bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rates of Fusion Procedures following Lumbar Microdiscectomy
Authors: Singh Paramjit , Wang Justin , Cohen Jeremiah , Smith Lance , Buser Zorica , Wang Jeffrey 
Published: May 2015

Introduction Ten percent of the patients with lumbar herniated disc disease end up having chronic pain and disability from herniation. Microdiscectomy has long been the standard treatment for lumbar disc herniation. Given the high physical stresses experienced by the lumbar spine, there is a risk of adjacent segment disease following microdiscectomy and need for fusion. However, fusion rates in patients who have undergone lumbar microdiscectomy are unknown. Goal of our study was to define the demographic characteristics and the rates of single and multilevel fusions following lumbar microdiscectomy. Materials and Methods The PearlDiver database was searched using ICD-9 diagnostic codes for lumbar disc herniation, disc degeneration, and spinal stenosis from 2007 to 2010 using United Healthcare database. Current Procedural Terminology (CPT) codes were used to identify patients who underwent microdiscectomy and had a single or multilevel lumbar fusions procedure afterwards. Patients were stratified by year of diagnosis, age, and gender. Results In 2007 and 2008, there were 8,374 patients who underwent lumbar microdiscectomy. The average age of patients was 45 years. From those patients, 3.47% (291) required a fusion procedure within the 1st year, 1.8% (151) patients had fusion surgery within 2, and 0.63% (53) within 3 years after microdiscectomy. Across 4 years from 2007 to 2011, the 1-year fusion rate following lumbar microdiscectomy was 3.61%. Conclusion According to our results, a patient's likelihood of requiring a fusion within a year of lumbar microdiscectomy is 3.61%. After 2 years, a patient's likelihood of requiring a fusion decreases significantly. Spinal instability following lumbar microdiscectomy is a potential complication that will occur only in a very small percentage of patient population and should be considered before undergoing operation. Next steps involve analyzing single versus multilevel fusions and separating conditions that can lead to microdiscectomy and fusion.
Minimally Invasive Transforaminal Lumbar Interbody Fusion versus Lumbar Lateral Interbody Fusion: Patient-Centered Results
Authors: Briski David C. , Cook Brandon W. , Zavatsky Joseph M. 
Published: May 2015

Introduction The documented benefits of minimally invasive surgery (MIS) continue to be elucidated. These include decreased soft-tissue disruption, blood loss, and shorter hospital length of stay (LOS). The various MIS techniques have inherent benefits. The direct patient benefit of the one procedure over the other (LLIF vs. TLIF) has yet to be clinically established. We analyzed the operative time and blood loss, postoperative VAS scores, and LOS associated with each procedure. Methods A retrospective multicentered review was performed from 2008 to 2014. All patients with one and two-level MIS TLIF and LLIF procedures were included. Total operative time, blood loss, immediate postoperative, and day of discharge VAS pain scores along with LOS were recorded. Patients were divided into two groups. Group 1 had LLIF procedures. Group 2 had TLIF procedures. Results A total of 92 patients were treated during this time period. Group 1 included 52 patients. Group 2 included 40 patients. There was no difference in BMI, number of levels fused, perioperative complications, and immediate postoperative or discharge VAS scores, between the two groups. A statistically significant benefit was observed in the LLIF group compared with the TLIF group when assessing the number of patients discharged on postoperative day (POD) 1 (48 vs. 0%, p < 0.001), overall length of stay (2.1 vs. 3.5 days, p < 0.001), mean operative time (154 vs. 265 minutes, p < 0.001), and total operative blood loss (102 vs. 206 mL, p < 0.001). Conclusion The benefits of MIS surgery continue to be validated and include decreased soft-tissue damage, blood loss, and shorter hospital LOS. The overall LOS was significantly shorter in the LLIF group. There were also a greater number of patients discharged on POD 1 in the LLIF group and total operative time and blood loss were also significantly lower in the LLIF group. Further prospective analysis is required to better delineate the benefits of one procedure over the other.
Comparative Analysis between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis and Lumbar Spondylolisthesis
Authors: Wang Dechun 
Published: May 2015

Introduction To compare the effectiveness between minimally invasive transforaminal lumbar interbody fusion (TLIF) and open TLIF for the treatment of lumbar spinal stenosis and lumbar spondylolisthesis. Materials and Methods A total of 84 cases separated randomly into Mini-TLIF group and open group were involved in the prospective study from August 2012 to July 2013. All patients underwent Mini-TLIF or open TLIF by the same group of surgeons. Operation time, length of incision, volume of blood loss, volume of postoperation drainage, intraoperative fluoroscopy time, and postoperative ambulation time were compared according to different surgical levels. Changes of VAS and CPK around the surgery were calculated. Length of hospital stay and cost were also counted and analyzed. Results In cases with single-level disorders, compared with open TLIF, length of incision, volume of postoperative drainage, length of postoperative ambulation time, and hospital stay were less, but operation and fluoroscopy time were much longer for Mini-TLIF ( p < 0.05). There were no differences between the two groups in volume of blood loss, cost, and changes of VAS and CPK. In cases with two-level disorders, volume of postoperative drainage was less for Mini-TLIF versus open TLIF, but operation and fluoroscopy time during operation were much longer ( p < 0.05). There were no differences in other terms between the two groups. Conclusion In treatment of lumbar spinal stenosis and lumbar spondylolisthesis, for those cases with single-level disorders, Mini-TLIF has smaller incision, reduced volume of postoperative drainage, decreased postoperative ambulation time, and shorter hospital stays with the same efficiency, but will take more time for operation and fluoroscopy. As for those with two-level disorders, Mini-TLIF has reduced postoperative drainage, but needs more time for operation and fluoroscopy.
Freehand Thoracic Pedicle Screw Placement Techniques: A Comprehensive Review of Safety and Efficacy
Authors: Sattarov Kamran , Skoch Jesse , Avila-Guerra Mauricio , Abbasifard Salman , Patel Apar , Walter Christina , Baaj Ali 
Published: May 2015

Introduction Freehand techniques for thoracic pedicle screw placement have gained popularity as they reduce intraoperative radiation exposure and overall operative time. The goal of this work is to present our technique as well as systematically and comprehensively review the published literature on this topic. Material and Methods A PubMed search from 2001 to 2014 was performed, focusing on clinical studies that describe technical aspects of freehand thoracic pedicle screw placement. Cadaveric studies were excluded. Results The search yielded 15 studies and, of those, only 5 described technical aspects of thoracic screw placement. Definitive entry points were represented in four studies, and in one study entry point varied by a thoracic level. There were no definitive guidelines for sagittal or an axial trajectory with an exception of a one study in which sagittal trajectory was based on suboptimally visualized endplate. In our technique, we identified a uniform entry point for each thoracic level that is 3 mm caudal to the junction of the transverse process and the lateral margin of the superior articulating process. The sagittal trajectory is orthogonal to the dorsal curvature of the corresponding spine. Conclusion Freehand thoracic pedicle screw placement is safe and effective based on published reports in the literature. Few studies, however, detail the technique and provide meaningful instructions for trainees. We are hopeful that precise parameters that rely on less variability in entry point and trajectories will facilitate trainee education.
Microscopic Transoral versus Endoscopic Endonasal Approach to the Craniocervical Junction
Authors: Paidakakos Nikolaos , Sklavounou Maria , Bouramas Dimos 
Published: May 2015

Introduction Odontoidectomy represents the treatment of choice in case of irreducible atlanto–axial dislocation with compression of the ventral spinal cord. The transoral–transpharyngeal approach represents the gold standard and more commonly used technique. The endoscopic endonasal approach represents a new technique that provides direct, minimal access to the odontoid process. Materials and Methods We reviewed our experience with both techniques (47 transoral, 6 transnasal), analyzing technical factors, intraoperative nuances, caveats and complications, and functional outcomes. Results Endoscopic endonasal odontoidectomy proved to be a safe, effective, and well-tolerated procedure. Anatomically, there is considerable overlap at the pharyngeal level in the structures that can be viewed by the transoral and transnasal routes. The transoral approach provides a wider corridor with less restricted manipulation of instruments than the transnasal approach, but the transnasal approach provides a better view of the clivus, upper part of the craniovertebral junction, and the structures posterior to the removed odontoid and anterior arch of C1. Conclusion The two different approaches for odontoidectomy should be considered complementary rather than strict alternatives: the endonasal endoscopic can be advantageous in selected cases, presenting some anatomical conditions related to the oral cavity (micrognathia and macroglossia) and to high position of the odontoid. Combined approaches can also become necessary in particular cases. Careful patient selection and preoperative surgical planning is critical to obtaining satisfactory removal and low rate of postoperative complications.
Bicortical S1 Screw Fixation May Obviate the Need for Iliac Screws in Minimally Invasive Surgery for Adult Spinal Deformity
Authors: Zavatsky Joseph M. , Cook Brandon W. , Briski David C. 
Published: May 2015

Introduction Minimally invasive surgery (MIS) allows for the maintenance of the spine's soft-tissue envelope, preserving many of its stabilizing structures. Lumbosacral stability increases when S1 screws are placed in a bicortical fashion. MIS techniques, along with bicortical S1 screw placement, may obviate the need for iliac screw fixation in the treatment of adult spinal deformity (ASD). Methods A retrospective review from 2009 to 2014 included all patients treated for ASD using MIS techniques. Lateral interbody fusion (LIF) was performed for all lumbar interbody fusion levels L1–L5. Transforaminal lumbar interbody fusion (TLIF) was performed at all L5–S1 levels. Patients were divided into two groups. Group 1 (Hybrid) had open pedicle screws with bilateral iliac screw fixation. Group 2 (MIS) had percutaneous pedicle screws without iliac screws. All S1 pedicle screws were placed in a bicortical fashion in both groups. CT scans were obtained at 1-year postoperation. Two independent board-certified radiologists assessed fusion. Results Twenty-seven patients met the inclusion criteria and were at least 1 year out from surgery. Average follow-up was 2 years. Group 1 included 11 patients (38 levels); Group 2 included 16 patients (52 levels). There was no difference in age, height, weight, BMI, number of lateral levels fused, and pre- or postoperative Cobb angles between the two groups. There was a statistical difference in the mean length of the posterior construct between Group 1 and Group 2 (10 vs. 6 levels, p < 0.05), mean blood loss (1,727 vs. 465 mL, p < 0.001), mean operative times (505 vs. 329 minutes, p < 0.001), number of complications (8 [72%] vs. 5 [31%] patients, p = 0.03), and mean length of stay (14 vs. 7.6 days, p = < 0.01). CT scans were available for 25 of the 27 patients and both radiologists agreed there was solid fusion at all interbody levels including L5–S1 (100% fusion rate). Two patients, one from each group, had full-length scoliosis X-rays that demonstrated fusion, without evidence of hardware failure, radiolucency, migration or sacral fracture. Conclusion MIS techniques preserve many of the spine's stabilizing structures. Additional stability is observed when S1 screws are placed bicortically and may obviate the need for iliac screw fixation. These techniques resulted in a 100% interbody fusion rate without failure, thus questioning the dogma that iliac screw fixation is required in long ASD MIS constructs.
Evaluation of the Usefulness of the Biopsy Guided by Computerized Axial Tomography for the Etiological Diagnosis of the Spine Destruction Syndrome
Authors: Reyes-Sánchez Alejandro , Obil Chavaria Claudia , Sánchez-Bringas Guadalupe , Lara Eleazar 
Published: May 2015

Introduction It has been observed in biopsy directed by TAC as an axis for the diagnosis of vertebral syndrome of destruction. Material and Method: Cross-sectional, analytical study of diagnostic tests, which took place in individuals of any age who were admitted with a diagnosis of the syndrome of vertebral destruction, attended for the first time. The sample size consisted of 91 patients. Computerized axial tomography–guided biopsy was performed. We compared the results of the biopsy between the two pathologists from different institutions. Results Definitive histological findings were grouped into the following seven categories: osteomyelitis (15.3%), tumors (38.46%), metastasis (37.36%), normal tissue (3.29%), inflammation (2.19%), showing inadequate (0%), and Pott disease (3.29%). According to the values of Z obtained by a test of two proportions, with n = 91, p = 0.05, the critical value of Z, two-tailed, was from 1966 (+ and −); they found no significant difference between the results reported by the two different pathology services in vertebral biopsy guided by CT in vertebral destruction syndrome; determining that this part of the process is a counselor on a 96.7% and final by 79%. Conclusion Percutaneous biopsy guided by tomography is an essential tool for the diagnosis of the syndrome of vertebral destruction approach and the ability to get diagnostics in the 96.7% indicates that it is a fundamental in the study of this syndrome.
Acute Calcific Tendinitis of the Longus Colli Muscle: A Little Recognized Cause of Cervical Pain; concerning Four New Cases and Literature Review
Authors: Lopez Allendes Rodolfo , Lopez Zugarramurdi Rodolfo , Sanchez Garcia Andres , Lopez Zugarramurdi Maite , Roman Veas Javier , Salgado Castillo Santiago 
Published: May 2015

Introduction The purpose of our study is to describe four new cases of this condition, to deepen knowledge of the clinical and imaging findings of this condition, which we must consider in all nontraumatic cervical pain (literature review) so as to avoid complementary examinations or unnecessary, invasive treatments. Materials and Methods A retrospective study of four clinical cases in the emergency service, reporting posterior cervical pain, radiating to the base of the neck, slowly progressive with no relation to a traumatic event. This study included clinical evaluation, physical examination, and imaging studies. Results The following were evaluated: history, clinical picture, age, gender, type of images requested and their results, treatment undertaken, and time of evolution of the symptoms. A literature review of this condition was made, comparing what has been published with our experience. Conclusions It is important to recognize that a patient presenting with cervical pain and dysphagia can raise different diagnoses; among which it is worth emphasizing an infection for its severity or an abscess in the retropharyngeal space. Calcific tendinitis of the longus colli muscle must also be recognized as a possible cause, as a proper diagnosis determines behaviors completely different to those that must be taken in the event of any infectious process.
Spondylolysis and Spina Bifida Occulta in Pediatric Patients: Prevalence Study using Computed Tomography as a Screening Tool
Authors: Urrutia Julio , Zamora Tomas , Cuellar Jorge 
Published: May 2015

Introduction The prevalence of spondylolysis reported from radiograph-based studies has been questioned in the recent computed tomography (CT)–based studies in adults; however, no new data are available in pediatric patients. Spina bifida occulta (SBO), which has been associated to spondylolysis, may be increasing its prevalence, according to the recent studies in adults in the last decades, but without new data in pediatric patients. We aimed to determine the prevalence of spondylolysis and SBO in pediatric patients using abdomen and pelvis CT as a screening tool. Patients and Methods We studied 228 patients, 4 to 15 years' old (107 males), who were evaluated with abdomen and pelvis CT scans for reasons not related to the spine. The entire lumbosacral spine was evaluated to detect the presence of spondylolysis and SBO. We compared the prevalence of spondylolysis in patients with and without SBO. A logistic regression analysis was performed to determine the effect of age and sex as independent predictors of spondylolysis and SBO. Results The mean age of all study patients was 11.2 ± 2.7 years. A total of 107 patients were males (46.9%) and 121 were females (53.1%). The prevalence of lumbar spondylolysis was 3.5%, 95% CI: 1.1 to 5.9% (eight patients). Spondylolysis was observed at L5 in seven patients and at L4 in one; seven patients exhibited bilateral spondylolysis, while one patient had a unilateral pars defect. Among the patients with spondylolysis, two exhibited olisthesis (0.9% of the sample), both corresponding to grade I slip. Males exhibited a 4.7% (95% CI: 0.6–8.7) prevalence of spondylolysis (five patients) compared with a 2.5% (95% CI: 0.3–5.3) prevalence in females (three patients), p = 0.48. The prevalence of SBO was 41.2%, 95% CI: 34.8–59.2% (94 patients). Overall, 6 patients had SBO at L5 (6.4%), 80 patients at S1 (85.1%), and 8 patients at S2 (8.5%). SBO was found in 51.4% of males (95% CI: 41.8–61) and in 32.2% of females (95% CI: 23.8–40.7), p < 0.01. The prevalence of SBO decreased with increasing age. The prevalence of spondylolysis was 5.3% in the patients with SBO and 2.2% in patients without SBO, p = 0.28. Logistic regression analysis revealed that male sex (OR = 2.1, 95% CI: 1.2–3.7; p < 0.01) and age (OR = 0.8, 95% CI: 0.7–0.9; p < 0.01) were significantly related to the presence of SBO. Conversely, neither sex (OR = 2, 95% CI: 0.5–8.5; p = 0.32) nor age (OR = 1, 95% CI: 0.8–1.4; p = 0.78) were significantly related to the presence of spondylolysis. Conclusion This is the first study using CT as a screening method to evaluate the prevalence of spondylolysis and SBO in a pediatric population. We found a 3.5% prevalence of lumbar spondylolysis and a 41.2% prevalence of SBO in this cohort. Most patients with spondylolysis had a pars defect at L5. We also demonstrated that SBO was independently influenced by male and younger age.
Does the Prevalence of Spondylolysis and Spina Bifida Occulta Observed in Pediatric Patients Remain Stable in Adults?
Authors: Urrutia Julio , Zamora Tomas , Cuellar Jorge 
Published: May 2015

Introduction The prevalence of spondylolysis reported from radiograph-based studies in children had been questioned in computed tomography (CT)–based studies in adults; however, our group recently confirmed the previously reported data in pediatric populations in a CT-based study. Spina bifida occulta (SBO), which has been associated with spondylolysis, has demonstrated a decreasing prevalence with increasing age during childhood and adolescence. No studies have compared the prevalence of spondylolysis and SBO in pediatric and adult patients using CT as a screening method. The aim of this study was to compare the prevalence of lumbar spondylolysis and SBO in pediatric and adult populations. Patients and Methods We studied 228 pediatric patients (4–15 years' old) and 235 adults (30–45 years' old) who consecutively underwent abdominal and pelvic CT scans at a tertiary care University Hospital for reasons not related to the spine. The entire lumbosacral spine was evaluated to detect the presence of spondylolysis and SBO. We compared the prevalence of spondylolysis and SBO in pediatric patients and adults. Results The mean age of our pediatric patients was 11.2 ± 2.7 years; 107 patients were males (46.9%) and 121 were females (53.1%). The mean age of the adult patients was 37.46 ± 4.5 years; 95 patients were males (40.4%) and 140 were females (59.6%). Among pediatric patients, the prevalence of spondylolysis was 3.5%, 95% CI: 1.1 to 5.9% (eight patients); the prevalence of spondylolysis in adults was 3.8%, 95% CI: 1.7 to 6.8% (nine patients), p = 1. In pediatric patients, males exhibited a 4.7% (95% CI, 0.6–8.7) prevalence of spondylolysis (five patients) compared with a 2.5% (95% CI, 0.3–5.3) prevalence in females (three patients), p = 0.48. In adults, males had a 3.2% (95% CI, 0.0–7.2) prevalence of pars defect (three patients), whereas females exhibited a 4.3% (95% CI, 1.4–8.1) prevalence (six patients), p = 0.74. The prevalence of SBO in pediatric patients was 41.2%, 95% CI: 34.8 to 59.2% (94 patients), while it was 7.7% in adults, 95% CI: 4.3 to 11.5% (18 patients), p < 0.01. The prevalence of SBO decreased with increasing age. Among pediatric patients, SBO was found in 51.4% of males (95% CI, 41.8–61) and in 32.2% of females (95% CI, 23.8–40.7), p < 0.01. In adults, we observed SBO in 8.4% of males (95% CI, 3.3–14.7) and in 7.1% of females (95% CI, 3.1–11.6), p = 0.80. Conclusion The prevalence of lumbar spondylolysis remained constant from pediatric age through adulthood. The prevalence of SBO decreased from 41.2% in children to 7.7% in adults. This finding suggests that SBO may not represent a pathological condition or an anatomic variant; the closure of the vertebral arch may be a continuous process that is completed through adulthood in many patients, which is in opposition to the usual theory that vertebral arch ossification should be completed during early childhood.