bluuebunny/crossref_metadata_2025_split huggingface dataset:
Imaging Detection of Adjacent Ligamentous Injury Associated with Traumatic Cervical Spine Fractures: Implications for Treatment
Authors: Awad Basem I. , Carmody Margaret , Lubelski Daniel , Claridge Jeffry , Como John , Mroz Thomas E. , Moore Timothy , Steinmetz Michael P. 
Published: May 2015

Introduction Magnetic resonance imaging (MRI) is a vital tool for detection of instability and soft tissue trauma following cervical spine injuries (CSIs). However, high cost, prolonged imaging time, and limited use in hemodynamically unstable patients necessitates that the utility of MRI on all CSI patients be scrutinized. Methods A retrospective review was performed of all patients treated for a CSI at a level I trauma center between 2005 and 2010. Patients were identified using CT imaging and a subgroup underwent MRI. Adjacent level ligamentous injury (ALLI) was defined as supraspinous and interspinous ligaments and classified concerning the fracture level. We identified correlations between fracture type, level, and treatment strategy to develop guidelines for necessary MRI use. Results MRI was performed on 240/787 patients. Evidence of soft tissue injury was identified in 54.6% of these patients. ALLI was the most common soft tissue injury occurring in 80/240 of cases, which were then subdivided to either above (31/80), below (31/80) or both above and below (18/80) the concurrent fracture level. Patients with ALLI were significantly more likely to have injured C3 ( p < 0.01) and C5 ( p < 0.03), and present in association with widened disc space (13 vs. 4%, p = 0.03) and multiple CSI (1.7 vs. 1.5, p = 0.008). None of the patients who presented with ALLI above and below, and underwent surgical fixation, had the whole ALLI levels included in the fixation strategy. Contrary, 100 and 87% of patients with ALLI only above and only below, respectively, had the whole ALLI included. Conclusions MRI found an associated soft tissue injury in only 50% of imaged patients. Multiple fractured cervical levels, fractures particularly at C3 and C5, and widened disc space should all raise the treating physician's level of suspicion for ALLI. Our data shows MRI-directed treatment has substantial value in a select group of patients.
Avoiding Infertility after Spinal Cord Injury by Hyperbaric Oxygenation Therapy
Authors: Falavigna Asdrubal , da Silva Pedro Guarise , Conzatti Lucas Piccoli , Coberlini Louise , Cardoso Scheila , Peletti-Figueró Manuela , Paschoalotto Fabio 
Published: May 2015

Introduction After a primary mechanical injury in the spinal cord, a cascade of inflammatory events is triggered leading to the degeneration and death of potentially viable neuronal tissue. Besides motor loss, the injured patients suffer from erectile and ejaculatory dysfunctions, and spermatogenesis deficiencies. The objective is to study the efficacy of hyperbaric therapy in the acute phase in rats with spinal cord injury (SCI) to recover spermatogenesis. Materials and Methods Experimental study approved by the ethics and research committee. Eighteen rats were submitted to T9 spinal cord trauma by a 25 g weight drop using the MASCIS Impactor. They were allocated randomly to the hyperbaric therapy (HBT) and control group. The rats submitted to HBT had 1 hour sessions daily at 2 atmospheres of oxygen for 7 days. Previous works by the authors of this study support the HBT protocol chosen. The control group had supportive treatment. Testicular biopsies were performed by median abdominal incision in all rats on the 1st and 28th day of study. The samples obtained were soaked in hypoosmotic solution to evaluate the concentration of sperm per mL, number of round cells per field, number of infectious cells per field (peroxidase-Endtz test), and sperm viability (HOS test). The data were analyzed using SPSS software v.20, described by mean and standard deviation, and compared using the Student t-test or Mann–Whitney U-test according to the parametricity of the variable. A p-value of < 0.05 was considered significant. Results The mean concentration of sperm per mL did not change in the HBT ( p = 0.41) and control groups ( p = 0.74) over the 28 days of the study. The number of round cells and inflammatory cells per field was significantly greater in both groups on the 28th day. Sperm viability from day 1 to day 28 diminished two times more in the control ( p = 0.001) than in the HBT group ( p = 0.017) and sperm viability was significantly greater on day 28 in the HBT group as compared with the control group (86.67 ± 5.59% vs. 48.75 ± 21.83%) ( p < 0.001). The other variables analyzed did not present a statistically significant difference between the groups. Conclusion The SCI promote spermatogenesis deficiencies that can be partially recovered by the HBT performed in the acute phase of SCI. Sperm viability was two times greater in the HBT group when compared with the control group 28 days after the injury.
Cerebrospinal Fluid Phosphorylated Neurofilament Subunit NF-H (pNF-H) is a Specific Biomarker and Its Pattern is Predictive for Spinal Cord Injury
Authors: Iencean Stefan Mircea , Iencean Andrei Stefan 
Published: May 2015

Introduction In this study, we measured the phosphorylated neurofilament subunit NF-H (pNF-H) in the cerebrospinal fluid (CSF) of patients with spinal cord injury (SCI) and we set the correlation between the pNF-H levels and the severity of the injury. Patients and Methods The study included 20 patients with acute traumatic SCI: 12 patients with complete SCI and 8 patients with incomplete SCI. All patients were classified according to the American Spinal Injury Association Impairment Scale and all patients underwent surgery during the first 24 hours (decompression, stabilization). We measured daily the heavy phosphorylated neurofilament subunit (pNF-H) concentration by sandwich ELISA test in CSF of all patients and we correlated the values of pNF-H with the clinical evolution. Results For all patients with SCI, pNF-H was detectable in CSF samples and the values were different in the cases of complete SCI compared with the cases of incomplete SCI and the cerebrospinal pNF-H level was more elevated in cases of complete SCI. The level of CSF pNF-H was 10 to 100 times higher in complete SCI than in incomplete SCI, where the level was close to normal. The patients with a favorable neurological evolution after treatment had a specific pattern of daily values of NFP-H: a sudden increase up to a maximum value then a progressive decrease until normal. The maximum values were different in each case, from 10 times up to 200 times higher than the normal. Conclusions The phosphorylated form of the high molecular weight neurofilament subunit NF-H (pNF-H) in CSF is a specific biomarker for SCI and it can distinguish the severity of SCI. pNF-H is a predictive biomarker because its value pattern can show the reducing or stopping of the secondary lesion and the favorable result.
Clinical Outcomes of Sacral Chordoma Surgeries
Authors: Li Yan Michael , Rhines Laurence 
Published: May 2015

Introduction Chordoma is the most frequent primary spine tumor, with majority involved in the sacrococcygeal region. Because chordoma is rare, slowly growing, and locally aggressive, it is difficult to evaluate the effectiveness of treatment protocols and prediction of outcome. En bloc resection of primary sacral tumors is the primary modality. Rates of local recurrence and survival were dependent on negative surgical margins. Methods To assess our series of 36 sacral chordoma surgeries, emphasizing overall surgical and oncologic outcomes. Patients underwent sacral resections for chordoma at our institution between 1995 and 2011. Medical records of all patients were reviewed, including 36 patients who underwent primary en bloc sacral resections, either total and high sacrectomies by a combined anterior and posterior approach, or posterior-only en bloc midsacral resection. Results Sacral amputation was defined by the level: L5 (9 cases, 26%), S1 (8 cases, 23%), S2 (13 cases, 27%), and S3 (5 cases, 14%). Extent of resection was en bloc in 34 cases and intralesional in 2 cases. Flap reconstruction was performed in 29 cases (85%), with gluteal in 20 cases (69%) and VRAM in 9 cases (31%). All patients were followed-up 87 ± 54 months (range: 22–215 months) after surgery. Twenty-two patients have disease-free survival till date. Fourteen of the 34 patients who underwent en bloc resection had recurrence: 7 patients died 70 months after surgery and the other 7 survived 114 months after surgery. Among them, 5 cases had local sacral and iliac recurrence, while 10 cases had distal metastasis, such as liver, lung, and muscular skeleton. Conclusion En bloc sacral resections/reconstructions in patients with chordoma increase survival and decrease tumor recurrence.
Prognostic Variables for Local Recurrence and Overall Survival after Surgical Treatment of Sacral Chordoma: An Analysis from AOSpine Tumor Knowledge Forum Primary Spinal Tumor Retrospective Database
Authors: Varga Peter , Szövérfi Zsolt , Lazáry Aron , Gokaslan Ziya , Fisher Charles , Boriani Stefano , Dekutoski Mark , Chou Dean , Quraishi Nasir , Fehlings Michael , Rhines Laurence 
Published: May 2015

Introduction Sacral chordomas are rare, locally invasive, malignant neoplasms. Although, their surgical and oncological therapy has changed significantly over the last few decades, the prognosis is still poor. The objective of this study was to identify factors that have an impact on the overall and local recurrence-free survival of patients with sacral chordoma. Materials and Methods Utilizing the AOSpine Knowledge Forum Tumor multicenter ambispective database, surgically treated sacral chordoma cases were identified. Kaplan–Meier, log-rank test, and Cox regression modeling were used to assess the effect of several pre-, peri-, and postoperative variables on overall survival and local recurrence-free survival. Results A total of 167 patients with surgically treated sacral chordoma were identified. The male/female ratio was 98:69 with a mean age of 57 years (SD = 15) at the time of surgery (18–89 years). The local recurrence occurred in 35% ( n = 57) and death occurred in 30% of the patients ( n = 50) during the study period (5 days–16.2 years). The median overall survival was 6 years postsurgery and local recurrence-free survival was 4 years. In the univariate analysis, age ( p < 0.001) and preoperative motor deficit ( p = 0.003) were significantly associated with poor overall survival, and nerve root sacrifice showed a trend toward significance ( p = 0.088). Previous tumor surgery at the same site ( p = 0.002), intralesional resection ( p < 0.001), and tumor volume ( p = 0.030) were significantly associated with local recurrence. In the multivariate models, age and motor deficit were associated with poor survival, while previous surgery and intralesional resection were significantly related to local recurrence. Conclusion This study identifies two predictive variables for mortality (age and impaired motor function) and two for local recurrence (previous tumor surgery and intralesional surgery) in surgically treated sacral chordoma.
Outcomes following Surgical Intervention for Impending and Gross Instability (SINS criteria) Caused by Multiple Myeloma in the Spinal Column
Authors: Goodwin C. Rory , Sciubba Daniel , Sarabia-Estrada Rachel , Petteys Rory , Zadnik Patricia , Karami Kristophe , Mehta Ankit , Amin Anubhav , Groves Mari , Wolinsky Jean-Paul , Witham Timothy , Bydon Ali , Gokaslan Ziya 
Published: May 2015

Introduction Multiple myeloma is the most common primary tumor of the spine. Spinal multiple myeloma is classically a radiosensitive lesion; however, clinical or radiographic signs of instability merit surgical intervention. The authors present the epidemiology, surgical indications, and outcome data of the largest single series of 31 consecutive surgically treated patients with diagnoses of multiple myeloma and plasmacytoma of the spine. Methods The Spinal Instability Neoplastic Score (SINS) was utilized to make an assessment of surgical instability as the criteria for operative intervention. Patients were analyzed using lesion location, Frankel score, adjuvant therapy, outcome, and survival. Results All patients undergoing surgical intervention had either indeterminate or gross spinal column instability according to SINS criteria. Median survival was 78.9 months. No significant difference in survival was seen for patients with higher SINS scores or for older patients (> 55 years). There was a statistically significant difference in survival benefit observed in patients receiving chemotherapy and radiation versus radiation alone as an adjuvant to surgery ( p = 0.02). Conclusion The report demonstrates outcomes for patients with indeterminate stability and gross spinal instability because of multiple myeloma and plasmacytoma of the spine who underwent surgical intervention with improved neurological function following surgery and low rates of instrumentation failure.
Validation of the Spinal Instability Neoplastic Score: A Retrospective Analysis
Authors: Versteeg Anne , Fisher Charles , Oner Cumhur , Verlaan Jorrit-Jan 
Published: May 2015

Introduction With improved survival rates of cancer patients, the incidence of spinal metastases is increasing. Spinal metastases increase the risk for pathological fractures that subsequently increase the risk of spinal instability, spinal cord compression, and neurological compromise. The Spinal Instability Neoplastic Score (SINS) was developed by the Spinal Oncology Study Group (SOSG) to assess neoplastic-related spinal instability and to provide a tool to guide referrals between the appropriate oncology specialists. Considering the multidisciplinary aspect of care of metastatic cancer patients, reliability of the SINS was tested among radiation oncologists and radiologists. Yet, validation of the SINS score has only been done using selected cases by the developers of the SINS. Therefore, the purpose of this study was to retrospectively validate the SINS in the clinical setting. Methods A retrospective database review of patients who underwent palliative surgery or radiotherapy only for the treatment of painful spinal metastases has been conducted. All patients were ambulatory (ASIA E and D) and the two cohorts were matched at the time of follow-up to eliminate neurological compromise and prognosis as indications or exclusion for surgical intervention. Demographics and oncology data were extracted from the hospital charts. The SINS score was calculated based on pretreatment imaging. Results A total of 124 patients were included for analysis. Patients in the surgical cohort were significantly younger and presented more often with a combination of back and radicular pain. The median SINS score in the surgical cohort was 11 (range 7–16) and differed significantly (< 0.001) from the median SINS score of 7 (range 2–16) in the radiation therapy cohort. Sensitivity–specificity analysis showed an optimal cut-off point of a SINS score of 9 for surgical consultation with a sensitivity of 84% and a specificity of 72.6%. The set cut-off value of 7 of the SOSG demonstrated a sensitivity of 96% and a specificity of 41.9% in this analysis. Conclusion In retrospect, a high SINS score corresponded with the indication for surgical intervention for the treatment of neoplastic-related spinal instability.
Image-Guided Cervical Pedicle Screw Fixation: Implant Precision and Complications in 67 Consecutive Patients
Authors: Duff John Michael , Henchoz Yves , Levivier Marc , Bobinski Lukas 
Published: May 2015

Introduction Cervical pedicle screws (CPS) are an alternative technique to lateral mass fixation. We present our experience of 67 patients who underwent image-guided CPS instrumentation, either exclusively or as part of a construct. Implant precision, as measured by the orthogonal view evaluation method (OVEM), and complications are reported in all patients. Materials and Methods Retrospective chart review of a single institution experience of 67 consecutive patients, with 356 screws placed ( Table 1 ), including 232 subaxial pedicle screws. Implant precision was measured using OVEM (unpublished data). This allows multiple orthogonal views along the long axis of the screw through the bone target on CT multiplanar images. Grade I: no bone breach, GrIa: screw thread breach, GrII: internal screw diameter breach, and GrIII: neurovascular injury. Complications including those related to implant placement are presented in Table 2 . Results There were two implant-related complications. One, when a lateral mass screw was pulled out and replaced with a CPS. The other was because of a post CPS placement radiculopathy, which resolved on screw revision. There were three postoperative wound infections (4.5%) and five patients with postoperative pneumonia (7.5%). [Table: see text][Table: see text] Conclusion CPS is an alternative screw implantation technique which appears to be safe and effective with two screw revisions necessary (3% patients), with no neurovascular injury. There was a 23% navigational “failure” using OVEM criteria (GrII), which may be attributed to strict precision criteria. CPS may be useful when high biomechanical loads are anticipated, where there is poor bone quality or a pedicle fracture.
Spinal Navigation in Minimally Invasive Spinal Fixation Surgery: A Retrospective Study of Our 4-Year Experience
Authors: Nicassio Nicola , Trivedi Rikin , Patel Krunal 
Published: May 2015

Introduction Spinal navigation is considered a useful adjunct in minimally invasive spine surgery. Numerous reports suggesting lower radiation exposure have been described, but there have been concerns around increased operative times that navigation may attract. Materials and Methods Radiation exposure and surgical times were analyzed in all minimally invasive instrumented spine surgery cases performed between January 2010 and March 2014. A total of 141 cases were identified (degenerative, tumor, and trauma). These were divided into two groups: those performed with fluoroscopy guidance and those performed using intraoperative spinal navigation. These two groups were compared for cumulative radiation dose and operative times. Results Mann–Whitney nonparametric tests demonstrated a statistically significant lower radiation exposure in the navigated cases compared with the fluoroscopy cases (233.26 vs. 710.12 cGy/cm2; p < 0.05) without any significant difference in operative times (195 vs. 206 minutes; p = 0.52). Conclusion Evolving technologies are increasing our ability to improve spinal fixation. Our experience indicates that spinal navigation, in particular in longer spinal stabilization procedures, can be a powerful tool to reduce radiation exposure to both the patient and operating room personnel.
Combination of Elective Preoperative Vertebral Artery Stenting with O-Arm-Assisted Navigation in Cervical Spine Tumor Excision
Authors: Alfawareh Mohammad , Alotaibi Dawi 
Published: May 2015

Introduction The cervical spine is considered the most mobile segment of the spine, most of the movement occurs at the upper cervical. In addition to the flexion–extension movement, a rotational movement is added because of the orientation of lateral masses of C1 and C2 and the unique ligamentous structures which play an integral role in stabilization of the upper cervical spines. In general, primary spinal tumor is not as common as metastatic secondary tumors; the reported incidence is less than 10% of all spinal tumors. The management of cervical spine bony tumors is challenging and different from the rest of the spine, not only the rarity to be affected compared with other spines but also the anatomical regional difficulties that come with it, in addition to the challenge in approach, the proximity to the vertebral artery, and the spinal cord. The mainstay treatment of primary cervical spine tumor is surgical resection, although there have been reports of minimal invasive management with embolization. Vertebral artery injury is a rare complication of cervical spine tumor excision and the sequel of vertebral artery injury varies from arterio-venous fistula, pseudo aneurysm, thrombosis with embolic stroke, or even death. Purpose The purpose of this study is to report our new technique for the management of the cervical spine tumors by combining vertebral artery elective preoperative stenting with O-arm navigation-assisted tumor excision. Materials and Methods For the retrospective analysis of our patient's data for cervical spine tumors, between January 2010 and December 2013, inclusion criteria were: patients with primary cervical spine tumors underwent elective preoperative VA stenting, excision done under O-arm navigation with sufficient follow-up. Exclusion criteria were patients with secondary tumors, patients lost to follow-up, and if surgery was done without navigation. Results A total of 15 patients met our inclusion criteria, 5 were excluded: 2 lost to follow-up, in 1 stenting was not done, and the other 3 were done without navigation. Mean age was 16.4 years, average follow-up period was 16 months, 7 females and 6 males, neck pain was a presenting symptom in 8, neck swelling in 1, and one incidental finding in routine check-up. Diagnosis was aneurysmal bone cyst in 7, osteoblastoma in 2, and giant cell tumor in 1. The level was C2 in 5, C3 in 3, C4 in 1, and C6 in 1. Our results are of 10 case series with different primary bone tumors that were successfully managed by a combination of both techniques. Conclusions Combining both techniques provides successful tumor excision, with several advantages: keeping the patency of the VA, possibility of VA hand feeling during the procedure, and possibility of visualizing the VA at the time of surgery under O-arm navigation.
fMRI May Help Resolve Incompatibility between Clinical and Conventional MRI Findings
Authors: Mak Kin Cheung , Li Xiang , Hu Yong , Luk Keith 
Published: May 2015

Introduction When assessing patients with cervical myelopathy, it is not uncommon to find patients with localizing signs that may not be entirely compatible with the 2D images seen on conventional MRI. Dynamic MRI films may add information, but with fMRI, specifically diffusion tensor imaging (DTI), more information regarding the microstructure of the tracts may be gleaned. Thus, this helps ensure that the diagnosis of cervical myelopathy is accurate and that the operation will be over the correct level(s). Materials and Methods A prospective case series in consecutive patients with cervical myelopathy was reviewed. The parameters looked at included multilevel compression, sidedness of compression, and detailed neurological assessment. T2-weighted (T2W) magnetic resonance imaging (MRI) and DTI were used to compare against a reference, the neurological findings. “Level diagnosis” and sidedness compatibility were then assessed. Results Weighted orientation entropy-based DTI analysis provided a closer match to the “level diagnosis.” Detailed DTI analysis also enabled reconciliation of neurological findings compared with conventional MRI. This was compared using simple anterior–posterior compression and high signal intensity (when available) as a means to identify level and determine clinical compatibility. Conclusion DTI has the potential of becoming a new standard for examining patients with cervical myelopathy, both in identifying diagnostic compatibility and the level most contributory to the neurological deficit. Further studies are required to further establish actual clinical usefulness of this modality.