bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphometric Features of Posterior Cranial Fossa are Different between Chiari I Malformation with and without Syringomyelia
Authors: Yan Huang , Zhu Zezhang , Liu Zhen , Qian Bang-Ping , Wang Bin , Sun Xu , Yu Yang , Zhu Feng , Qiu Yong 
Published: May 2015

Introduction To investigate whether the posterior cranial fossa (PCF) morphology in Chiari I malformation without syringomyelia (CMI only) is different from that in Chiari I malformation with syringomyelia (CMI-S). Patients and Methods A total of 14 patients with CMI and without syringomyelia constituted the CMI-only group, whereas 30 patients with CMI and syringomyelia were assigned to the CMI-S group. Another cohort of 30 age-matched asymptomatic adolescents was enrolled to serve as the control group. Six measurements were evaluated and compared between these three groups from T1-weighted magnetic resonance (MR) imaging, including the length of the clivus (AB), the anteroposterior diameter of the foramen magnum (BC), the length of the supraoccipital (CD), the anteroposterior diameter of the posterior fossa (DA), the posterior fossa height (BE), and the clivus gradient (∠α). The PCF morphology in relation to syrinx severity was also investigated. Results Compared with the normal controls, the AB, CD, DA, BE, and ∠α were significantly larger in the CMI-S group. Similar changes in AB, CD, DA, and BE were also demonstrated in the CMI-only group, whereas the clivus gradient (∠α) was found to be relatively normal when compared with the control group. A significantly decreased clivus gradient was observed in the CMI-S groups compared with CMI-only group. In addition, the clivus was significantly flattened in patients with a distended syrinx in comparison to those with a nondistended syrinx. Conclusion Small sizes of the posterior fossa were detected both in CMI cases with and without syrinx. The clivus gradient served as the only morphologic difference in the PCF between CMI-S and CMI-only patients and was correlated with the severity of the syrinx, may support the theory that the restricted circulation of cerebrospinal fluid at the anterior paramedial subarachnoid space contributes to the formation of a syrinx.
First Year Experience using an Interdisciplinary Hybrid Operating Theater for Spinal Surgery in a Level 1 Trauma Hospital
Authors: Richter Peter , Yarboro Seth , Kraus Michael , Gebhard Florian 
Published: May 2015

Introduction An interdisciplinary hybrid operating theater was established in June 2012 at the University of Ulm. A floor-based 3D flat panel robotic C-arm (Artis Zeego, Siemens, Germany) is connected to the operating table and the ceiling-based navigation system (BrainLab Curve, BrainLab, Germany). The robotic C-arm is controlled by the surgeon through a control panel mounted on the operating table in the sterile field. The large field of view of the flat panel C-arm allows visualization of the entire lumbar spine or pelvic ring with a single intraoperative 3D scan. This operating room is shared by four different disciplines (orthopedic surgery, neurosurgery, vascular, and cardiac surgery). This hybrid setup represents an advanced imaging and navigation system, and is the first of its type. Material and Methods We included all orthopedic surgeries performed in the hybrid operating theater during the first year. All the cases were reviewed for postoperative complications. Results A total of 92 cases in 91 patients were performed in the first year. Posterior stabilization of the spine was the most common procedure (57.6%) followed by sacroiliac screws (13%). Other procedures included tumor resection of the spine or pelvis, kyphoplasty, and fixation of acetabular and extremity fractures. Overall, 51.1% of the cases used navigation and 46.7% a minimally invasive technique. Complications included four postoperative seroma and two consecutive infections. All seroma and infections occurred in tumor resections. In large tumor resections, two neurological deficits were detected. Another patient developed dysphagia after fixation of an odontoid and atlas fracture. Conclusion None of the complications occurred because of the use of the hybrid operating theater instead of a conventional operating theater. The hybrid operating theater combines high quality, large field intraoperative imaging with advanced navigation. This results in a higher surgeon confidence in hardware placement and total tumor resection. The control panel mounted on the operating table enables the surgeon to operate this complex imaging device in the sterile field. The interdisciplinary use of the operating theater optimizes utilization.
Safety and Efficacy of Skipping C7 Instrumentation in Posterior Cervicothoracic Fusion
Authors: Tobin Matthew , Rangwala Shivani , Birk Daniel , Neckrysh Sergey 
Published: May 2015

Introduction Surgical manipulations at C7 level present the most difficulty during a posterior cervicothoracic fusion where instrumentation across the cervicothoracic junction is required. There is increased risk of vascular injury, neurological injury, and possibility of postoperative instability because of the surgical complications at this site. Placement of C7 instrumentation also poses additional difficulty during rod placement. Vertebral artery (when present) and C8 nerve roots are the most important structures susceptible to the surgical injury at C7 level. Our clinical observations suggested that skipping instrumentation at C7 in a multiple level posterior cervicothoracic fusion will result in minimal intraoperative complications, decreased surgical time, while still maintaining fixation, sagittal balance parameters, and successful rates of fusion. Methods This was a retrospective chart review of 49 patients (mean age: 62 years; range: 45–87 years) undergoing multilevel posterior cervicothoracic fusion between November 2010 and October 2014. Of the 49 patients, 42 had no screws placed at C7 level and 7 patients had instrumentation done at C7 and served as a control group. Assessment of the safety and efficacy of skipping C7 instrumentation were based on intraoperative complications, operative time, estimated blood loss (EBL), and radiographic evidence of fusion and spine stability. Results There were no intraoperative complications though two patients (one skipped and one not skipped) required extended time under anesthesia because of the difficulty in patient positioning and intubation. Skipping C7 resulted in reduced average operative time compared with those patients instrumented at C7 (203 vs. 171 minutes, respectively). In addition, skipping C7 reduced average EBL compared with patients instrumented at C7 (531 vs. 445 mL, respectively). In addition, patients skipped at C7 maintained sagittal balance with fusion rates identical to control patients at follow-up with a very low incidence of pseudarthrosis. Conclusion Skipping instrumentation at C7 in a multilevel posterior cervicothoracic fusion demonstrates lower EBL and faster operative times compared with performing instrumentation at the C7 level. In addition, in a postoperative assessment of patients undergoing posterior cervicothoracic fusion identical rates of fusion were achieved. Serious negative outcomes of skipping C7 were not found in this retrospective study. The results of this study point to the clinical benefits of skipping C7 to minimize surgical risk and complications in patients undergoing posterior cervical fusion across the cervicothoracic junction.
Immediate and Late Postoperative Pain Relief after Kyphoplasty using Unilateral Pedicular Access in Acute and Subacute Osteoporotic Dorsal Lumbar Vertebral Fractures
Authors: Feltes Carlos , Feltes Michelle 
Published: May 2015

Introduction Osteoporotic vertebral compression fractures (VCFs) are a significant cause of disability because of the pain in the elderly population. Kyphoplasty has been advocated as a treatment alternative for the successful management of these fractures in terms of immediate pain relief, and also for restoration of the premorbid level of daily activities. In this retrospective study, the authors report their experience in the period of 8 years (2007–2014) with the early and late management of VCFs with kyphoplasty using a unilateral pedicular approach. Patients and Methods A retrospective analysis was conducted in 80 patients (59 women and 21 men) whose ages ranged from 55 to 92 years (mean age, 73 years). The interval between onset of symptoms and surgical intervention ranged from 3 to 12 weeks. Overall, 90 levels (67 thoracic and 23 lumbar) were treated using the unilateral pedicular approach in this cohort. Immediate and early postoperative (3-month follow-up visit) visual analog scale (VAS) pain scores, activity levels, and restoration of vertebral body (VB) height were assessed. Results The mean preoperative VAS score was 8.4, whereas the immediate and early postoperative scores were 1.7. These findings reflected a resolution of 85 to 100% of preoperative pain. All patients resumed routine activities within hours of the procedure, although improvement in VB height was not accomplished in this cohort. No major complications were encountered in this clinical series. Conclusion Kyphoplasty using a unilateral pedicular approach in this cohort proved to be an effective method for the treatment of osteoporotic VCFs, although failure to restore VB height does not seem to interfere with the excellent pain management and good functional outcome provided by this procedure.
Influence of Nonorganic Signs on Patients undergoing Lumbar Fusion for Degenerative Disorders
Authors: Vialle Emiliano , Vialle Luiz Roberto , Oliveira Barbara , Gomez Juan 
Published: May 2015

Introduction Back pain is an important socioeconomic problem, and the results of the surgical management of lumbar degenerative disorders have a wide variation throughout the literature, possibly because of the several factors affecting pain level and perception in this group of patients. This study aims to evaluate the influence of nonorganic signs on the outcomes of lumbar fusion for degenerative pathologies. The secondary aim is to evaluate the capacity of physicians to identify patients at risk for poor results secondary to nonorganic signs. Material and Method: Prospective clinical study, with independent data collection and analysis pre- and postoperatively (6 months). Patient selection included those with indication for lumbar surgery secondary to lumbar degenerative pathology up to three levels, failure of conservative treatment for at least 6 months and capability to understand the questionnaires and the informed consent. Staff physicians evaluated patients subjectively regarding the presence of depressive and/or nonorganic signs; if the physician suspected that the patient had signs of depression or nonorganic signs, the patient would be excluded from the study. Overall, 60 patients were followed with DRAM, Zung, Oswestry disability questionnaire, presence of nonorganic signs, and VAS pre- and postoperatively. Data regarding spine pathology and patient's medical history were also collected. Results There were no significant differences regarding pain levels and surgical results between patients with ( n = 26) and without ( n = 30) nonorganic signs. The same happened with high (50% of the patients) and low scores using the DRAM and Zung evaluation of depressive symptoms. Conclusion Although results were similar in the subset of patients, this study showed that subjective analysis was not able to correctly identify patients with risk factors for depression, and that the application of specific questionnaires such as the ones in this study help to improve patient selection for lumbar spine procedures.
Trends in Operative and Conservative Treatments for Lumbar Disc Herniation and Radiculopathy
Authors: Fu Changfeng , Buser Zorica , Wang Justin , Smith Lance , Cohen Jeremiah , Wang Jeffrey 
Published: May 2015

Introduction Lumbar disc herniation is one of the major factors leading to lumbar radiculopathy. Both operative and nonoperative treatments have been shown to be effective in treating patients with lumbar herniated disc and radiculopathy. Even though both approaches can provide a rapid improvement, there are potential adverse events and rising costs associated with both, surgical and nonsurgical procedures. The aim of our study was to better understand the procedural trends, cost, and re-operative incidence in patients with lumbar herniated discs and radiculopathy. Patients and Methods Patients with lumbar herniated disc and radiculopathy from 2007 to 2010 were identified in the United healthcare database using ICD-9 and CPT codes. Treatment procedure were recorded and classified in the following three groups: surgical group, including discectomy, microdiscectomy, and endoscopic direct visualization discectomy procedures; minimally invasive group, including endoscopic assistance indirect visualization discectomy, intervertebral chemonucleolysis, and disc aspiration; and nonsurgical group, including bed rest, analgesics, nonsteroidal anti-inflammatory drugs, exercise, physical therapy, or epidural steroid injection. Data were collected and analyzed based on the patient age (< 40, 40–65, and > 65 years) and regional distribution (Midwest, Northeast, South, and West). Results A total of 162,682 patients were diagnosed with lumbar disc herniation with sciatica. There were 10,183 patients within the surgical group, 235 in the minimally invasive group, and 152,337 patients in nonsurgical group. There was a significant difference in procedure type based on the age and region. In < 40 years of age subgroup, there was an increase in the operation rates, 5.99, 6.15, 6.32, and 6.51%, from 2007 through 2010. The operation rates decreased with age, 6.95% (< 40 years), 5.65% (40–65 years), and 4.28% in > 65 years group. On the other hand, number of nonsurgical procedures increased with age and was 92.57, 93.99, and 95.32%, respectively. Surgical rates were the highest in the West region (7.58%) and the lowest in the Northeast (3.67%). Nonsurgical procedures had the opposite trends with the Northeast (96.18%) having the highest and West (92.31%) the lowest rate. Conclusion There was a difference in the operation rate based on the age and region distribution, with the subgroup < 40 years having the highest operation rate and the > 65 years of age subgroup having the lowest operation rate. The West region has the highest and the Northeast region has the lowest operational rate. Within the nonsurgical group, we observed opposite trends. Our next steps include cost analyzes and defining the surgical likelihood of patient having nonoperative procedures.
Efficacy of Topping-Off Surgery in Preventing Adjacent Segment Degenerative Stenosis of the Lumbar Spine: A Radiographical and Clinical Study
Authors: Hai Yong , Chen Xiaolong 
Published: May 2015

Introduction Adjacent segment degeneration or disease (ASD or ASDs) has been one of the most concerned issues after fusion of the lumbar spine. To investigate the radiographical and clinical outcome of adjacent segment degeneration after topping-off (posterior lumbar interbody fusion + above segment interspinous implant) procedure, a retrospective study was conducted. Materials and Methods All lumbar spinal stenosis cases from the department of orthopedics of Beijing Chaoyang hospital that received PLIF + above segment Coflex between August 2008 and October 2012 were analyzed retrospectively. Analysis the gender, age, body mass index of all the patients was done. The X-ray films before and after surgery were measured and got some data (total lordosis, the height of disc, range of motion, lordosis, and olithesis). One-year follow-up were examined by MRI, observed the degeneration of intervertebral disc. All data used SPSS 12.0 for analysis. Results There were 32 patients in topping-off (males 21 and females 11), including (L4/5 PLIF + L5–S1 Coflex) 12 patients in group 1 and (L3/4 PLIF +  L4/5 Coflex) 20 patients in group 2. Age averaged 61.5 years (range, 30–79 years) and follow-up averaged 24.6 months (range, 14–63 months). The average surgery time was 110 ± 21 minutes. The average blood loss was 401 ± 110 mL. Postoperation the ODI, JOA, and VAS score improved. There was no significant difference in the height of disc of the Coflex segment and above segment between before and after surgery. Segmental lordosis of Coflex and total lordosis were all increased significantly ( t = −1.9 and −2.0, p < 0.05). There was no significant difference in the number of the disc change of Modic grade of end plate ( p > 0.05). Conclusion Topping-off surgery is fit for the patients who have serious stenosis of lumbar spinal cord with mild and moderate stenosis of adjacent segment, which can restrict the adjacent segment's range of motion and prevent excessive olisthesis of adjacent segment in both extension and flexion, also can sustain the height of Coflex segment. It shows a good result after short-term follow-up. Topping-off surgery plays an active role in preventing the adjacent segmental degeneration.
Surgery in Pott Disease: Experience of 582 Cases
Authors: Alam Shah , Karim Rezaul , Islam Sieful , Jonayed Sharif Ahmed , Khalid Hasan , Chakraborty Shubhendu , Alam Tashfique 
Published: May 2015

Introduction Tuberculosis of the spine is the most common and dangerous form of TB infection accounting 50 to 60% of osseous tuberculosis. Although uncommon, spinal TB still occurs even in both developed and developing countries. The diagnosis of spinal tuberculosis is difficult and it commonly presents at an advanced stage. Delay in establishing diagnosis and management cause spinal cord compression and spinal deformity. Patients mostly present with lower limb weakness, Gibbus, pain, palpable mass, and kyphotic deformity in long standing cases. Material and Methods To evaluate the efficacy and clinical outcome of surgical treatment of spinal tuberculosis treated by different approaches consisting decompression surgery, autogenous bone grafting and anti-TB chemotherapy. Before that a strong evidence-based diagnosis must be established which can be done by clinical features, MT test, and MRI of spine. Because vertebral body collapse from TB may be misdiagnosed as compression fracture. A total of 582 patients who had tuberculosis of the cervical, thoracic, and lumbar spine with moderate-to-severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated at NITOR and BSOH, Dhaka, in the period from January 2003 to July 2014. Anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were done. Posterior decompression, posterior interbody, and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods. Appropriate anti-TB drugs were given to all patients for 18 to 24 months. The postoperative follow-up period was 12 months (range, 3–21 months). Results Overall, 427 (73.4%) cases with neurological deficits recovered totally or partially. No neurological improvement had occurred in 69 (11.9%) cases with paraplegia. Overall, 56 (9.6%) cases were lost from follow-up. X-ray showing bony fusion was achieved in all cases for mean of 6 months (range, 4–8 months). There was no recurrence. Seven (5.1%) cases developed bed sore postoperatively. Excellent result was seen in 70% cases, fair in 15%, good in 10%, and poor in 5% cases. Conclusion For patients with spinal tuberculosis anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion.
Long-Term Outcome of Deep Wound Infection following Lumbar Arthrodesis for Degenerative Disc Disease
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Volquind Daniel , Traynellis Vincent 
Published: May 2015

Introduction Deep wound infections are one of the most common and serious complications of spinal surgery. The impact of such infections on long-term outcomes is not well understood. The purpose of this study was to evaluate the functional status and satisfaction in patients who suffered a deep wound infection after undergoing lumbar arthrodesis for symptomatic degenerative disc disease. Patients and Methods The authors conducted a prospective study in 13 patients with a clinical and radiological diagnosis of symptomatic degenerative lumbar stenosis and instability; after undergoing decompression and instrumentation–augmented arthrodesis, the patients suffered a deep wound infection (infection group). A 3:1 (39 patients) matched cohort was selected for comparison (control group). All surgeries were performed during the same period and by a single surgeon. The postoperative infections were all treated in a similar manner and the instrumentation was not removed. Both groups were followed up and assessed with validated following outcome instruments: Numerical Rating Scale of pain, Oswestry Disability Index, 36-Item Short Form Health Survey, Beck Depression Inventory, and Hospital Anxiety and Depression Scale. Patient satisfaction was also determined. Results The median follow-up duration was 22 months (range, 6–108 months). The mean patient age was 62 ± 10 years, and 59.6% of the patients were female. There was no significant difference between the groups in pain, functional disability, quality of life, or depression and anxiety. However, 53.8% of the patients with infection were not satisfied with the procedure at the final evaluation, compared with 15.4% of the patients without a deep wound infection ( p = 0.003). Conclusion Patients with successfully treated postoperative deep wound infections do not have a difference in functional outcome compared with patients who underwent an identical operation but did not suffer a complicating infection. Patients who suffered an infection were more likely to be unsatisfied with the procedure than patients who did not.