bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimally Invasive Stereotactic Separation Surgery for Resection of Metastatic Spine Lesion: A Feasibility Study
Authors: Nasser Rani , Yassari Reza , Sharan Alok 
Published: May 2015

Introduction The current treatment of spinal metastasis consists of algorithms combining reconstructive surgical and radiation modalities. Recently, the concept of separation surgery followed by adjuvant stereotactic radiosurgery (SRS) was shown to be a safe and effective treatment to achieve long-term local tumor control. We examined the possibility of a minimally invasive approach to separation surgery first in a cadaveric feasibility study and then in a patient cohort with spinal metastasis in conjunction with intraoperative computer-assisted navigation. Methods A cadaveric study using standard minimally invasive access systems examined the feasibility of spinal cord decompression in the thoracic and lumbar spine. Subsequently, 10 patients (7 males and 3 females) with spinal metastasis underwent minimally invasive separation surgery (MISS) and percutaneous pedicle screw fixation using intraoperative navigation or standard fluoroscopy. The O-arm three-dimensional imaging with stereotactic navigation was used intraoperatively to localize and guide the resection of the metastatic spinal tumors. All patients were at least 3/5 strength in the lower extremities preoperatively. Pre- and postoperative CT scan and CT myelography were used to evaluate the degree of decompression. Endpoints included neurological function, operative time, estimated blood loss, incision length, hospital stay duration, and complications. Results The cadaveric study demonstrated a proof of principle with a wide decompression of the spinal cord. For the operative cases, the postoperative imaging demonstrated excellent separation that meets the requirements for safe SRS. All patients remained at/or improved their neurological baseline with excellent pain control. One patient incurred a perioperative complication (pulmonary embolism). The mean estimated blood loss was 290 mL. The mean incision length was 4.9 cm. The operative time mean was 5.2 hours and the mean length of stay was 7.5 days. Conclusion MISS for spinal metastasis allows for a circumferential decompression of the spinal cord and safe postoperative SRS. In addition, we demonstrated the efficacy of intraoperative navigation in guiding the resection. Future prospective enrollment of patients can help to determine which patients would be ideal candidates for MISS and if the smaller incision and an enduring faster healing process can allow a faster start of radiation and chemotherapy.
Functional Recovery and in Vivo Cell Tracking after Human Adipose Tissue-Derived Stem Cells Therapy for Experimental Spinal Cord Injury
Authors: Vialle Emiliano , Kuniyoshi Rebelatto Carmen Lúcia , Barchiki Fabiane , Fracaro Letícia , Lamartini Antonione , Hamamoto Lucas , Argenton Soraya , Arruda André , Conrad Samuel , Brofman Paulo Roberto , Vialle Luiz Roberto 
Published: May 2015

Introduction The use of human adipose tissue-derived stem cells (hADSC) as therapy in spinal cord injury (SCI) is a promising approach for the recovery of motor function of injured patients. This study aims to evaluate the effects of hADSC, applied to the cauda equina in an animal model of blunt spinal trauma, on their motor function. A secondary aim is to analyze cell migration toward the injury site. Method All samples were collected after an informed consent had been obtained in accordance with guidelines for research involving human subjects, and with the approval of the ethics committee (approval number 769). A total of 40 Wistar rats were anesthetized, injured at Th10 using the NYU impactor device and randomly divided into four groups: Group A, animals were submitted to one culture medium injection immediately after injury; group B, animals were submitted to two culture medium injections, immediately after and 7 days postlesion; group C, animals were submitted to one cell injection (1 × 106 cells) immediately after injury and group D, animals were submitted to two cell injections, immediately after and 7 days postlesion. Standard animal care, according to the university's protocol was maintained for 40 days with motor analysis every 72 hours using the Basso, Beattie, and Bresnahan (BBB) scale. Some animals were transplanted with luc gene-transduced cells to evaluate cell migration, which was assessed by in vivo bioluminescence images of animals in groups C and D (IVIS Lumina II). Results A statistically significant recovery of motor function was observed in animals transplanted with hADSC compared with the control group ( p = 0.007 for one injection protocol, p = 0.005 for the two injection protocol). No differences were observed between one and two injection protocols ( p = 0.13). Bioluminescence analysis revealed cell migration to the injury site after injection. Conclusion hADSC injected at the cauda equina migrate toward the injury site and promote significant motor recovery.
Association between BMP-2 and COL6A1 Gene Polymorphisms with Susceptibility to Ossification of the Posterior Longitudinal Ligament of the Cervical Spine in Korean Patients and Family Members
Authors: Kuh Sung-Uk , Kim Kyung-Hyun , Park Jeong-Yoon , Kang Moo-Sung , Ryu Dal-Sung , Lee Won-Chul 
Published: May 2015

Introduction: COL6A1 and BMP-2 genes have been implicated in ossification of the posterior longitudinal ligament (OPLL) susceptibility in Japanese and Chinese Han populations. However, no study has yet investigated the DNA of unaffected family members of patients with OPLL. This study investigated differences in genetic polymorphisms of BMP-2 and COL6A1 between Korean patients with OPLL and their family members (with and without OPLL). Patients and Methods A total of 321 patients (110 patients with OPLL and 211 family members) were enrolled in the study. Associations between two single nucleotide polymorphisms (SNPs) of the BMP-2 gene (Ser37Ala and Ser87Ser) and two SNPs of COL6A1 (promoter [−572] and intron 33 [+20]) with susceptibility to OPLL of the cervical spine were investigated between the two groups (OPLL+ and OPLL − ). Results Of the 321 patients, 162 had cervical OPLL (50.4%; 110 patients, 52 family members). There was a familial tendency of OPLL in 34 of the 110 families (30.9%). Allele and haplotype frequencies of the four SNPs in the BMP-2 and COL6A1 genes did not differ significantly between the OPLL+ and OPLL− groups, even when excluding participants over 50 years of age. Conclusions This is the first report identifying SNPs of COL6A1 and BMP-2 in Korean patients and family members with OPLL. Although allele and haplotype frequencies were similar to those of a previous study in Japanese and Chinese patients, unaffected family members also showed similar rates of these SNPs in the present study. These results suggest that these SNPs may not directly influence the expression of OPLL.
Multilevel Cervical Arthroplasty versus Multilevel Fusion in Three-Level Cervical Disc Disease (Clinical and Radiological Outcomes)
Authors: Vorsic Matjaz , Bunc Gorazd , Velnar Tomaz , Ravnik Janez 
Published: May 2015

Introduction The surgical treatment for cervical disc disease increased in the last decade using different surgical techniques. The percentage of the patients being surgically treated for three-level cervical disc disease remains small therefore the optimal surgical approach for these patients remains the subject of discussion. Multiple cervical disc arthroplasty, multilevel fusion, and hybrid procedures are among the options using the anterior approach. The aim of the study was to compare the multilevel cervical disc arthroplasty and multilevel fusion and compare clinical as well as the radiographic results in patients treated for three-level symptomatic cervical degenerative disc disease 2 years after the surgery. Methods Overall, 23 patients with three-level symptomatic cervical degenerative disc disease were treated with complete anterior cervical discectomy and either with ProDisc-C disc arthroplasty or with fusion using Cervios chronoOS prostheses (ACDF) or standalone cervical cages. Overall 8 multilevel arthroplasty and 14 ACDF's procedures were performed. Clinical outcomes were assessed before and 12 and 24 months after the procedure using neurological examination, the neck disability index (NDI) and visual analogue scale (VAS) for neck and arm pain, with 15% improvement in NDI and 20% in VAS defined as clinically significant. Comparison between both groups (arthroplasty and fusion group) was based on clinical outcomes using neurological examination, VAS, NDI, and patient's satisfaction. Preoperative and postoperative ROMs (range of motion) were evaluated by measuring the lateral and flexion–extension radiographs. Results Both groups had a statistically significant improvement in NDI and VAS for neck and arm pain ( p < 0.05), 2 years after the surgery and the arthroplasty group had a slightly better improvement according to NDI (71.4% of patients in the arthroplasty group achieved ≥ 15% improvement in NDI and 67.5 of patients in ACDF group). The arthroplasty group showed faster recovery of C2 to C7 range of motion. There was a statistically significant difference in the C2 to C7 ROM between the two groups at 12 and 24 months postoperatively ( p < 0.05). The ROM of the arthroplasty group approached the preoperative value at 12 months however it decreased again at 24 months. Conclusions Disc arthroplasty can be an effective alternative in the surgical treatment for the multilevel cervical disc disease, preserving segmental motion after surgery and providing improvement in pain and functional outcome for the patients. The right surgical treatment for the three-level disc disease remains the subject of discussion and more long-term follow-up studies will be needed to determine the definitive treatment.
Histological Analysis of Degenerate Discs (Disc Study)—is there Support for Infection as a Possible Etiology for Disc Degeneration?
Authors: Ganko Renata , Rao Prashanth , Salisbury Elizabeth , Lambert Neil , Mobbs Ralph J. 
Published: May 2015

Introduction A controversial study implicated bacterial factors in chronic back pain and reported a potential treatment option with long-term antibiotics. Currently, a multicentric case–control study is being conducted looking at bacterial in surgical disc specimens: Is growth a true infection or a contaminant? A histopathological arm has been added to aid in this differentiation. The aim of this study was to look for histopathological evidence of degeneration and inflammation and to identify histological differences in surgically excised disc samples of patients who grew bacteria on disc cultures compared with those that did not. Material and Methods A subset of patients as a part of a DISC study operated at Prince of Wales Public and Private Hospitals, Sydney were included in the study. The study was approved by HREC 13/218 started in 2013 and is ongoing. Cervical and lumbar disc samples were sent for both bacterial culture and histopathology. Histopathology was graded by two independent pathologists (blinded to culture results) using the previously evidenced histologic degeneration score (HDS) and a newly devised disc inflammatory score (DIS). Demographic factors, surgical factors and MODIC changes on MRI were correlated with histopathology data. Results There were 125 samples from 104 patients. Of the patients, there was a 54:50, male to female ratio. Discs levels from the cervical and lumbar regions were sampled (45:80, respectively). Of the total number of samples 33/125 (26.4%) grew bacteria, and 57.6% (19/33) of these grew Propionibacterium acnes. Using the HIS, only disc degeneration was found, with no significant evidence of inflammation in disc specimens. Conclusion In our histopathological study, there was no evidence of inflammation in degenerate discs and no differences in histopathology between positive and negative disc cultures. This raises a strong possibility of contamination in positive cultures of disc samples. In addition to this, there is further validation required of the new DIS score.
Neuronavigated Percutaneous Treatment of Thoracolumbar Spine Fractures
Authors: Conti Carlo , Carletti Sandro 
Published: May 2015

Introduction Treatment goals of amielic thoracolumbar spine fractures are the stabilization of traumatized segment, possibly restoring the physiological spine curvature, and vertebral healing or fusion of the affected segment. Percutaneous minimally invasive techniques are becoming a viable option in the treatment of selected thoracolumbar fractures; intraoperative neuronavigation of biplanar fluoroscopy associated with preoperative CT scan allows precise pedicle insertion and reduces intraoperative X-ray exposure. Materials and Methods Over a period of 2 years, 43 patients with thoracolumbar fractures at our institution were elected for minimally invasive surgery using neuronavigated technique. All patients experienced one or two thoracolumbar fractures (varying from A3.1 to B2.3, according to the AO/Magerl classification) without neurological deficits. Pain profile was assessed by visual analog scale (VAS) and all radiological findings were evaluated with vertebral body index (VBI), vertebral body angle (VBA), and Cobb angle. Procedures used for treatment include kyphoplasty alone and short segment percutaneous pedicle screw fixation with or without vertebral body augmentation. All the procedures were performed under general anesthesia, but for collaborating patients who need kyphoplasty analgosedation was used. Clinical mean follow-up was 15 months (2–24 months) and has been assessed with VAS and the ability to return to their original lifestyle and/or occupation; radiographic postoperative evaluation consisted of X-ray for kyphoplasty patients and CT for those instrumented to determine the accuracy of screw placement. Results The mean surgical duration was 92 minutes (passing from 32 minutes for the fastest kyphoplasty to 170 minutes for the slowest fixation). There was no case of screw or needle malposition during kyphoplasty. Total radiation exposure was 54 seconds. Postoperatively, almost all the patients improved their symptoms and nobody needed reoperation because of postoperative complications, except for a case in which an initial screw pull-out was stopped with a second stage kyphoplasty. Conclusion Neuronavigation in minimally invasive spine surgery represents a viable solution for the treatment of amielic thoracolumbar fractures. Minimal invasive techniques have been shown to reduce blood loss, postoperative pain, and hospitalization; with the neuronavigated support, there is also a sensible reduction in X-ray exposure of patients and operative room operators.
Effects of Single versus Hypofractionated Focused Radiation Therapy on Vertebral Structure and Biomechanical Integrity
Authors: Holmes Christina , Elder Benjamin , Lina Ioan , Liauw Jason , Lo Sheng-Fu Larry , Mao Annie , Naumann Matthew , Theodros Debebe , Puvanesarajah Varun , Witham Timothy 
Published: May 2015

Introduction Stereotactic radiosurgery has shown great promise in the treatment of metastatic lesions within the spine. However, recent clinical studies have indicated that the procedure may increase the risk of developing vertebral compression fractions, particularly in osteoporotic patients (Rose et al, 2009. J Clinical Onc. 27(29):5075; Boehling et al, 2012. J Neurosurg Spine. 16:379). There is thus a critical need for research examining the effects of focused radiation on bone quality and mechanical properties. We have developed a rabbit model which enables the analysis of the effects of focused radiation on vertebral osteonecrosis, structure, and biomechanical integrity. Using this model, we are testing the hypothesis that fractionation of radiation dosing can reduce radiation osteonecrosis and preserve structural and biomechanical integrity of the spine. Material and Methods The L5 vertebral body of New Zealand White (NZW) rabbits was treated, under computerized tomography (CT) guidance, with either a single 24 Gy dose of radiation or three fractionated doses over 3 consecutive days of 8 Gy radiation via the small animal radiation research platform (SARRP) (Wong et al, 2008. Int J Radiat Oncol Biol Phys. 71(5): 1591). Effects of radiation treatment on L2, L4, L5, and L6 vertebral osteonecrosis, structure, and biomechanical integrity were evaluated 6 months postirradiation via high-resolution CT imaging (Skyscan, Bruker, Belgium), histology, and nondestructive biomechanical compression testing and were compared with nonirradiated controls. Vertebral bone volume over total volume (BV/TV), trabecular thickness (Tb.Th.), and trabecular spacing (TB.Sp) were evaluated from CT images via CTAn software (Bruker, Belgium). Result/Conclusion: Results till date suggest that a localized single dose of 24 Gy radiation leads to loss of vertebral bone volume and trabecular number and a subsequent increase in trabecular spacing. Similarly, hypofractionation of the radiation dose (3 × 8 Gy) leads to reduced trabecular number and increased trabecular spacing, yet preserves normalized bone volume. Whether these changes in bone morphology translate into reduced mechanical integrity is currently under analysis. Future work will utilize this model to evaluate the efficacy of various therapies, such as teriparatide (PTH [1–34]), in the prevention of radiation-induced osteonecrosis.
Cosmetic and Radiological Outcome after Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis Patients: A Comparison of Anterior versus Posterior Approaches
Authors: Liu Hao , Liu Zhen , Zhu Zezhang , Qian Bang-Ping , Wang Bin , Yu Yang , Zhu Feng , Sun Xu , Qiu Yong 
Published: May 2015

Introduction Improving cosmesis is an important aim of the AIS surgery. Anterior and posterior instrumentations are two established methods of correcting Lenke 5C AIS. Both methods have respective advantages and disadvantages. However, there was no detailed report in the literature focusing on the comparison between the cosmetic and radiographic outcomes of these two methods. The objective of this study is to evaluate and compare the cosmetic and radiographic outcomes of anterior versus posterior instrumentation in Lenke 5C AIS. Materials and Methods A retrospective analysis was conducted in 68 consecutive female Lenke 5C patients who had surgery between 2006 and 2010. Thirty-two patients had anterior surgery (Group A) and 36 patients had posterior surgery (Group B). Patients were evaluated at a minimum follow-up of 2 years. Cobb angles, apical vertebral translation (AVT), and apical vertebral rotation (AVR) were measured in the standard long-standing posteroanterior radiographs. Waistline height index, waistline depth index, waistline area index, waist area index, and hump index (α) were measured clinically and the five parameters combined into a composite cosmetic index (CCI). Cosmetic and radiologic outcomes of both Groups A and B were evaluated and compared. Results The mean age, preoperative CCI, major curve magnitude, number of levels involved in the major curve, AVT, and AVR were similar for the anterior and posterior groups (age: 16.25 vs. 16.00 years; CCI: 53.76 vs. 52.65; curve size: 45.67 vs. 46.33 degrees; number of levels: P50 = 5 vs. P50 = 5; AVT: 17.39 vs. 18.40%; AVR: 2.13 vs. 2.24 degrees). There were significant increases noted in terms of correction of CCI before and after surgery in both groups ( p < 0.001). Average coronal correction of major curves was 89% at follow-up in Group A and 87% in Group B. No significant differences were observed regarding correction of CCI, Cobb angle, and AVT at last follow-up between both groups ( p > 0.05). However, significant differences were noted in Group A with regard to shorter fusion levels ( p < 0.001) and improved correction of AVR ( p < 0.05). There were no complications in either group which extended hospital stay or required an unplanned second surgery. Conclusion Anterior versus posterior surgery comparison in treating Lenke 5C AIS did not show any significant differences with regard to cosmetic and lumbar/thoracolumbar curve correction, but demonstrated shorter fusion levels and improved correction of vertebral rotation in anterior instrumentation group.
Incidence and Risk Factors of Proximal Junctional Kyphosis in Surgically Treated Young Children with Scoliosis
Authors: Sun Xu , Chen Xi , Zhu Zezhang , Wang Bin , Qian Bang-Ping , Yu Yang , Zhu Feng , Liu Zhen , Qiu Yong 
Published: May 2015

Introduction Proximal junctional kyphosis (PJK) is a well-recognized postoperative phenomenon in adults and adolescents after scoliosis surgery; however, no reports have addressed the incidence, risk factors, and behavior of PJK in young children following spinal correction surgery. The objective of this study is to determine the incidence, risk factors, and behavior of PJK in young children undergoing posterior instrumented spinal fusion. Materials and Methods This study reviewed 61 consecutive young children with congenital scoliosis treated with posterior instrumented spinal fusion (≥ 4 levels) from 2009 to 2011 in our center. They were younger than 10 years at surgery and had a UIV located between TI and T11. They were followed-up for at least 2 years. PJK was defined by a proximal junctional angle greater than 10 degrees and at least 10 degrees greater than the corresponding preoperative measurement. Radiographic measurements were performed preoperatively, immediately after surgery, and at latest follow-up, including proximal junctional angle (PJA), thoracic kyphosis, lumbar lordosis, kyphosis angles at T1–UIV, and UIV–T12, as well as the matching of rod contour. Matched rod contour referred to the difference between the proximal instrumented region angle and the proximal rod curvature less than 5 degrees. Comparison was performed between patients with and without PJK. Results The average age at surgery was 5.4 years (2–10 years) and the average follow-up was 2.7 years (2–4 years). PJK developed in 11 of the 61 patients (incidence, 18%). PJK group had larger preoperative thoracic kyphosis (48.7 vs. 36.3 degrees), longer fusion levels (9.2 vs. 6.8 levels), and larger amount of kyphosis correction (20.8 vs. 11.7 degrees). In addition, proximal instrumentation failure and unmatching of rod contour were identified as risk factors significantly associated with the occurrence of PJK. In the PJK group, average PJA increased by 14.4 degrees after 3 to 6 months postoperatively and then by 2.5 degrees until final follow-up. Six patients had screw pullout at the upmost instrumented vertebra but none complained of pain or appearance problems. They received brace treatment and their PJK was resolved. Conclusion This study demonstrated that 18% of young children were observed with PJK after correction surgery for congenital scoliosis. PJK mainly occurred within 6 months postoperatively, and its risk factors included preoperative hyperkyphosis and over correction of kyphosis, proximal instrumentation failure, and unmatching of rod contour. Brace treatment served as a salvage option for PJK in young children.