatient clinics, and A&E departments by reducing the complexity of diagnosis and treatment of lumbar pain. The aim was also to prevent mis- or underdiagnosis of life-threatening internistic disease patterns or possible spinal emergencies on one side and unnecessary diagnostic and therapeutical actions on the other side. An evaluation of practical application in daily routine will follow over time.
Study of Spine Rotator Muscles in Adolescent Idiopathic Scoliosis Patients
Authors: Wajchenberg Marcelo , Eulalio Martins Delio , Paiva Luciano Rafael , Del Curto David , Barros Puertas Eduardo , Schmidt Beny , Souza Bulle Oliveira Acary 
Published: May 2015

Introduction Several studies have presented morphological, biochemical, and histopathological changes in the paraspinal skeletal muscle of patients with adolescent idiopathic scoliosis (AIS). Some abnormalities, such as an increased amount of type I fibers in the concavity and the decreased number of type II in the convexity, an increase in the intracellular concentration of glycogen and lipids, structural changes in the sarcolemma and myotendinous junction, changes in the activity muscle enzyme, and an increase in intracellular calcium concentration, have been demonstrated. The aim of this article is to evaluate the rotator muscle fibers at the apical vertebra of curves of patients with AIS by histological and immunohistochemical analysis. Materials and Methods Twenty-one patients with AIS submitted to surgical correction between 2010 and 2013 had the spinal rotator muscles biopsied in the concavity and convexity of the apical vertebra of the thoracic curve during the surgery. Serial cryosections were stained with hematoxylin and eosin (HE), Sudan Red, NADH, ATPase, and Cytochrome oxidase. We evaluated muscle atrophy and hypertrophy, fatty proliferation, presence of endomysial and perimysial fibrosis, presence of hyaline fibers, mitochondrial proliferation, muscle necrosis, nuclear centralization, and inflammation. Two independent observers evaluated the sections. Results The average value of the angle of the main thoracic curve was 68 degrees Cobb. For analysis of nonparametric paired variables between the concave and convex sides, McNemar test was used with a significance level of 5%. The results of relative frequency and “ p” values showed significant differences in both endomysial and perimysial fibrosis and fatty involution when compared with both sides of the apical vertebra. Conclusion The paraspinal muscles at the apex of the deformity had a higher involvement in the concavity when analyzing the fatty involution and fibrosis. However, both sides showed signs of myopathy, muscle atrophy through areas of necrosis, presence of hyaline fibers, and mitochondrial proliferation.
Comparison of Shoulder Balance between Rod Derotation and Rod Derotation with Direct Vertebral Rotation in Double Thoracic Adolescent Idiopathic Scoliosis
Authors: Chang Dong-Gune , Kim Jin-Hyok , Ha Kee-Yong , Lim Dong-Ju , Suk Se-Il 
Published: May 2015

Introduction There is no report on the effect of DVR on the shoulder balance using segmental pedicle screw instrumentation in the treatment of double thoracic adolescent idiopathic scoliosis (AIS) with minimum 5-year follow-up. This study is to evaluate the shoulder balance resulting from the correction of double thoracic AIS comparing rod derotation (RD) with direct vertebral rotation (DVR) and RD only following pedicle screw instrumentations. Materials and Methods Double thoracic AIS patients ( n = 57) were treated by fusing both thoracic curves with RD and DVR ( n = 35), or RD ( n = 22) methods and retrospectively studied with a minimum 5 years follow-up. Results In the RD with DVR group, the preoperative PT curve of 40.2 degrees improved to 17.9 degrees postoperatively and 19.9 degrees at last follow-up. In the RD group, the preoperative PT curve of 37.5 degrees improved to 22.4 degrees postoperatively and 23.2 degrees at last follow-up. In the RD with DVR group, the preoperative DT curve of 56.6 degrees improved to 16.1 degrees postoperatively and 16.7 degrees at last follow-up. In the RD group, the preoperative DT curve of 50.6 degrees improved to 17.8 degrees postoperatively and 18.2 degrees at last follow-up. In the RD with DVR group, the average preoperative SHD of 16.3 mm was improved to 7.2 mm postoperatively and was 7.0 mm at last follow-up. In the RD group, the average preoperative SHD of 15.1 mm was changed to 7.5 mm postoperatively and was 7.3 mm at last follow-up. Conclusion Shoulder balance was not significantly improved even with additional correction method of DVR using segmental pedicle screw instrumentation in double thoracic AIS. The PT curve was rigid and corrected less in both groups. Therefore, less correction of the DT curve effectively achieves better shoulder balance.
Impact of Pedicle Screw Instrumentation with Addition of Crosslink on Growth of Spinal Canal in Young Children
Authors: Chen Zhong-Hui , Sun Xu , Wang Bin , Qian Bang-Ping , Yu Yang , Zhu Zezhang , Liu Zhen , Zhu Feng , Qiu Yong 
Published: May 2015

Introduction The use of pedicle screws has been popularized in the treatment of pediatric spinal deformity. Despite many studies regarding the effect of pedicle screws on the immature spine, there is a paucity of data concerning the impact of the screw-rod-crosslink complex on the development of spinal canal in young children. The objective of this study is to determine the influence of the screw-rod-crosslink complex on the development of spinal canal. Materials and Methods This study reviewed 34 patients with congenital scoliosis (14 boys and 20 girls) who were treated with posterior-only hemivertebrectomy and pedicle-screw-based short-segment instrumentation before the age of 5 years. They were followed-up for at least 24 months. Of these patients, 10 underwent only pedicle screw instrumentation without crosslink, and 24 with additional crosslink placement. The vertebrae were divided into three regions as follows: (1) S-CL (screw-crosslink) region, in which the vertebrae were inserted with bilateral pedicle screws and two rods connected with the crosslink; (2) S (screw) region, in which the vertebrae were inserted with bilateral pedicle screws but without crosslink; (3) NS (no screws) region, which comprised vertebrae cephalad or caudal to the instrumented region. The area, anteroposterior and transverse diameters of the spinal canal were measured at all vertebrae on the postoperative and last follow-up computed tomography axial images. The instrumentation-related parameters were also measured, including the distance between the bilateral screws and the screw base angle. The changes in the above measurements were compared between each region to evaluate the instrumentation's effect on the spinal canal growth. Results The mean age at surgery was 37 ± 11 months (range, 21–57 months) and the mean follow-up was 37 ± 13 months (range, 24–68 months). In each region, the spinal canal dimensions significantly increased during the follow-up period. There was no significant difference in the spinal canal growth rate between the S and NS regions or between the S-CL and NS regions. In addition, a comparison of the S-CL and S regions regarding the changes in measurements of the instrumentation construct revealed no significant differences. Conclusion Pedicle-screw-based instrumentation does not cause retardation of the development of spinal canal in young children. Moreover, use of the crosslink added to the screw-rod instrumentation also demonstrates no negative effect on the growth of the spinal canal. Thus, the addition of the crosslink to screw-based instrumentation is recommended to increase fixation stability in growing patients, even in very young pediatric population.
Natural Evolution of Syrinx in Patients Undergoing Posterior Correction for Scoliosis Secondary to Syringomyelia
Authors: Zhu Zezhang , Sha Shifu , Liu Zhen , Xie Dingding , Wang Bin , Sun Xu , Qian Bang-Ping , Zhu Feng , Yu Yang , Qiu Yong 
Published: May 2015

Introduction While correction surgery for syringomyelia-associated scoliosis frequently results in an elongation of the spine and may potentially influence the natural history of syringomyelia, a paucity of data exists regarding the syrinx behavior in the postoperative course. This study aims to investigate the natural evolution of syrinx in patients undergoing one-stage posterior instrumented spinal fusion for treatment of scoliosis secondary to idiopathic syringomyelia (IS). Materials and Methods Twenty-two patients with IS-associated scoliosis treated with one-stage posterior correction and fusion were evaluated at a minimum of 12-month follow-up (mean, 28.5 months; range, 12–57 months). Standing anteroposterior and lateral radiographs were examined for curve pattern, primary curve magnitude, thoracic kyphosis, and postoperative correction. Preoperatively and at follow-up, T2-weighted MR images, location, configuration, and size of the syrinx cavity were systematically assessed, and significant syrinx resolution was defined as more than 20% decrease in length or maximal syrinx/cord ratio. Results The series consisted of 15 male and 7 female patients with a mean age of 19.0 years (range, 12–35 years). Postoperative percent correction of the primary curve averaged to 64.0 ± 15.7% and was well maintained (58.5 ± 11.5%) at latest evaluation. Regarding syrinx size, the maximal syrinx/cord ratio improved from 0.44 to 0.41, with an average change rate of 3.5%. Overall, 10 (45.5%) and 11 (50.0%) patients met the criteria for syrinx improvement and stabilization, and syrinx deterioration was observed only in 1 case (4.5%). Age, gender, preoperative syrinx length, and number of fused vertebra were not associated with the prognosis of syringomyelia ( p > 0.05), whereas a significantly greater coronal correction was found in patients harboring a collapsed syrinx than in those with syrinx deterioration or stabilization (73.9 vs. 54.6%, p = 0.001). Using Spearman correlation test, improvement rate of the maximal syrinx/cord ratio was found to be strongly related to the coronal percent correction of the primary curve (r =  − 0.547, p = 0.008). There were no neurological or other major complications related to the surgery. Conclusion For treatment of scoliosis secondary to IS in the setting of minimal neurological deficits, one-stage spinal fusion with lengthening of the vertebral column provides an effective coronal and sagittal correction without neurological complications. Following surgery, the vast majority (95.5%) of syringes shrank or remained stable, indicating that deformity correction did not exert a deleterious effect on the natural evolution of syringomyelia.
Roentgenographic Evaluation of the Spine in Patients with Osteogenesis Imperfecta
Authors: Vaz de Lima Marcos , Santili Claudio , Akari Miguel 
Published: May 2015

Background Context Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder that leads to bone weakness and deformities, especially in the spine, which can lead to poor outcomes. Purpose The aim of this study was to find patterns and risk factors in spinal deformities in patients with OI. Study Design/Setting Retrospective study at Irmandade da Santa Casa de Misericórdia de São Paulo. Methods Radiographs of the spine were evaluated. Patient Sample Seventy patients with OI were selected. Outcome Measures We observed the presence or absence of the following changes: biconcave vertebrae, chest and vertebral deformities, unilateral rib, and thoracolumbar kyphosis. The greater curve was considered to be the primary one and the secondary curve was considered compensatory. Results In the study sample, we observed that the patients' ages ranged between 7 and 50 years, with the mean age as 13 years, and 76% had scoliosis. In 68% of the cases, the main curve in the thoracic region was observed with the convexity to the right. Conclusion The following are associated with the presence of scoliosis in patients with OI: biconcave vertebrae, vertebral and chest deformity, unilateral rib, and thoracolumbar kyphosis. The thoracolumbar kyphosis is associated with thoracic hypokyphosis in patients with OI.
Classification of Degenerative Segment Disease in Adults with Deformity of the Lumbar or Thoracolumbar Spine
Authors: Berjano Pedro , Damilano Marco , Ismael Maryem , Cecchinato Riccardo , Lamartina Claudio 
Published: May 2015

Introduction Lumbar and thoracolumbar deformity in the adult is a condition with impairment of health status that can need surgical treatment. In contrast with adolescent deformity, where magnitude of the curve plays a significant role in surgical indication, the aspects relevant in adult deformity are pain and dysfunction that correlate with segment degeneration and imbalance. Previous classifications of adult deformity have been of little use for surgical planning. Materials and Methods Chart review and classification of radiographic and clinical findings. A classification of degenerative disc disease based on distribution of diseased segments and balance status of the spine is presented. Results Four main categories are presented: Type I (limited nonapical segment disease), Type II (limited apical segment disease), Type III (extended segment disease: apical and nonapical), and Type IV (imbalanced spine: IVa, sagittally imbalanced; IVb, sagittally and coronally imbalanced). Conclusion Types I and II can be treated by fusion of a selective area of the curve. Type III needs fusion of all the extension of the coronal curve. Type IV usually needs aggressive corrective procedures, frequently including posterior tricolumnar osteotomies. This classification permits interpreting the extension and magnitude of the disease and can help establish a surgical plan regarding selective fusion and methods of sagittal correction. Future research is needed to validate the classification.
New Implant Anchored Cage for Anterior Cervical Interbody Fusion
Authors: Lecaros Javier , Lecaros Miguel , Martínez Daniel , Fleiderman José , Urzúa Alejandro , Munjin Milán , Ilabaca Francisco , Ballesteros Vicente 
Published: May 2015

Introduction Currently, the anterior cervical discectomy and fusion (ACDF) is the “gold standard” treatment after anterior cervical decompression, in elderly patients or those who have contraindications for disc prosthesis. In this context, a new anchored implant with zero profile has been introduced for ACDF, which seeks to solve the problems that entail to add an anterior cervical plate and to obtain a higher level of stability to the segment, in comparison with cage only. The objective of this study is to describe the operative and postsurgical results, associated to the new zero-profile implant COALITION (Globus Medical, Inc, Audubon, Pennsylvania, United States), in patients who had surgery after cervical spine degenerative disease. Materials and Methods The data of 32 patients were reviewed by the Spine surgeons of Hospital del Trabajador (Santiago de Chile), between 2011 and 2014 under the ACDF technique using COALITION, in the context of cervical degenerative disease. The operative time, ambulation start, hospital stay, and dysphagia and dysphonia were measured. Results The patients had an average age of 51.64 ± 9.78 DE, on a male/female ratio of 16/15. A total of 53 levels were obtained (C3–C4: 3, C4–C5: 12, C5–C6: 20, and C6–C7: 18). The operative time was an average of 167.64 ± 50.28 minutes, using autologous iliac crest graft. The ambulation start time was 1 day (range, 1–2 days), with a hospital stay of 4 days (range, 2–7 days). The immediate dysphagia in postoperative was 56.25%, from this 77.77% was mild according to Bazaz score. Only 22.2% of the patients with immediate dysphagia persisted with a mild level, according to Bazaz score after 1 week of discharge from hospital. None of the patients presented chronicle dysphagia. Only four patients presented dysphonia symptoms that remitted spontaneously. Conclusion The new zero-profile implant demonstrated good postoperative results, with a low dysphagia and dysphonia prevalence, and these were completely resolved in all the cases.
Comparison of Allograft and Polyetheretherketone Cage in Anterior Cervical Discectomy and Fusion
Authors: Santos Edward Rainier , Yson Sharon , Sembrano Jonathan 
Published: May 2015

Introduction Structural allografts and PEEK cages are commonly used as interbody fusion devices in ACDF. The subsidence rates of these two spacers have not yet been directly compared. The primary aim of this study was to compare the subsidence rate of allograft and PEEK cage in ACDF. The secondary aim was to determine if the presence of subsidence affects the clinical outcome. Methods We reviewed 67 cases (117 levels) of ACDF with either structural allograft or PEEK cages. There were 85 levels (48 cases) with PEEK and 32 levels (19 cases) with allograft spacers. All surgeries were performed by a fellowship-trained spine surgeon from November 2005 to September 2012. Immediate postoperative and 6-month lateral cervical radiographs were evaluated for subsidence by measuring the anterior disc height and posterior disc height at each operative level. Subsidence was defined as a decrease in anterior or posterior disc heights > 1 mm. The subsidence rate between the two groups was compared using the chi-square to test for significance (α = 0.05). NDI was recorded to evaluate the clinical outcome of the subsidence (SG) and nonsubsidence groups (NSG). t-test was used to test for difference between the two groups (α = 0.05). Results There was no statistically significant difference between subsidence rate of the PEEK group (54%; 46/685) and the allograft group (59%; 19/32) ( p = 0.69). Overall mean subsidence was 1.0 ± 1.3 mm anteriorly and 1.2 ± 1.2 mm posteriorly. The mean NDI improvement was 11.7 (from 47.1 to 35.4; average follow-up: 12 months) for the SG and 14.0 (from 45.8 to 31.8; average follow-up: 13 months) for the NSG ( p = 0.74). Conclusion The subsidence rate does not seem to be affected by the use of either PEEK or allograft as spacers in ACDF. Furthermore, subsidence alone does not seem to be predictive of clinical outcomes of ACDF.
Comparison of Subsidence Rates of Large and Small Footprint Cages in Anterior Cervical Interbody Fusion
Authors: Sembrano Jonathan , Yson Sharon , Santos Edward Rainier 
Published: May 2015

Introduction Subsidence rates after ACDF have been reported widely in literature and range from 0 to 57%. Polyetheretherketone (PEEK) cages are one of the most commonly used interbody spacers. Although subsidence rates of different types of cages have been described, there are still no data on the effect of cage footprint size on subsidence. The primary aim of this study was to compare the subsidence rate between small and large footprint polyetheretherketone (PEEK) cages. The secondary aim was to determine if a correlation exists between subsidence and health outcome scores. Methods We performed a retrospective medical chart and radiographic review. Two fellowship-trained spine surgeons performed the surgeries from November 2008 to January 2013. Immediate postoperative and 6-month lateral cervical radiographs were evaluated for subsidence. Anterior and posterior disc heights at each operative level were measured. Subsidence was defined as a decrease in anterior or posterior disc height of > 1 mm. Cases were then designated to either the subsidence group (SG) or nonsubsidence group (NSG). Small footprint cage group (SF) consisted of PEEK cages measuring 14 × 11, 14 × 12, or 12.5 × 11.5 mm. Large footprint cage group (LF) consisted of cages measuring 15 × 13, 16 × 14, or 18 × 16 mm. Subsidence rates of the SF and LF groups were compared using chi-square test (α = 0.05). Preoperative and final (minimum 6 months) postoperative Neck Disability Index (NDI) scores of the SG and NSG were compared using t-test (α = 0.05). Results We reviewed 140 levels (71 cases*) of ACDF using small and large footprint PEEK cages. The small footprint group had 45 cases* (79 levels) and the small footprint group had 27 cases* (61 levels) with large footprint cages (* one case had both large and small footprint cages implanted on different levels) . There was a statistically significant difference between the subsidence rates of SF (54%; 43/79) and LF (30%; 18/61) ( p = 0.003). Fig. 1 breaks down the subsidence rate by cage size. Overall mean subsidence (SG) was 1.6 ± 1.1 mm anteriorly and 1.9 ± 1.1 mm posteriorly. Mean NDI improvement was 8.8 ± 23.2 mm (average follow-up: 13 months) for the SG and 22.9 ± 18.8 (average follow-up: 13 months) for the NSG ( p = 0.01). Conclusion Use of large footprint cages seems to have a protective effect against subsidence. Furthermore, cage subsidence > 1 mm results in less clinical improvement. [Figure: see text]