bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of Anterior Spinal Fusion in Spondylolisthesis with or without Interbody Fusion Device (CAGE)
Authors: Kumar Manoj , Dhanraj Prashanth , Shivanna Deepak 
Published: May 2015

Introduction Lumbar spine spondylolisthesis (LSS) has been surgically managed by interbody fusion using pedicle screw and rod fixation. Many surgeons advocate the use of an interbody fusion device (cage) to assist in fusion and increase the stability of the construct. Objective The aim of the study is to assess and compare the functional and radiological outcome of patients undergoing surgical fixation with or without interbody cage. Materials and Methods We performed a prospective nonrandomized study in adults aged 28 to 68 years with LSS. Enrolment was done between 2010 and 2012 at the Department of Orthopaedics and Department of Neurosurgery, Bangalore Medical College and Research Institute, Bangalore, India. Clinical follow-up at 6 weeks, 3, 6, and 12 months intervals regarding pain, fusion (AP, lateral and flexion—extension radiographs) and the functional outcome was evaluated by visual analog scale (VAS) pain rating, and Oswestry disability index (ODI), SF-36, modified Benzel Japanese Orthopaedic Association score. Results A total of 20 patients with LSS were enrolled. The mean age of patients at the time of surgery was 46.85 years (± 21.15). Mean follow-up duration 14 months (range, 12–24 months). Earliest union seen at 6 months follow-up in 30% of bone graft (BG) and 50% of cage group (CG). At end of 1 year 90% of BG and 100% of CG group showed radiological union. Average fusion rate were 10 and 8.5 months in BG and CG, respectively. Radicular improvements were seen in 70 and 90% of BG and CG, respectively. Functional outcome was significantly better at 3, 6 months, and 1 year in both the groups ( p < 0.001). Complications were seen in 60 and 20% cases of BG and CG, respectively. Patient satisfaction was 80 and 90% in BG and CG, respectively. All patients returned to preinjury status except one in BG group. Conclusion Addition of an interbody fusion device (cage) helps in greater stability, lower implant failure, higher fusion rate, and better functional outcome in surgically treated patient of lumbar Spondylolisthesis at follow-up, however no significant difference seen between two groups ( p < 0.3, 0.5, and 0.26).
Fusion Rate Difference between Sublaminar Wire and Screw Fixation in Type 2 Odontoid Traumatic Fractures
Authors: El Fiki Ahmed , Alaa Mohamed 
Published: May 2015

Introduction Traumatic odontoid fracture type 2 is not uncommon in cervical spine trauma. Different techniques of fusion are usually applied depending on many factors with the aim of acquiring bony fusion at C1–2 segment. Material and Methods Twenty patient of traumatic type 2 odontoid fractures were operated in our institute from December 2010 till march 2014. Sublaminar wiring was done in 10 cases and the rest were operated by C1–2 screw fixation. Clinical condition and bony fusion were evaluated at 3 and 6 months. Results Fourteen patients were with improving or stationary clinical state plus good fusion signs. While six patients developed either clinical deterioration or radiological failure of fusion. Among these six patients, four cases were fused by sublaminar wire and two patients were operated by screw and rod fixation. All cases with fusion failure were re operated again. Conclusion Screw system fixation for traumatic odontoid fracture type 2 take upper hand than sublaminar wiring regarding bony fusion and clinical condition but longer time follow-up and larger series are needed.
Civilian Gunshot Wound to the Spine: 87 Cases
Authors: Reis Marco Tulio , Zanini Rocha Guilherme , Malheiros José Augusto , Malheiros José Augusto , Gonçalves Diogo , Alves Belo Joao Tiago 
Published: May 2015

Introduction Penetrating spinal cord injury (SCI) by gunshot is relatively common in Brazil, and the literature available is scarce. This study aims to report the experience of a level I trauma center, exploring epidemiological data, clinical features, treatment, and outcomes of victims of gunshot wound to the spine. Material and Methods A retrospective study was performed and included all victims of gunshot wound to the spine at João XXIII Hospital from April 2011 to March 2014 (36-month period). The epidemiological profile, topography of the injury, neurological status, treatment, and in-hospital morbidity and mortality are reported. Statistical analysis was performed on Epi Info 7.0 with Fisher exact test. Correlation with the current literature was conducted. Results A total of 1,088 patients were admitted with blunt and penetrating spinal injury in the 36 months evaluated. A total of 87 cases were gunshot wounds (8% of the 1,088 cases). A majority of the patients were men (93.1%) and young (76.1% are under 30 years). Topographically, 48% affected the cervical spine, followed by 32% in the thoracic spine. The motor status had a dichotomous presentation, with complete neurological deficit (ASIA A, 58.6%) and no neurological deficit (ASIA E, 27.6%). Incomplete neurological deficits represented a small number of cases. The vertebral instability, defined as the presence of acute or delayed deformity, was unusual (three cases, 3.4%). Almost 50% ( n = 44) of the patients had isolated spinal trauma and the remaining presented with associated traumas. Thoracic trauma was the most prevalent, followed by abdominal and facial injury. Only 10 patients (11.5%) required surgical treatment: laminectomy with bullet removal in 7 cases and instrumented fixation in the remaining 3. Infection was present in five cases: four postoperative infections and one in a patient with nonoperative management. Surgical treatment was associated with a 50-fold increase risk of infection ( p = 0.0004). CSF fistula was observed in only one case after surgical treatment and because of the rarity of the event, a statistical analysis could not be performed. Overall mortality was 14.9% (13 patients) and was more common in patients with cervical lesions (10 patients). Associated trauma was present in 70% of the patients who died, but did not acquire statistical significance ( p = 0.1) with mortality risk. Conclusion Gunshot wound to the spine is common in our population, affecting especially young men, associated with neurological deficit in two-thirds of the patients. Instability is a rare event in these patients (3.4%) and surgical treatment was associated with a significant risk of infection.
Efficacy and Safety of Riluzole in Acute Spinal Cord Injury: Rationale and Design of AOSpine Phase III Multicenter Double Blinded Randomized Controlled Trial
Authors: Fehlings Michael , Kopjar Branko , Grossman Robert , Wilson Jefferson 
Published: May 2015

Introduction There is convincing evidence from the preclinical realm that the pharmacologic agent riluzole attenuates certain aspects of the secondary injury cascade leading to diminished neurological tissue destruction in animal spinal cord injury (SCI) models. The safety and pharmacokinetic profile of riluzole has been studied in a multicenter pilot study in 36 patients. Efficacy of riluzole in acute human SCI has not been established. Material and Methods This phase II/III multicenter double-blind randomized controlled trial will involve up to 35 sites. A total of 351 patients with acute C4–C8 SCI and ASIA Impairment Grade A, B, or C will be randomized 1:1 to riluzole and placebo. Primary outcome is the change in ASIA Total Motor Score between baseline and 180 days. Other measures include ASIA Upper Extremity Motor Score; ASIA Lower Extremity Motor Score; ASIA Sensory Score; ASIA Grade; Spinal Cord Independence Measure; SF-36v2; EQ-5D, and GRASSP. The statistical design utilizes two-stage sequential adaptive trial. A sample size of 316 patients (158 in each arm) will have 90% power to detect 9 points difference in the ASIA Motor Score at one-sided α = 0.025. To account for losses to follow-up of up to 10%, the study will enroll 351 patients. Results Within the phase 1 study, a matched cohort analysis was performed comparing complication rates and neurological outcomes between patients who received riluzole and non-riluzole-treated patients from a prospective SCI registry. Although the groups experienced similar rates of complications, riluzole-treated cervical SCI patients experienced an additional 15.5 points in AMS recovery at 90 days after injury as compared with non-riluzole-treated patients. Although the phase I study was underpowered to investigate the efficacy, the current phase II/III study is poised to definitively address this question. Patient enrollment for this trial began on October 1, 2013. Conclusion This is a pivotal study of riluzole in acute SCI.
Prognostic Significance of T Gene SNP s2305089 in Individuals with Spinal Column Chordoma
Authors: Varga Peter , Lo Sheng-Fu Larry , Puvanesarajah Varun , Fisher Charles , Rhines Laurence , Boriani Stefano , Lazary Aron , Wang Wei-Lien , Gambarotti Marco , Germscheid Niccole , Yip Stephen , Gokaslan Ziya , Bettegowda Chetan 
Published: May 2015

Introduction Chordoma is the most common primary spinal tumor with a median survival of 6 to 7 years, with high recurrence rates. Radical surgical resection remains the mainstay of treatment, with radiation often utilized to enhance local disease control. There are no approved chemotherapeutic agents for chordomas. Brachyury, coded by the T gene, has been implicated in the pathogenesis of chordomas and is highly expressed in most of these tumors. Recently, Pillay et al found that the single nucleotide polymorphism (SNP) rs2305089 in the T gene was associated with chordoma development. The variant A allele at rs2305089 results in a p.Gy177Asp change in Brachyury. Given the rarity of this disease, with an incidence of 0.08 per 100,000 individuals, determining the clinical significance of this SNP has been challenging. Materials and Methods This study included both prospective and retrospective data collected from five high-volume centers within Europe and North America. Data were collected between 1990 and 2013, through the AOSpine Knowledge Forum Tumor (AOSKFT) primary tumor database. Institutional approval was obtained before studying the tumor samples. Results In the overall cohort of 109 patients, survival at last follow-up (mean follow-up: 1,330 ± 1,475 days) was 69.7%. Seven (6.4%) patients had the GG genotype, while 66 (60.6%) and 36 (33.3%) patients had the AA and GA genotypes, respectively. In the 102 cases with the A variant, 75 (73.5%) were alive at the last follow-up compared with only 1 (14.3%) of the 7 patients with the GG genotype. Local recurrence rates were similar between the populations with the A variant and those without, with 40 (39.2%) patients with the A variant experiencing local recurrence compared with 2 (33.3%) patients without the A variant. Conclusions There is a trend toward worse survival in individuals with the GG genotype than with the AA or GA genotypes. To our knowledge, this is the first time the rs2305089 SNP has been considered in the prognosis and survival of individuals with chordoma.
The Influence of a Performance Improvement Program on MRI in Spinal Trauma
Authors: Kraus Michael , Mueller Marguerite , Schmitz Bernd , Gebhard Florian , Cunningham Michael 
Published: May 2015

Introduction Performance improvement (PI) programs are an educational tool to analyze clinical parameters taking the behavior and attitude of clinicians into account.1 The impact of this tool is not fully explored in orthopedic and trauma surgery. This educational research aimed to deliver an effective PI program to orthopedic trauma surgeons, neurosurgeons, and radiologists to improve communication and the use of MRI in spinal trauma. Materials and Methods Following a worldwide web session on MRI in spinal injuries to identify the clinical need for an educational intervention, a three-step PI process was defined and implemented over a 6-month period in a hospital department. Opportunities for improvement were identified by applying a 10-item quality checklist to 26 cases. Then a focused educational intervention was delivered to address identified gaps, and a set of 22 post-education cases was compared. Results A total of 26 cases collected before the educational intervention showed several areas for potential improvement. In only 5 of the 26 cases, a specific trauma mechanism or a possible inflammatory or malignant illness was mentioned by the surgeon, where such information may lead to a change in MRI sequence planning. In 23 cases, the radiologist did not believe that the communication led to a change of plan, although sequences other than usual were performed. The educational intervention outlined the data and suggested actions. Comparing the information transfer of the pre- and postinterventional data there was a significant improvement following the intervention ( p = 0.0013). Following the intervention, the communication between surgeons and radiologists significantly influenced the sequences ( p = 0.0152). Conclusion There are specific aspects that may be improved concerning communication between the surgeon and the radiologist. Our PI program was able to demonstrate a significant influence on the behavior and attitude of surgeons and radiologists. In the future, the impact on patient-related outcome parameters has to demonstrate the clinical influence of PI programs in the care of spine patients. References Martin C, Rüetschi U, Cunningham M. Design and implementation of performance improvement programs for orthopedic trauma surgeons. Presented at: AMEE Conference; 2013
Comparison of Intraoperative Stitched Fluoroscopic Images to Postoperative Standing Full Spine Radiographs
Authors: Sembrano Jonathan , Peterson Erica , Yson Sharon , Santos Edward Rainier , Polly David 
Published: May 2015

Introduction Spinal deformity surgery requires assessment of correction achieved intraoperatively. Long cassette X-rays have been used in the past. Recent advances include availability of 3D scanners (e.g., O-arm). These are also able to take 2D images which can be stitched together to simulate full length X-rays. The process of “stitching” can be performed quickly and may potentially save time compared with conventional X-ray film developing. This is the first study to look at correlation between stitched O-arm fluoroscopic images and postoperative standing X-rays. Methods Patients who underwent fusion of ≥ 3 levels for coronal/sagittal deformity and who had intraoperative stitched O-arm images were identified. The intraoperative images and postoperative full-spine X-rays were reviewed. Coronal and sagittal curves and balance were measured by and averaged between two independent observers. Correlation between intra- and postoperative parameters was tested by computation of Pearson coefficient. Results Between March 2011 and June 2013, 80 patients met the inclusion criteria. Mean age was 27 years (range, 6–85 years). Correlation between intraoperative stitched images and postoperative full-length films was very strong for focal curve measurements at the operative levels (major curve Cobb r = 0.90, lordosis/kyphosis across instrumented levels r = 0.74, T5–T12 kyphosis r = 0.88). However, global balance parameters and regional lordosis were found to either have poor correlation (shoulder–pelvis balance 0.41, L1–S1 lordosis 0.62) or were not measurable on the stitched images (T1–pelvic angle). Conclusion Intraoperative AP and lateral stitched O-arm images correlated strongly with postoperative full-spine standing X-rays for focal angular measurements, such as major curve coronal Cobb angles, instrumented level lordosis, and mid-thoracic (T5–T12) kyphosis. However, global balance parameters, such as shoulder–pelvis balance and T1–pelvic angle, cannot be reliably measured on stitched images. This may be either because of differences between prone and upright positioning, image quality, technique of stitching, or the inability to include the entire spine and pelvis in the images.
Laminoplasty versus Laminectomy and Fusion to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multicenter AOSpine International CSM Study
Authors: Fehlings Michael , Kopjar Branko , Kale Shashank , Defino Helton , Barbagallo Giuseppe , Bartels Ronald , Zhou Qiang , Arnold Paul , Zileli Mehmet , Tan Gamaliel , Moraes Osmar , Yukawa Yasutsugu , Alvarado Manuel , Scerrati Massimo , Toyone Tomoaki , Tanaka Masato , Bolger Ciaran , Ibrahim Ahmed , Tetreault Lindsay 
Published: May 2015

Introduction Recent studies conducted in North America have demonstrated the benefits of surgical treatment for symptomatic CSM. However, differences in pathology, comorbidities, treatment approaches, and cultural response to treatment may affect the generalizability of these findings at the global level. Patients and Methods Patients receiving surgery for clinically symptomatic CSM were enrolled in a prospective multicenter, cohort study which is continuing to accrue patients at 16 sites in Europe, Asia, and North and South America. Patients included were a part of a larger ongoing prospective observational study that has enrolled 492 patients with CSM involving 16 clinical sites in Europe, Asia, and North and South America. Of those, 108 received laminectomy and fusion, and 66 received laminoplasty. The choice of surgical approach was at the discretion of the surgeon. Outcome measures were mJOA, the Nurick scale, NDI, and the SF36 PCS and MCS component scores. Results Average age was 60.2 years (SD 10.8), 29.8% were female. Patients treated with laminectomy and fusion had more levels operated (5.0 vs. 4.4, p < 0.01), shorter length of stay (7.7 vs. 15.7 days, p < 0.01), and less severe neurologic impairment measured by mJOA (12.6 vs. 11.2, p < 0.01). There were no differences in age, baseline NDI, SF36v2 PCS, and SF36v2 MCS. At 12-month follow-up, there were no differences in neurologic and functional outcomes for laminoplasty compared with laminectomy and fusion; mJOA (3.0 and 2.3, respectively, p = 0.15). Moreover, there were no differences in NDI (13.3 and 12.0, respectively, p = 0.71), SF-36v2 PCS (8.5 and 7.7, respectively, p = 0.66), and SF-36v2 MCS (7.9 and 6.9, respectively, p = 0.56). Conclusion Patients undergoing laminectomy and fusion and laminoplasty surgery for CSM show similar improvements in generic and disease-specific outcome measures allowing for baseline differences in clinical presentation between the two groups of patients. Longer-term follow-up will be required to determine whether any differences in outcome between the two forms of treatment emerge.
Change in Pelvic Sagittal Parameters with Growth in Children with Adolescent Scoliosis
Authors: Songur Murat , Choi John , Cheung Kenneth M. C. 
Published: May 2015

Introduction Commonly measured spinopelvic parameters (pelvic incidence, sacral slope, and pelvic tilt) have an effect on global sagittal balance of the spine. It was shown previously by cross-sectional studies that pelvic incidence increases with growth in children. But this change was not demonstrated in longitudinal radiological follow-up studies. In this study, we aimed to investigate the changes in spinopelvic parameters with growth in surgically treated AIS patients. Methods Whole body lateral radiographs eligible for spinopelvic measurements with radiological follow-up before and after skeletal maturity of AIS patients treated surgically were evaluated. First evaluations are made on preoperative radiographs of AIS patients (Risser O or 1). Second evaluations were made on postoperative radiographs taken after skeletal maturity (Risser 5). On whole body lateral radiographs pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis between L1 cranial endplate and S1 endplate (LL), and thoracic kyphosis between cranial endplate of T5 and caudal endplate of T12 (TK) were performed using Centricity DICOM software (General Electric). Measurements were made by two observers. Intra- and interobserver reliabilities were also evaluated by repeat measurements. Intra- and interobserver reliabilities for measurements were evaluated by intraclass correlation (ICC). Results A total of 171 surgically treated cases for AIS were reviewed. Of them, 33 cases had radiological follow-up data before and after skeletal maturity with lateral X-rays eligible for spinopelvic parameters measurement. Mean interval between evaluations was 7.49 years. Intra- and interobserver reliabilities for measurements were accepted as “good” with ICC values between 0.951 and 0.989. A significant increase in PI and SS was observed before and after skeletal maturity (46.32 ± 11.61 vs. 52.14 ± 11.69 degrees and 38.14 ± 7.57 vs. 43.19 ± 7.46 degrees, respectively). Increase in LL was also statistically significant and correlated with PI (53.38 ± 9.53 vs. 61.92 ± 10.48 degrees). Changes in TK and PT were not significant. Conclusions Results were concordant with previous cross-sectional and anthropometric studies regarding increase in pelvic incidence by growth. It is also concluded that overall lumbar lordosis is influenced by pelvic incidence both before and after skeletal maturity. As thoracic kyphosis is mainly influenced by instrumentation, no significant difference and relation with spinopelvic parameters were encountered. As reported previously, sagittal profile changes are well tolerated in adolescents, there was no major change in PT. But concerning long fusions, change in pelvic incidence and sacral slope can have a substantial effect on long sagittal profile of surgical candidates.