bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of Current Spine Classification Systems to Civilian Gunshot Wounds that were Designed for Blunt Force Trauma
Authors: Neway William , Staggers Rucker , Theiss Steven 
Published: May 2015

Introduction Spine classification systems have been used for years to create a universal language for describing injuries to the spinal column, as well as guiding clinical management. These classification systems were developed for use with blunt force trauma, but it is unknown whether they can be used for injuries to the spine caused by a gunshot wound. Purpose This study aims to investigate whether classification systems such as the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Denis Classification can be applied to spinal injuries as a result of gunshot wounds in addition to blunt force trauma. Patients and Methods A retrospective analysis of the trauma patient database registry from the University of Alabama at Birmingham was undertaken for gunshot and spine fracture ICD-9 codes. A total of 32 patients had sustained spinal injuries caused by a gunshot wound. Each patient was evaluated for location of spine fracture and vertebral structures involved, neurological involvement, stability, treatment, and follow-up status. We then applied the TLICS and Denis classification system to evaluate ease of application and usefulness. Results A total of 32 patients were evaluated and found to have gunshot wounds that resulted in injury to the spinal vertebra, vertebral ligaments, intervertebral disk, or the spinal cord. The location of injuries ranged from C1 to L5 and varied in the type of fracture. Injuries that had neurological involvement correlated with injury to the posterior column (as per the Denis Classification). There was little correlation with the anterior or middle columns with neurological involvement. Of 32 patients, only 1 had received surgical treatment. This patient had a disruption of all three columns, but similarly, there were nine other patients whose injuries involved all three columns, and yet they did not receive surgery. Conclusion TLICS was very difficult to apply to gunshot wounds and the Denis system provided no prognostic information despite a relative ease of use. It is our opinion that a new classification system needs to be designed to specifically include the injury patterns seen from a gunshot wound. Also, there was a little evidence that abstaining from a surgical treatment would cause any significant short- or long-term problems for the patient. Involvement of the posterior column correlated with neurological involvement but does not implicate the need for surgery or debridement.
Assessment and Management of Cervical Spine Injury in Head Injury Victims: A Tertiary Care Center Experience
Authors: Jayabalan Suresh 
Published: May 2015

Introduction Cervical spine injury is the common missed finding during the head injury. As the victims of the same will be unconscious in most occasions, clinical evaluation is difficult and we need to rely on investigation as well as clinical examination. It is important to rule out and manage appropriately to attain the proper outcome. Patients and Methods Patients with head injury who were less than GCS 8 and clinical evidence of spinal injuries were added in this study at a tertiary trauma care center at South India for past 4 years. Patients were screened with CT C spine along with CT head on initial evaluation. Any evidence of cervical spinal injury in both imaging and/or clinical examination underwent MRI spine. Treatment initiated appropriately. In a series of 524 patients with GCS less than 8 from May 2010 to May 2014, 74 patients underwent MRI spine based on CT C spine and clinical examination pertaining to cervical spine injury. Patients with thoracic and lumbar spinal injuries were excluded from the study. Follow-up made through clinical visits and telephonic enquiry. Results A total of 47 patients had evidence of cervical spine injury in the form of contusions, altered signal changes, spinal stable and unstable fractures, and ligamentous injury. All patients received appropriate treatment including spinal fixation and continuous rehabilitation. Overall, 19 patients presented with unstable spinal fracture which needs stabilization. Overall, eight patients had extensive spinal cord contusions or altered signal changes. Overall, 17 patients had disc bulges or ligamentous injuries with cord signal changes. Overall, two patients had epidural hematoma. Conclusion Assessment and diagnosing the cervical spine injury is a real challenge in severe head injury victims. Strict protocol and appropriate management are the key to the success for the proper outcome. CT C spine and clinical examination during the initial evaluation help in attaining the goal and in early decision making.
In Vivo Repair of Rat Annulus Fibrosus Defects using High-Density Collagen Gels
Authors: Moriguchi Yu , Borde Brandon , Grunert Peter , Khair Thamina , Hudson Katherine , Bonassar Lawrence , Härtl Roger 
Published: May 2015

Introduction Although a discectomy successfully relieves the neurological symptoms of a herniated intervertebral disc (IVD), it does not treat the underlying degenerative process; the annular defect remains unrepaired. Persistent annular defect is associated with an increased risk of recurrent herniation and progressive degenerative changes to the IVD. It may also be the primary cause of chronic low back pain following discectomy. To date, there is no established method for repairing annular defects in vivo. The presented study aims to determine whether injectable high-density collagen (HDC) gels can reduce further disc herniation and inhibit degenerative changes in a needle-punctured rat-tail model, and whether riboflavin (RF) cross-linking of injected collagen influences the repair process. Materials and Methods A total of 31 athymic rats were punctured with an 18-gauge needle in C3/4 of the caudal spine. They were divided into four groups: group 1 punctured and injected with HDC cross-linked with 0.5 mM (n = 6) or 0.75 mM (n = 7) RF; group 2 punctured and injected with noncross-linked collagen (n = 6); group 3 punctured and untreated (n = 8); group 4 punctured and injected with FITC-labeled cross-linked collagen (n = 4). Degenerative changes to punctured discs, NP size, and NP hydration were analyzed using X-ray, MRI), and histology. Functionality of repaired AF tissue was measured by mechanical tests, by comparing the hydraulic permeability of treated discs to that of healthy discs. Results After 5 weeks, untreated discs showed signs of terminal degenerative changes on MRI and histological sections ( Fig. 1 ). No NP tissue remained in the disc space. In contrast, discs treated with RF cross-linked collagen gels retained 63% of NP and 80% of disc height at 5 weeks, and showed minimal degenerative changes on histological section. Interestingly, a series of in vivo imaging showed that after 5 weeks, discs treated with cross-linked HDC demonstrated consistent improvement in both volume and hydration over time, while untreated discs and discs treated with noncross-linked HDC, lost volume, and water content. Injected collagen was seen to form a zipper-like adhesion to the host AF and connective tissue after 1 week and by 5 weeks a fibrous cap that persisted until 18 weeks. NP hydration and IVD functionality of treated discs were found to be similar to those of adjacent healthy discs at 18 weeks. [Figure: see text] Conclusion Injection of high-density collagen gel cross-linked with RF can repair annular defects, prevent the degenerative cascade, and maintain the functionality of IVDs in a rat-tail spine. Further studies will be performed to confirm the ability of HDC gels to repair annular defects in a large animal model.
Gene and Protein Expression Pattern of Cytokines in Disc Herniation Depend on Time of Symptoms
Authors: Bozsodi Arpad , Lazary Aron , Varga Peter 
Published: May 2015

Introduction Sciatica caused by lumbar disc herniation is a frequent clinical condition. The development of the radicular pain is explained by mechanical and biological (inflammatory) factors. Spontaneous pain relief in the first weeks is not uncommon, but a significant part of the patients have got persistent (and/or recurrent) disabling pain requiring surgical intervention. The biological background of the alteration in clinical symptoms is still unknown. Objective The aim of this study was to investigate the protein and the mRNA expression of different cytokines in human herniated disc tissues. Methods A total of 24 patients who underwent lumbar microdiscectomy were included into the study. Sequestered disc tissue was collected during the surgery and analyzed using a Human Cytokine Array Panel (R&D Systems) and TaqMan Gene Expression Assays to determine the protein ( n = 12) and mRNA expression ( n = 12) of different cytokines. Cytokine expression levels were analyzed in relation to the duration of the symptoms (acute: less than 6 weeks, chronic: more than 3 months). Nonparametric statistical tests were used to determine significant differences in protein/mRNA expression. A minimum of 1.5-fold difference and p < 0.05 was considered significant. Results IL-6, IL-8, and GRO-a were expressed significantly higher in acute disc herniations either in protein and mRNA levels. RANTES, IFN-g, and G-CSF proteins were found to be increased in chronic herniations and higher expression of RANTES and IFN-g were confirmed at mRNA level. Conclusions Cytokine profile in herniated disc tissue changes with time. It can be associated with an altered inflammation process and the consequent change of the clinical picture. New biological approach selectively modulating the inflammatory response can be one of the future developments in the nonsurgical management of intervertebral disc herniation.
Effect of Postoperative Surgical Drain Concentrations of Vancomycin on Human Osteoblast Activity
Authors: Sinclair Sarina , Lyman Kade S. , Annis Prokopis , Spiker Ryan , Brodke Darrel S. , Lawrence Brandon D. 
Published: May 2015

Introduction The addition of powdered vancomycin inside the surgical wound site has become a common practice in recent years to decrease the incidence of postoperative orthopedic infections. The effectiveness of vancomycin against bone infections has been well documented and it is commonly delivered locally during a variety of surgeries. While several studies have been conducted to review the effect of using this drug at the surgical site on infections, few studies have examined its impact on local bone cells at the cellular level. A wide range of antibiotic concentrations has been used within cell studies. The purpose of this pilot study was to examine the effect of vancomycin on osteoblasts at a concentration based on surgical drain samples following spinal fusion procedures using established in vitro techniques. Materials and Methods Postanesthesia care unit (PACU) drain samples were collected from 37 patients following spinal fusion procedures where powdered vancomycin was placed inside the surgical site. Vancomycin levels in the drain samples were measured using the inpatient laboratory and the hospital's standard operating procedures. A human osteoblast cell line was used to model osteoblasts in vitro. Cells were seeded in triplicate on tissue culture plates and fed the recommended base medium for 48 hours. After 48 hours (day 2), baseline data were collected and cell medium was changed to include vancomycin at a concentration of 0 or 1,000 µg/mL based on the PACU drain level results. After 3 days of exposure to vancomycin (day 5), cells were rinsed and cultured in plain base medium for three additional days (day 8). Cellular metabolic and osteogenic activity and was evaluated using well-established in vitro assays. Results The average vancomycin level present in the PACU drain samples was determined to be 1,253.67 µg/mL (STD = 0 701). This study found that the metabolic activity of the human osteoblasts appeared to be unaffected by the exposure to vancomycin. There was no significant difference in metabolic activity observed between the cells fed 0 and 1,000 µg/mL vancomycin at any time point. The addition of vancomycin did have an effect on the osteogenic activity, based on alkaline phosphatase (ALP) expression. Cells had lower ALP levels after 3 days of vancomycin exposure at the clinically relevant level ( p = 0.05). The vancomycin group continued to express lower levels of ALP after 3 days of recovery following removal of the drug ( p = 0.02). Conclusion This study is one of the first to test the cellular activity of human osteoblast cells after exposure to a clinically relevant concentration of vancomycin. The results suggest that the addition of vancomycin within the surgical wound to combat infection may result in a local antibiotic concentration level that can have an adverse impact on the cellular activity of local bone cells.
Clinical Impact Correlation of a Delphi-Based Proximal Junctional Kyphosis Severity Scale and HRQOL
Authors: Lau Darryl , Funao Haruki , Clark Aaron , Smith Justin , Bess Shay , Shaffrey Christopher , Schwab Frank , Lafage Virginie , Deviren Vedat , Hart Robert , Kebaish Khaled , Ames Christopher 
Published: May 2015

Introduction Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are adverse outcomes following adult spinal surgery (ASD) surgery. There is a lack of consensus regarding which patients (pts) require revision surgery. The Hart ISSG PJK severity scale correlates with the need for revision surgery. This study evaluates the Hart International Spine Study Group (ISSG) PJK severity scale and health-related quality of life (HRQOL) measures in pts with PJK. Patients and Methods All ASD pts with PJK and/or PJF who eventually underwent revision surgery were identified from two large academic medical centers. Pts were retrospectively assigned scores based on the Hart ISSG PJK severity scale: neurological status, focal pain, instrumentation problem, kyphosis severity/PLC integrity, UIV/UIV + 1 fracture, and level of UIV. Scores range from 0 to 15. Pre-PJK revision HRQOL measures included: Oswestry disability index (ODI), short-form 36 (SF-36), and Scoliosis Research Society questionnaire (SRS30). Scores were subcategorized into 0 to 2, 3 to 5, 6 to 8, 9 to 11, and 12 to 15, and differences in HRQOL outcomes were determined with linear regression. Correlation was assessed with a Pearson correlation coefficient. Results A total of 54 cases were included, out of which 31.5% were male, and the mean age was 64.9 years. The Hart ISSG PJK severity scale scores ranged from 4 to 15, with the median being 8. PJK/PJF occurred in the upper thoracic spine in 24.1% of the cases. 54.8% had fractures and 77.8% had instrumentation issues. Overall, 55.6% had neurological deficits, with 16.7% having weakness and/or myelopathy. All pts had preoperative pain (median VAS 9/10). While statistical significance on linear regression was not seen, there were obvious trends that correlated with the Hart ISSG PJK severity scale. Higher Hart ISSG PJK severity scale scores were associated with higher ODI ( p = 0.283, r = 0.350), lower SRS30 function ( p = 0.821, r = −0.323), and lower SRS mental ( p = 0.646, r = −0.592). Conclusion The Hart ISSG PJK severity scale has been shown to be predictive in the decision making of when patients require revision surgery. Based on the current study, it may also correlate with functional outcomes, specifically ODI and SRS30 components.
Better Patient Reported Outcome Measures: The NDI-8 and NDI-5 Assessed in 714 Patients
Authors: Brodke Darrel S. , Lawrence Brandon D. , Spiker Ryan , Neese Ashley , Hung Man 
Published: May 2015

Introduction Patient reported outcome measures (PROM) are now a mandatory part of the assessment of clinical results in comparative effectiveness research. The 10-item neck disability index (NDI) is the most commonly used disease specific PROM in studies of patients with cervical spinal disorders. It is well known, easy to administer and score (10 items—answers added together and multiplied by 2, to provide a score). Recent studies have shown significant deficiencies in the psychometrics of the standard NDI, including poor coverage (large floor effect), multivariance, and most concerning, extremely poor raw score to measure correlation—which means using the additive score is concerning, particularly with standard statistical testing. By excluding two questions, or five questions, an NDI-8 and NDI-5 can be constructed with much-improved psychometrics and decreased clinical burden, yet this has not been evaluated in a formal spine medical practice and is not used in clinical research. The goal of this study is to clarify the psychometric properties of the standard NDI-10, in comparison with the new NDI-8 and NDI-5, in search of an improved PROM for neck patients. Material and Methods Patient demographics and the NDI were collected on 714 patients with neck ± upper extremity pain. Using Rasch analysis, the NDI-10, -8, and -5 were assessed for psychometric properties, including overall item fit, variance, coverage, and raw score to measure correlation. Results Data were assessed from 714 consecutive patients (53% males, 86% whites) with average age being 55 years, seen at a university-based spine center. The NDI-5 and NDI-8 were highly correlated at 0.95, had excellent fit, similar to the NDI-10, and less variance than the NDI-10. Like the NDI-10, coverage for the NDI-8 and -5 were poor, with very high floor effects of 39.36 and 39.22% (compared with 35.5% in the NDI-10). Ceiling effects were acceptable for both measures. Most importantly, the raw score to measure correlation of the NDI-8 and NDI-5 are very high at 0.94 each, while the NDI-10 correlation was poor, at 0.02. Conclusion While the standard 10-item NDI is of questioned value, the NDI-5 and NDI-8 show improved psychometrics, in particular the raw score to measure correlation. With fewer items the NDI-5 decreases patient and clinic burden without significantly effecting coverage, and is therefore the preferred measure. Future work should be concerned with improving coverage with the addition of items at the extremes of disability, particularly low disability items.
Incidence, Impact, and Risk Factors of Adverse Events in Thoracic and Lumbar Spine Fractures: An Ambispective Cohort Analysis of 390 Patients
Authors: Glennie R. Andrew , Ailon Tamir , Dea Nic , Batke Juliet , Street John 
Published: May 2015

Background Context Adverse events (AEs) in thoracic and lumbar spine fractures are common but little is known about the type of AEs that are specific to this population. Further, very little is known about the incidence and clinical impact of these AEs on patients in the presence of traumatic spinal cord injury (TSCI) and whether they are treated operatively or nonoperatively. Purpose To determine the incidence of AEs in patients with thoracic or lumbar spine fractures treated both operatively and nonoperatively and determine their impact on length of stay (LOS). Secondly, determine the difference in incidence of AEs in both neurologically intact and compromised patients. Study Design/Setting Ambispective cohort study at a quaternary referral center. Patient Sample Patients admitted at our institution with thoracic or lumbar fractures from January 2009 to December 2013 were identified. Patients with full spine adverse events severity system data (SAVES) were included. Outcome Measures Number and type of AEs collected from SAVES were assessed. Impact of AE on acute LOS was also determined. Materials and Methods No funding was received or used in this study. Data on intra-, pre-, and postoperative AEs were prospectively collected using the SAVES data collection. Logistic regression was used to model the likelihood of experiencing at least one AE based on patient characteristics. The impact of the total number of AEs experienced by a patient and that of each of the most common AEs on LOS was determined using Poisson regression. Results A total of 390 patients were included in final analysis. Total, 276 patients (70.8%) were treated operatively. Overall 140 patients (36%) experienced neurological deficit as a result of their initial injury. AEs occurred in operatively treated patients 56% of the time and only 13% of the time in the nonoperative group. The presence of neurological deficit increased the risk of AEs especially in high thoracic (T1–T6) trauma increasing the odds of having an adverse event by 12.1 ( p < 0.0001). The most common AEs were urinary tract infections (UTIs) (19.7%), neuropathic pain (12.3%), pneumonias (11.8%), delirium (10.5%), and ileus (6.2%). LOS increased significantly with pneumonia ( p < 0.0001) and delirium ( p = 0.0001). Conclusions The presence of neurological injury and the need for operative fixation of thoracic or lumbar injuries leads to a greater risk of adverse events. Only pneumonia and delirium consistently increase LOS.
A 5 and 10-Year Follow-Up on Intradiscal Ozone Injection for Disc Herniation
Authors: Buric Josip , Rigobello Luca , Hooper David 
Published: May 2015

Introduction Disc herniation is the most common cause for spinal surgery and many clinicians employ epidural steroid injections with limited success. Intradiscal injection of ozone gas has been used as an alternative to epidural steroids and surgical discectomy. Early results are positive but long-term data are limited. Patients and Methods A total of 108 patients with confirmed contiguous disc herniation were treated with intradiscal injection of ozone in 2002 to 2003. Around 107 patients were available for telephone follow-up at 5 years; 60 patients were available for a similar telephone follow-up at 10 years. Patients were asked to describe their clinical outcome since the injection. Surgical events were documented. MRI images were reviewed to assess the reduction in disc herniation at 6 months. Results MRI films demonstrated a consistent reduction in the size of the disc herniation. A total of 79% of patients had a reduction in herniation volume and the average reduction was 56%. There were 19 patients that ultimately had surgery and 12 of them occurred in the first 6 months after injection. One of these 12 was due to surgery at another level. Two surgeries involved an interspinous spacer indicated by stenosis or DDD. All other surgeries were discectomies. Of the patients that avoided surgery 82% were improved at 5 years and 88% were improved at 10 years. Other than subsequent surgeries, no spine-related complications were experienced. Conclusion We conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through 10 years. This is a retrospective review and randomized trials are needed. Clinical Relevance: Intradiscal ozone injection may enable patients to address their pain without multiple epidural injections and surgery. The benefit of ozone is durable and does not preclude future surgical options. The risk reward profile for this treatment is favorable.