bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Nontraumatic Spinal Cord Injury
Authors: Zarate-Kalfopulos Baron , Robles-Ortíz Ricardo , Obil Chavaria Claudia , Jiménez González Adriana , Reyes-Sánchez Alejandro 
Published: May 2015

Introduction This study aims to evaluate the epidemiologic characteristics of patients with diagnosis of nontraumatic spinal cord injury (NTSCI) in a tertiary care hospital in Latin America. Patient and Methods: Retrospective single center study including 122 patients who were discharged between January 2005 and December 2012 from their initial inpatient rehabilitation after the onset of NTCSI confirmed by clinical and image studies. Descriptive statistics were performed for demographic characteristics, etiology, and the degree of neurological injury. Results From 585 patients admitted with diagnosis of spinal cord injury during the study period, 122 had NTSCI, the prevalence of NTSCI in our center was 20.9%. Of these 122 patients, 35 patients were excluded for the following different reasons: incomplete patient data in 22, 9 patients with cerebrovascular disease associated, and 4 patients with associated lesions below L2 level. Overall, 87 patients were included in the final statistical analysis, 48% male and 35.6% female. The mean age was 45.2 years, marital status of patients was 42.5% married and 29% single. Overall, 34% of patients had elementary education and 35.6% of patients were unemployed before NTSCI occurred. The lesions were classified using the American Spinal Injury Association Impairment Scale (AIS) results was AIS D (motor incomplete) in 40.22%, C (motor incomplete) in 14.94%, B (sensor incomplete) in 19.54%, and A (complete) in 24.13% of patients. The most frequent etiology was tumoral cord compression in 50 patients (57.4%) in 47 of these patients lesions were metastatic (94%) and 3 (6%) primary bone tumors. The second most frequent etiology was cervical or thoracic degenerative disease causing myelopathy in 17 patients (19.5%) followed by transverse myelitis in 9 patients (10.3%), and vertebral osteomyelitis in 7 patients (8%), arteriovenous malformations was present in 2 patients (2.29%), and undetermined in 2 patients (2.29%). Conclusion The results confirm that nontraumatic spinal cord injury represents a significant proportion of the population with spinal cord injury with a prevalence of 20.9%. Males with median age of 45 years are more frequently affected. The most common etiology is metastatic spinal lesion in 54% of patients. Most of the neurological lesions are classified as incomplete (75.87%) using the AIS scale. Epidemiological data of spinal cord injury is needed for an effective implementation of primary prevention strategies, appropriate management programs, and allocations of health resources in the field of spine surgery and rehabilitation care.
Will Immediate Postoperative Imbalance Improve in Patients with Thoracolumbar/Lumbar Degenerative Kyphoscoliosis? A Comparison between Smith–Petersen Osteotomy and Pedicle Subtraction Osteotomy with an Average 4 Years' Follow-Up
Authors: Qiu Yong , Bao Hongda , Zhu Feng , Qian Bang-Ping , Wang Bin , Sun Xu , Yu Yang , Liu Zhen , Zhu Zezhang 
Published: May 2015

Introduction There was a paucity of literature paying attention to the postoperative imbalance after pedicle subtraction osteotomy (PSO) or Smith–Petersen osteotomy (SPO) and natural evolution of the imbalance. This study aims to compare compensatory behavior of coronal and sagittal alignment following PSO and SPO for degenerative kyphoscoliosis. Patients and Methods A retrospective study was performed on 68 consecutive patients with degenerative kyphoscoliosis treated by lumbar PSO (25 patients) or SPO (43 patients) procedures at a single institution. Long-cassette standing radiographs were taken preoperatively, postoperatively, and at last, follow-up and radiographic parameters were measured. The LIV and level of osteotomy were compared between the patients with and without improvement. Results Negative SVA was observed in PSO group postoperatively, implying an overcorrection of SVA. This negative SVA improved spontaneously during follow-up ( p < 0.05). Coronal balance was found to worsen immediately post-op in the SPO group ( p < 0.05). At the last follow-up, spontaneous improvement was observed in 15 patients and the average CB decreased to 16.35 mm. For the 15 patients with improved CB, fusion at L5 or above was more common compared with the 11 patients with persisted postoperative imbalance ( p = 0.027), whereas no difference in term of levels of osteotomy was found ( p > 0.05). Conclusion The overcorrection of SVA is more often seen in PSO group. The coronal imbalance is more likely to occur in SPO group. The postoperative sagittal imbalance often spontaneously improves with time. LIV at S1 or with pelvic fixation should be regarded as potential risk factors for persistent coronal imbalance in patients with SPO.
Transoral Decompression and Posterior Stabilization in Fixed Anterior Pathology of the Craniocervical Junction
Authors: Paidakakos Nikolaos , Sklavounou Maria , Bouramas Dimos 
Published: May 2015

Introduction Management of the anterior compressive pathology of the craniovertebral junction (CVJ) is complex and demanding. We review our experience with the transoral surgical decompression of fixed anterior CVJ lesions, with particular attention to the decision making and to the indication for a consecutive stabilization. Patients and Methods Retrospective study (2000–2013) of 47 consecutive patients (14 males and 13 females). Mean age was 59.2 years (range, 32–82 years). Encountered lesions were rheumatoid arthritis with pannus (29, 9 of which with associated cranial settling), ankylosing spondylitis (four), tumors (seven: six extradural chordomas/chondrosarcomas and one metastasis), odontoid fractures with hypoporosis, and rotational instability (seven). Patients presented with a variety of following symptoms: high cervical pain (82%), varying degrees of quadriparesis (64%), lower cranial nerve deficits (23%), and central cord syndrome with neurogenic bladder (14%). All patients underwent one-stage transoral decompression and consecutive posterior atlantoaxial or occipitocervical stabilization. Clinical evaluation was made pre- and postoperatively using the Ranawat score. Follow-up period ranged between 6 and 48 months (average, 22 months). Results According to the Ranawat score, we had 21 grade I patients, in 20 of which pain was eradicated, 10 grade II patients, 8 of which passed to grade I, 11 grade IIIA patients, of which 6 passed to grade I and 5 to grade II, and 5 grade IIIB patients of which 4 passed to grade IIIA. In seven patients, the transarticular screws crossed the anterior cortex of the atlas, without clinical manifestations. In five patients, complete reduction of the C1–C2 rotation was not possible, because of the chronic nature of the defect. Surgical morbidity occurred in five cases (three dural tears and two occipital wound infections). There were two perioperative deaths ([a] dural rupture, pneumoencephaly, meningitis, and massive pulmonary embolism, [b] pulmonary infection, and cardiorespiratory arrest). Conclusion Successful and stable decompression of the CVJ requires extensive preoperative evaluation, appropriate tailoring, and adequate expertise. The transarticular C1–C2 fixation is a safe and effective stabilization method when the atlanto-occipital joints remain competent. Complications appear mostly in patients with rotational deformity of the C1–C2 complex. Patients with clinical and radiological findings of myelopathy improve less even if surgery is successful.
Spinal Injury in Pediatric Population: Review of 152 Cases
Authors: Bansal M. L. 
Published: May 2015

Introduction Injury to the spinal cord and the spinal column is relatively uncommon in pediatric population. It accounts for roughly 5% of the total spinal cord injuries. SCI in children younger 5 years are even rarer. Objective of the study was to analyze the incidence, type of spinal injuries, and epidemiological parameters in Indian children with spinal injury admitted at Indian Spinal Injury Centre (ISIC). Patients and Methods Hospital medical records were reviewed and patients with the diagnosis of cervical spine injury in age group 0 to 18 years admitted between 2002 and 2011 were included. The injury characteristics of patients were compared across three groups of 0 to 9, 10 to 14 and 15 to 18 years of age. Results A total of 152 spinal injury patients were included in this study, which represents 10% of the total pediatric trauma admitted at our hospital. Boys (78%) were more commonly injured than girls. Fall (51%) was the most common mode of injury followed by motor vehicle accident. Cervical spine was the most common level of injury with 34% of cases followed by thoracic region with 30% of cases. However, the proportion of both genders, mode of injury, and levels of injury were not different across the age groups ( p < 0.05). Fracture was the most common pattern of injury in all age groups. SCIWORA was not very common (6.6%) in our study. Patients were divided according to ASIA scale in to complete and incomplete category. Outcome was measured on the basis of improvement in patient neurological level and their dependency level. Conclusion This retrospective study in Indian children is comparable with other international studies and provides important information regarding patient and injury characteristics of pediatric trauma cases.
Impact of Regional and Focal Cervical Alignment on Myelopathy Severity: Report of 151 Patients
Authors: Protopsaltis Themistocles , Fehlings Michael , Liu Shian , Smith Justin , Lafage Virginie , Shaffrey Christopher , Kim Han Jo , Arnold Paul , Chapman Jens , Lafage Renaud , Challier Vincent , Schwab Frank , Massicotte Eric , Yoon S. Tim , Ames Christopher 
Published: May 2015

Introduction Cervical sagittal alignment (C2–C7 SVA) has been correlated to myelopathy severity but kyphosis as a regional parameter has not been demonstrated to correlate with health-related quality of life (HRQOL) measures. We hypothesized that regional and focal sagittal cervical alignment may also correlate with HRQOLs in patients with cervical spondylotic myelopathy (CSM). Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 151 patients met inclusion criteria (47%): symptomatic CSM, age > 18 years, baseline lateral radiographs, modified Japanese Orthopaedic Association (mJOA) and neck disability index (NDI). Average age was 56.3 ± 11.7 years with females making up 43.9% ( n = 69) of the study population. Regional alignment and HRQOLs were analyzed with patients stratified into a high-cSVA group (hiSVA, n = 45, 0.5 SD ≥ mean) or a low cSVA group (loSVA, n = 43, 0.5 SD ≤ mean). Focal alignment (kyphosis and olisthesis between adjacent vertebrae) analysis was also conducted. Results The hiSVA (mean cSVA 39.4 ± 7.4 mm) cohort had a significantly worse mJOA than the loSVA (mean cSVA 11.31 ± 5.3 mm) cohort (mean mJOA 12.5 vs. 13.7, p = 0.037). No significant correlations between C2–C7 lordosis and HRQOLs existed. There were significant correlations with focal alignment and worse clinical assessments: max sagittal slip with mJOA ( R = −0.24, p = 0.002) and Nurick ( R = 0.18, p = 0.024). Level of slip was also significant, with olisthesis at higher levels correlating with worse health status. Number of kyphotic segments also positively correlated with NDI ( R = 0.19, p < 0.001). Conclusion Similar to previous studies, high baseline cSVA correlated with significantly worse mJOA. Interestingly, the mean cSVA of the hiSVA cohort was 39.4 ± 7.4 mm, suggesting that 40 mm may be a potential threshold below which cervical sagittal malalignment should be corrected. Regarding focal alignment, increased olisthesis is correlated with worse mJOA and Nurick grade, especially at higher cervical levels. Even focal abnormalities all along the cervical spine are correlated with worse NDI, demonstrating that while level of olisthesis may matter, the number of vertebrae with a kyphotic relationship may also cause pain and disability.
Posterior-Only Approach for Reduction of Occipitocervical Instability with Vertical Migration of the Dens
Authors: Paidakakos Nikolaos , Sklavounou Maria , Bouramas Dimos 
Published: May 2015

Introduction Occipitocervical instability with vertical odontoid migration is a rare but potentially debilitating anomaly. Anterior decompression followed by posterior stabilization is commonly used to address the pathology, but the former is associated with significant morbidity. More recently, posterior-only techniques have been described to obtain reduction and stabilization for nonfused cases of cranial settling. Patients and Methods Retrospective analysis of seven cases of patients (four males, three females, age range 34–73 years) who suffered from occipitocervical instability with reducible vertical dislocation of the odontoid in the setting of various underlying pathology. Six patients were myelopathic preoperatively. The neurological status was classified according to the Nurick scale. Pain was assessed according to the Visual Analog Scale. Radiological measurements included preoperative and postoperative evaluation of the position of the tip of the odontoid process in relation to Chamberlain, McGregor, McRae, and Wackenheim lines, and measurement of the Ranawat line, the clival angle, and the Klaus height index. Follow-up ranged from 8 to 42 months. Results Five patients improved neurologically, and one remained stable. Pain improved significantly in these patients, and was completely eliminated in three of them. Obvious reduction of the deformity was demonstrated by the postoperative radiological craniometric measurements. One patient did not improve neurologically. Postoperative imaging revealed a very small reduction with practically unchanged ventral compression of the cord. He underwent transoral decompression at a second stage. No patient suffered from severe complications. No screw pullout, loosening, or fracture of implant has been observed so far. Conclusion Modern screw–rod systems enable intraoperative correction of nonfused deformity and indirect decompression of the cervicomedullary junction obviating the need for ventral decompression or preoperative traction. Patient selection is critical to ensure successful application of the reduction maneuvers.
Surgical Outcomes of Cervical Disc Herniation Causing Deltoid Palsy: Multicenter Study
Authors: Park Jong-Beom , Chung Jae-Yoon , Chang Han 
Published: May 2015

Introduction In general, deltoid palsy develops in patients with cervical disc herniation (CDH) at the level of C4–5, resulting in compression of the C5 nerve root. Because of duplicate nerve innervation, however, deltoid palsy can also develop when CDH is at the levels of C3–4 and C5–6. To date, little has been known about the surgical outcomes of CDH causing deltoid palsy. We report on by far the largest series of CDH causing deltoid palsy focusing on surgical outcomes in the literature. Patients and Methods A total of 61 patients with CDH causing deltoid palsy (less than grade 3) were identified among 13 surgeons and included in this study. Average age of the patients was 51.4 years (range, 25–69 years), with 49 males and 12 females. Overall, 35 patients were soft disc and 26 patients were hard disc. Overall, 32 patients had single-level CDH (22 C4–5, 9 C5–6 and 1 C3–4), 22 had two-level (19 C4–5-6, 2 C3–4-5 and 1 C5–6-7), 4 had three-level (4 C4–5-6–7), 3 had four-level (3 C3–4-5–6-7). All the patients underwent surgery for deltoid palsy and arm pain not responding to conservative treatment: 57 ACDF, 2 ADR, and 2 foraminotomy and discectomy. Average follow-up was 20.7 months (range, 6–83 months). The severity of deltoid palsy was classified into five grades according to manual motor power test, and the severity of radiculopathy was recorded on a visual analog scale (VAS) of arm pain (0–10 points). The degree of improvement in both the severity of deltoid palsy and arm pain following surgery was evaluated. Patients with accompanying myelopathy, shoulder diseases, or peripheral neuropathy were excluded from the study. Results Average duration of deltoid palsy was 11.9 weeks (range, 1–156 weeks). Both deltoid palsy and radiculopathy improved significantly with surgery (2.4 vs. 4.5 grades, p < 0.001) and (6.4 vs. 2.1 points, p < 0.001), respectively. Of 61 patients, 36 (59%) patients achieved full recovery of deltoid palsy with an average time of 8.4 weeks (range, 1–54 weeks). Longer duration of deltoid palsy negatively affected the degree of improvement of deltoid palsy after surgery (correlation coefficient −0.351; p < 0.01). Severity of preoperative deltoid palsy, type of disc (soft disc or hard disc), and gender did not affect the degree of improvement of deltoid palsy after surgery. Conclusion This study demonstrates that surgical decompression significantly improves the degree of deltoid palsy and radiculopathy because of the CDH irrespective of the type of disc. The longer the duration of deltoid palsy preoperatively, the lower the degree of improvement of deltoid palsy postoperatively. Thus, early surgical decompression is recommended for improvement of deltoid palsy in patients with CDH.
The Impact of Dynamic Alignment, Motion, and Center of Rotation on Myelopathy Grade and Regional Disability in Cervical Spondylotic Myelopathy
Authors: Liu Shian , Lafage Renaud , Smith Justin , Protopsaltis Themistocles , Lafage Virginie , Challier Vincent , Shaffrey Christopher , Kim Han Jo , Arnold Paul , Chapman Jens , Schwab Frank , Massicotte Eric , Yoon S. Tim , Fehlings Michael , Ames Christopher 
Published: May 2015

Introduction Cervical stenosis is a defining feature of CSM. Matsunaga et al proposed that elements of stenosis are both static and dynamic, where the dynamic elements magnify the canal deformation of the static state. We hypothesize that dynamic motion may be associated with myelopathy severity and neck disability and present novel methods of dynamic motion analysis in CSM. Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 110 patients (34%) met inclusion criteria symptomatic CSM, age over 18 years, baseline flexion/extension radiographs, and HRQOLs (mJOA, NDI, SF-36, and Nurick grade). The mean age was 57 ± 12 years with 41% female ( n = 46). Correlations with HRQOLs were analyzed for regional and focal parameters in flexion and extension. Baseline dynamic parameters (F/E cone relative to a fixed C7, center of rotation, range of motion arc relative to the COR) were also analyzed for correlations to HRQOLs. Results At baseline, the mean HRQOLs demonstrated disability and the mean radiographic parameters demonstrated sagittal malalignment. Among regional parameters, there was a significant correlation between increased C2–C7 angle in flexion and Nurick grade ( R = 0.189, p = 0.048) with no significant correlations in extension. Focal parameters including C7 slip were significantly correlated with disability (Flex R = −0.377, p = 0.003; Ext R = −0.261, p = 0.027). Reduced flexion/extension motion cones, a more posterior center of rotation, and smaller range of motion correlated with worse HRQOLs. Conclusion Dynamic motion analysis may play an important role in understanding CSM. Focal parameters demonstrated a significant correlation with worse HRQOLs especially C7 slip in flexion and extension. Novel methods of motion analysis demonstrated reduced motion cones correlated with worse myelopathy grades. More posterior center of rotation and smaller range of motion were both correlated with worse general health scores (PCS and Nurick).
Safety of Cervical Spine Implant Anterior Cervical Decompression and Fusion with Zero Profile Interbody Fusion Device: A Retrospective Study
Authors: Vadhva Mukta , Khatri Manoj 
Published: May 2015

Introduction To assess the safety of Zero Profile Interbody fusion (Zero P) device in anterior cervical decompression and fusion (ACDF) for degenerative cervical stenosis. Patients and Method: A total of 89 consecutive patients treated with Zero P interbody device from September 2009 to September 2012 were included in this retrospective study. Inclusion criterion: Degenerative cervical stenosis with myelopathy, persistent radiculopathy after at least 3 months of failed conservative management. Exclusion criterion: Pediatric population; patients with infection, metastatic disease, and trauma. There were 39 females, 50 males with mean age of 55 years (ranging from 24 to 84 years). Overall, 56 (64%) had surgery at one level, 31 (35%) at two levels, 1 (1%) at three levels. Total number of levels operated were 121. Common levels operated were C56 (62%) and C67 (47%). Majority were operated because of the radicular symptoms, 56 (64%) had radicular symptoms, 28(31%) had myelopathy, and 5 (5%) myeloradiculopathy. Results All had a minimum of 6 months' follow-up (maximum 2 years). No patient had cage subsidence or extrusion. Overall, 1 patient had superficial infection which settled with antibiotics, 10 (11%) had dysphagia which settled in 6 to 12 weeks Conclusion Our study demonstrates that ACDF with Zero P can be considered a safe option in management of the patients with cervical degenerative stenosis. We would also recommend a prospective randomized study as a follow-up on to this retrospective study. Preoperative kyphosis or lordosis did not change the outcome or make the surgical technique any more difficult, hence, this implant can also be used in these circumstances.