bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the Impact of Thoracolumbar Deformity on Cervical Disability and Pain: How the Back Affects the Neck
Authors: Clark Aaron , Oh Taemin , Saigal Rajiv , Li Carol , Ryan Devon , Klineberg Eric , Hart Robert , Kim Han Jo , Schwab Frank , Smith Justin , Protopsaltis Themistocles , Lafage Virginie , Ames Christopher 
Published: May 2015

Introduction Patients with thoracolumbar deformity employ compensatory mechanisms to maintain horizontal gaze, which may result in cervical malalignment. However, the effects of these reciprocal changes on regional cervical disability have not been well-studied in this pt population. The objective of this study is twofold: (1) to report baseline regional neck disability in adult spinal deformity (ASD) and (2) to define the relationship between neck disability and degree of cervical deformity. Patients and Methods This is a single center retrospective analysis of consecutive patients with ASD. Preoperative radiographs were analyzed for cervical, thoracic, lumbar, and spino-pelvic parameters. Preoperative disability was assessed using indices for neck disability (NDI), Oswestry disability (ODI), neck pain (VAS-neck), and back pain (VAS-back). Patients were also grouped into mild sagittal plane deformity (C7 SVA < 5 cm) and severe (> 10 cm). Correlations were made by linear regression, and comparisons between groups were made using student's t test. Results A total of 61 patients were assessed. Mean preoperative disability indices were as follows: NDI = 32, ODI = 49, VAS-neck = 3.2, and VAS-back = 6.9. Significant correlations were found between ODI and NDI ( p < 0.001, R = 0.61), ODI and VAS-back ( p < 0.001, R = 0.68), NDI and VAS-back ( p = 0.004, R = 0.39), and NDI and VAS-neck ( p < 0.001, R = 0.61). There were significant correlations between ODI and C7 sagittal vertical axis (SVA; p = 0.005), pelvic tilt ( p = 0.004), and pelvic incidence/lumbar lordosis mismatch ( p = 0.03). No other significant correlations were found between disability indices and radiographic parameters. No differences were found between patients with mild or severe sagittal deformity in NDI (31.8 vs. 31.5, respectively; p = 0.96) or VAS-neck (3.1 vs. 3.3, respectively; p = 0.80). Conclusion Patients with thoracolumbar deformity have moderate neck disability (NDI) and mild–moderate neck pain (VAS) preoperatively. There is a correlation between neck and low back regional disability, and NDI was highly correlated to back and neck pain. However, neither cervical disability nor severe sagittal deformity appears to correlate with neck disability or pain.
Disc and Vertebral Responses in the Unfused Lumbar Curve to Selective Thoracic Fusion in Lenke 1B/1C Scoliosis
Authors: Chen Xi , Sun Xu , Qian Bang-Ping , Chen Zhong-hui , Zhu Zezhang , Wang Bin , Zhu Feng , Yu Yang , Liu Zhen , Qiu Yong 
Published: May 2015

Introduction Several previous studies have reported spontaneous lumbar curve correction for both anterior and posterior selective fusion in patients with Lenke 1B or 1C; however, the mechanism for this phenomenon remains unclear. The objective of this study is to analyze the detailed response of compensatory lumbar curve to selective thoracic fusion in patients with adolescent idiopathic scoliosis (AIS) with Lenke 1B/1C curve. Patients and Methods This study included patients with AIS with Lenke type 1B or 1C curves treated with posterior selective thoracic fusion (LIV at L1) from 2006 to 2008 in our institution. They had a major right thoracic curve and a compensatory lumbar curve. They were followed for at least 24 months. Radiographic measurements including disc angle and vertebra tilt in the lumbar region were compared before surgery, after surgery, and at latest follow-up. Results A total of 20 patients (7 boys and 13 girls) with a mean age of 15 years were included in this study. The thoracic curve was corrected from 46 ± 7.2 degrees preoperatively to 8 ± 4.7 degrees postoperatively, and to 9 ± 5.1 degrees at the latest follow-up. The mean lumbar compensatory Cobb angle was 36 ± 6.9 degrees before surgery, spontaneously correcting to 12 ± 5.3 degrees at latest follow-up. The most significant change of vertebral tilt occurred at LIV and the L4 vertebra in the coronal plane. Change in disc angle was 6.4 ± 3.1 degrees at L1/L2, 3.2 ± 2.3 degrees at L2/L3, 1.0 ± 1.3degrees at L3/L4, −2.3 ± 1.9 degrees at L4/L5, and −0.7 ± 0.5degrees at L5/S1. L1/L2 disc ranks highest among all the discs in the contribution to correction of the lumbar curve. Conclusion LIV and the L4 vertebra have a trend to be horizontal after selective thoracic fusion. Spontaneous correction of the unfused lumbar curve relies on the compensatory changes of lumbar disc angle, which are mainly at the junctional disc right below LIV. This study suggests that the disc right below LIV assumes the greatest portion of correction force transmitting therefore is prone to degenerate earlier than normal.
Does Disc Wedging Contribute to the Flexibility of Thoracic Curve in Adolescent Idiopathic Scoliosis?
Authors: Liu Hao , Liu Zhen , Zhu Zezhang , Qian Bang-Ping , Wang Bin , Yu Yang , Sun Xu , Zhu Feng , Qiu Yong 
Published: May 2015

Introduction The appreciations of curve flexibility and segmental mobility in patients with adolescent idiopathic scoliosis (AIS) are important for determining structural curves, defining the safe range of correction, selecting the segment length for fusion, determining the most appropriate surgical procedure, and predicting the results of correction. However, the role of disc wedging in predicting spinal flexibility has not been well defined. The objective of this study was, therefore, to investigate the effect of disc wedging on curve flexibility and gain insight into segmental mobility by comparing disc wedging in upright and side bending radiographs in thoracic AIS. Patients and Methods This study included a total of 116 consecutive patients with AIS with main thoracic curve. According to thoracic curve flexibility index (TCFI), 56 patients with TCFI < 50% were assigned to group A (Stiff), and the other 60 patients with TCFI ≥ 50% were assigned to group B (Flexible). Age, curve magnitude, disc wedging, and disc wedging percentage were compared between the two groups. Segmental flexibility indices ([upright disc angle-bending disc angle]/[upright disc angle]) were computed and compared between periapical and remote levels. Correlations were estimated using Pearson correlation coefficients. After adjustment of covariates, logistic multivariate regression analysis of independent factors for TCFI was performed. Results Significant differences with respect to the age and curve magnitude were observed between the two groups (16.33 ± 3.08 vs. 13.50 ± 1.97, p < 0.01 and 56.06 ± 8.34 vs. 48.60 ± 7.87 degrees). The wedging angle and wedging percentage of discs in group B were significantly higher than those in group A (21.86 ± 6.18 vs. 17.52 ± 6.37 degrees, p < 0.01 and 43.55% ± 8.5 vs. 26.56% ± 9.1, p < 0.01). There was a significant correlation between disc wedging percentage and TCFI ( r = 0.766, p = 0.001). Multivariate regression analysis showed that the disc wedging percentage was the single greatest predictor of TCFI. And the disc wedging showed symmetric periapical distribution with significant decrease (all p values < 0.01) for every cephalad (+) and caudad (−) level change. The apical level +1 and −1 wedged at 6.3 and 6.7 degrees (range, 3.5–10.8 degrees), respectively. We noted mean periapical flexibility indices of 41% (+1), 44% (−1), 53% (+2) and 97% (−2), which were significantly less ( p < 0.01) than for the group of remote levels 90% (+3), 160% (−3), 116% (+4), and 208% (−4). Conclusion Disc wedging contributes to the spinal flexibility in thoracic AIS. The average flexibility indices of the periapical discs are significantly less than that of the remote discs. These may offer useful information in the evaluation of surgical options and preoperative planning.
The Outcome of Providence Nighttime Bracing in Adolescent Idiopathic Scoliosis
Authors: Simony Ane , Beuschau Inge , Quisth Lena , Andersen Mikkel O. 
Published: May 2015

Introduction Six years ago, the primary conservative treatment of adolescent idiopathic scoliosis (AIS) in the southern part of Denmark, went from full-time bracing to nighttime bracing. The purpose of this study is to evaluate the effectiveness of nighttime bracing in AIS. Patients and Methods Patients diagnosed with AIS and skeletal immature. With an apex of the primary curve from TH7 and below and with a Cobb angel between 20 and 45 degrees. The patients were asked to wear the brace at least 7 8 hours per night. No other previous treatments were accepted and a follow-up at least 6 months out of brace. The brace treatment was continued until 2 years post menarche or for male at the expected adult height. Cross-measured X-rays were used to compare the primary Cobb angel, the in-brace correction and the outcome Cobb angel. A decreased outcome Cobb angle as well as the overcorrection of the curve measured in brace was recorded as zero. The brace treatment was considered failed if progression more than 5 degrees occurred and if surgery were performed. Results A total of 55 patients, 8 males and 47 females, with the mean age at 14 years (range, 11–16.5 years) and the mean primary Cobb at 31 degrees (range, 20–41 degrees) were included in this study. The mean time of treatment was 18 months (range, 5–59 months). After ended treatment, the mean Cobb angle was 28 degrees (range, 7–50 degrees), and we observed in average no progression of the curves. The end results were 11 failures (range, 6–15 degrees); equal 20% and of these 11 patients, 3 patients had surgery performed (5%). Conclusion The results show a good curve control and an acceptable 20% failure rate, which is equal to other studies. The progression of the curves is controlled acceptable, even with the larger curves included in this study. The providence brace is an excellent alternative to standard conservative treatment. Larger studies are needed to establish the relationship between embrace correction and curve progression.
Camptocormia and Dropped Head Syndrome Induced by Chemoradiotherapy for Base Tongue Carcinoma: A Case Report and Review of Literature
Authors: Ono Allan Hiroshi , Zelada Flavio Benites , Narazaki Douglas Kenji , Jacobsen Teixeira William Gemio , Marcon Raphael Martus , Cristante Alexandre Fogaca , Barros Filho Tarcisio Eloy Pessoa 
Published: May 2015

Introduction Camptocormia (bent spine syndrome) is an acquired postural disease characterized by forward flexion of the thoracolumbar spine. Camptocormia leads to lumbar kyphosis and increases during walking or standing. Management of Camptocormia is still a challenge and the literature on this topic is limited. There is no specific pharmacologic treatment for primary axial myopathy. Patients and Methods Our patient is a 68-year-old man, diagnosed in 2009 with a base tongue squamous cell carcinoma, surgically removed in September 2010. By May 2011, it was diagnosed with local recurrence, submitted to radiosensitive chemotherapy, and followed by radical radiotherapy 35 fractions of 70 Gy. Results After general anesthesia, and neuromonitoring a median incision was made from C3 to the sacrum, former instrumentation C3–T3 were tested, and no loosening or breakage was detected. Pedicle screws were inserted by free hand technic except C7 and T1 because the small space for rod connectors and T6, T10, L2, and L5 were osteotomies were performed total of 28 screws until S2 with sacropelvic fixation. In T6 and T10, Ponte osteotomies were made, and closing wedge pedicle subtraction in L2 and laminectomy of L3. Patient presented good outcome, receiving discharge at 7th postoperatory day, and initiated naturotherapy, fonotherapy, and physiotherapy, and nasoenteral catheter were maintained until 3 weeks and some swallowing improvement reported by the 6th week. In the follow-up, patient maintained satisfied with procedure and returned to work by 3rd month, screening showed no recurrence of the tumor or distant metastasis. Conclusion This is the first case described where dropped head syndrome and camptocormia occurred in the same patient because of radiosensibilizing chemotherapy for a nasopharyngeal carcinoma. We only found a single case report of a patient with dropped head syndrome associated with chemoradiotherapy for a nasopharyngeal carcinoma in a 59-year-old Japanese patient, described by Hashimoto (2012), treated without surgery who developed symptoms 2 years after chemoradiotherapy.
Correlation of Myelopathy to Regional Neck Disability: A Surgical Approach-Specific Analysis in 217 Patients
Authors: Ames Christopher , Smith Justin , Liu Shian , Shaffrey Christopher , Kim Han Jo , Arnold Paul , Challier Vincent , Chapman Jens , Protopsaltis Themistocles , Schwab Frank , Scheer Justin , Massicotte Eric , Yoon S. Tim , Lafage Virginie , Fehlings Michael 
Published: May 2015

Introduction Outcomes for cervical spondylotic myelopathy (CSM) have been measured by numerous health-related quality of life (HRQOL) scales such as the disease-specific modified Japanese Orthopaedic Association (mJOA) and the regional-specific neck disability index (NDI). However, there is no literature analyzing the correlation of myelopathy improvement to regional neck disability changes after surgery. Materials and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 217 patients (78%) met the following inclusion criteria: symptomatic CSM, age over 18 years, and 6 months follow-up with mJOA and NDI. The patient population had a mean age of 57 years and 42% were females ( n = 92). NDI and mJOA were analyzed at baseline and 6 months post-op for the entire group. Correlations were also analyzed by the following subgroups: anterior approach group (AAG, n = 141) and posterior approach group (PAG, n = 76). Results From baseline to 6 months, there was a statistically significant improvement in both mJOA (BL 12.87–6 M 15.25, p < 0.0001) and NDI (BL 42.25–6M 31.61, p < 0.0001) in the overall group. There was a significant small negative correlation between NDI and mJOA at baseline ( R =  − 0.34, p < 0.0001) and at 6-month follow-up ( R =  − 0.44, p < 0.0001). Within the AAG, there was also a significant negative correlation between NDI and mJOA at baseline ( R =  − 0.31, p < 0.0001) and 6 months ( R =  − 0.53, p < 0.0001). Within the PAG, there was also a significant negative correlation between NDI and mJOA at baseline ( R =  − 0.43, p < 0.0001) and 6 months ( R =  − 0.34, p = 0.003). Conclusion Overall, NDI has a significant negative correlation with mJOA at baseline and postoperatively in patients with CSM. This correlation increases postoperatively in the overall group. The PAG showed a decrease in the correlation coefficient after surgery, whereas the AAG showed an increase. This could be because the posterior approach tended to be a more extensive surgery for multilevel disease in older patients, compared with the anterior approach, resulting in more soft tissue disruption and a delay in neck active motion. Regardless of the approach, mJOA still remains significantly correlated with NDI.
Cervical Spondylotic Myelopathy: Does Surgical Approach Influence Postoperative Sagittal Alignment and Outcomes?
Authors: Fehlings Michael , Smith Justin , Challier Vincent , Shaffrey Christopher , Kim Han Jo , Arnold Paul , Chapman Jens , Protopsaltis Themistocles , Lafage Virginie , Liu Shian , Lafage Renaud , Schwab Frank , Massicotte Eric , Yoon S. Tim , Ames Christopher 
Published: May 2015

Introduction The effect of surgical approach on outcomes for cervical spondylotic myelopathy (CSM) is controversial. Fehlings et al showed that patients treated with anterior techniques tend to be younger, less impaired, and had more focal pathology. In this study, we compared outcomes of an anterior approach group (AAG) versus a posterior approach group (PAG) with a focus on the effect of sagittal alignment. Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 117 patients met inclusion criteria, were nonrandomized to an AAG ( n = 51) or PAG ( n = 62), with postoperative static lateral radiographs, Nurick assessment, and health-related quality of life outcomes at 6 months and/or 1 year. The AAG underwent anterior decompression and fusion, PAG either laminoplasty or laminectomy with fusion. Sagittal regional and focal parameters were compared by multivariate regression. Results At baseline, the groups showed significant age difference (AAG 51 years, PAG 62 years, p < 0.001), rheumatological comorbidity (AAG 3%, PAG 19%, p = 0.011), and modified Japanese orthopaedic association (mJOA). The PAG had significantly more regional malalignment at baseline, but there were no focal alignment differences between the two. Surgical features were significantly different for greater than three levels treated (AAG 27%, PAG 97%, p < 0.001) and blood loss (AAG 152 mL, PAG 380 mL, p < 0.001). After surgery, both AAG and PAG improved significantly in mJOA and Nurick grade, however, there was no statistically significant difference in mJOA postoperatively. AAG had a significant decrease in SVA whereas the PAG had a significant increase in SVA. There were no relevant postoperative focal alignment differences. Conclusion The PAG had older patients with more disability. Even when age, baseline mJOA, and regional parameters were controlled, the PAG cohort still correlated with worse CGH_C7 SVA and TS–CL. It is interesting to note that the PAG had a lower mJOA than the AAG at baseline, they both improved and were not significantly different postoperatively. This suggests that both techniques relieve symptomatic disease, but patients in the posterior group may continue to progress in sagittal misalignment.
Reliability Assessment of a Novel Cervical Deformity Classification System
Authors: Smith Justin , Eastlack Robert , Blaskewitz Donald , Shaffrey Christopher , Schwab Frank , Bess Shay , Kim Han Jo , Klineberg Eric , O'Brien Michael , Albert Todd , Riew K. Daniel , Fehlings Michael , Lafage Virginie , Ames Christopher 
Published: May 2015

Introduction Despite the complexity of cervical deformity and the significant impact on patient quality of life, there exists no comprehensive classification. An initial novel classification system has been recently designed with a deformity descriptor and five modifiers that incorporate sagittal regional and global spino-pelvic alignment and neurological status. Our objective was to characterize the intra- and interobserver reliability of this classification. Material and Methods A series of 10 cervical deformity cases, broadly representative of the classification system, were selected and sufficient radiographic and clinical history to enable classification were assembled. A panel of deformity surgeons was queried to classify each case twice, with a minimum of 1 intervening week. Inter- and intrarater reliability measures were based on calculations of Fleiss kappa coefficient values. Results A total of 20 spine deformity surgeons participated in this study. Interrater reliability (Fleiss kappa coefficients) for the deformity descriptor rounds 1 and 2 were 0.489 and 0.280, respectively, and mean intrarater reliability was 0.584. For the modifiers, including the SRS–Schwab components, the interrater (round 1/round 2) and intrarater reliabilities (Fleiss kappa coefficients) were as follows: C2-C7 SVA (0.338/0.412, 0.584), horizontal gaze (0.779/0.430, 0.768), TS–CL (0.721/0.567, 0.720), myelopathy (0.602/0.477, 0.746), curve type (0.590/0.433, 0.564), PI–LL (0.554/0.386, 0.826), PT (0.714/0.627, 0.633), and C7–S1 SVA (0.071/0.064, 0.233), respectively. The parameter with the poorest reliability was the C7–S1 SVA, which may have resulted from differences in interpretation of positive and negative measurements. Conclusion The proposed classification provides a mechanism to assess cervical deformity within the framework of global spino-pelvic malalignment and clinically relevant parameters. The intra- and interobserver reliabilities suggest moderate agreement and serve as the basis for subsequent improvement and study of the proposed classification.
Rationale, Design, and Early Trial Performance of AOSpine North America Multicenter Double Blind Randomized Controlled Trial of Safety and Efficacy of Riluzole in CSM (CSM—Protect Trial)
Authors: Fehlings Michael , Kopjar Branko 
Published: May 2015

Introduction Although surgical decompression is an effective treatment for cervical spondylotic myelopathy (CSM), many patients have substantial residual neurological and functional impairment. Compelling evidence from preclinical models suggest a benefit of adding a neuroprotective drug which targets sodium/glutamate excitotoxicity to the treatment of patients with CSM. The purpose of this study is to evaluate efficacy and safety of sodium-glutamate antagonist riluzole in improving neurological outcomes in patients with CSM undergoing surgical treatment. Patients and Methods Prospective multicenter double-blind randomized controlled trial in which a total of 300 patients undergoing surgical decompression for CSM will be randomized 1:1 to riluzole 2 × 50 mg daily for 14 days before the surgery and 28 days after the surgery or to the placebo. Primary outcome measure is change in mJOA between baseline and 6 months. Secondary outcomes include ASIA, SF36v2, NDI, Eq. 5D, Pain VAS, and complications. Sample size was estimated based on data from recently completed prospective cohort study. The sample size of 270 completed subjects will have 80% power to detect absolute difference of 0.9 in mJOA score between the investigational and the control group. The statistical analysis is organized as a sequential adaptive trial with one interim analysis at 65% of the accrued sample for early futility and efficacy. Adaptive statistical design allows for sample size adjustment at the time of interim analysis. Results To date, 153 subjects have been enrolled. Average age of the enrolled subjects is 58.4 years (SD, 10.13). The baseline mJOA is 11.9 (SD, 1.5). Baseline NDI is 42.4 (SD, 20.1) and the baseline SF36v2 Physical Component Score (PCS) is 33.5 (SD, 9.3). Conclusion In spite of the benefits of the surgical intervention, patients with CSM experience significant residual impairment and neurological compromise. Adding neuroprotective treatment with riluzole may improve outcomes of surgery. This discussion will emphasize the unique study design and the biological rationale for considering riluzole as a potential neuroprotective adjunct for patients undergoing surgery for CSM.