bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative Patients' Perception of Motor Deficit caused by Lumbar Disc Herniation and its influence on Health-Related Quality of Life
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Bossardi Julia Bertholdo , Conzatti Lucas Piccoli 
Published: May 2015

Introduction The incidence of motor deficits (MD) varies from 15 to 69% during the investigative or preoperative period. There seems to be no consensus regarding the precise importance of neurological impairment in determining the need for surgery and its impact on the patient's self-reported health-related quality of life (HRQoL). The objective of this study was to evaluate the impact of MD on the HRQoL of patients with lumbar disc herniation (LDH) before a specific treatment. Patients and Methods A prospective cohort of 254 consecutively enrolled patients with LDH associated to neurological impairment and sciatica without a response to conservative treatment was evaluated. After exclusion criteria, 168 were included. Validated instruments in the preoperative period were used to evaluate QoL: pain, disability, QoL, anxiety, and depression. Results A normal motor strength was observed in 57 (33.9%) patients and MD was observed in 111 (66.1%) cases. No statistically significant differences were observed between patients with and without MD regarding gender, age, level of herniation, lateralization, and work compensation. Regarding QoL, no difference was detected in the eight domains of SF-36 and between the PCS and MCS groups. The only difference observed was a higher disability rate in the MD group, with the mean ODI difference being 7.84 (CI 95%, 1.82–13.87; p = 0.011) Motor weakness was observed by 35.1% ( n = 39/111) of patients with an abnormal motor examination and it was related to severity ( X2: 46.058; p < 0.0001). Conclusion In patients with LDH without a specific treatment, the presence of MD does not impair the pain, disability, depression, and self-reported QoL measures. The MD has no discriminative power for QoL measures in patients with LDH.
Outcome Assessment in Spine Surgery
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , Dal Castel Mateus , Coberlini Louise , Cardoso Scheila 
Published: May 2015

Introduction The use of clinical and functional evaluation instruments for vertebral pathologies, besides determining how the situation evolves after treatment, can predict the postoperative outcome. The objective of this study is to describe the methodology to evaluate outcome in the spinal surgery. Patients and Methods After surgical treatment is indicated, the patients are invited to participate in the study by signing a letter of free and informed consent. The patients complete the questionnaires at the doctor's office, and are helped regarding doubts in filling them out by a person who is not involved in the surgery. All the evaluation instruments used are self-applied. The following are used: numerical rating scale of pain (NRS), SF-36 questionnaire, Fear-Avoidance Beliefs questionnaire (FABq), Beck Depression Inventory (BDI), hospital anxiety and depression scale (HAD), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). The patient himself/herself answered the questionnaire, not the secretary or the surgeons. The patient fill out the questionnaire using a regular paper (paper-and-pen questionnaire) or computer software directly using the internet from their home. The surgeons give the patients feedback on the results. Results A total of 220 patients with lumbar spine pathologies and 32 with cervical pathologies were evaluated. Typically, when completing paper forms the data are collected, recorded, and computerized manually. The pros was that you got something answered by the patient and the cons were missing values—the patient does not answer some questions (3%), the secretary skips some questions (1%), misrecordings with the chance of error when inserting the data into the computer (range, 2–5%); and secretary's work were laborious and time consuming. When the patient answered the questionnaire directly to the computer software, the data were self-recorded by the patient using a touch-screen system at the clinic or by accessing the webpage using their own username and password. In those cases, the cons were that some patients do not know how to deal with a computer and the pros were that the data are already in the computer and in the Excel workbook and when the patient enters the office the surgeons already have the questionnaire results. The prevalence of depression according to the BDI was 28.0 and 31.2% in patients with lumbar and cervical surgical disease, and the prevalence of anxiety according to HAD-A is 40.1 and 46.9%, respectively. The mean of ODI was 46.5 and of NDI 25.4. Most of the patients, when they have been instructed about completing them, do not have any difficulty in finishing them. The mean time for the completion of all instruments is 25 to 35 minutes. Conclusion The use of instruments validated to evaluate patients with degenerative spinal diseases is feasible and should be encouraged among the spinal surgeons. Following the right steps, the patient is convinced of the importance of answering correctly.
Effective Protocol to Treat Patients with Deep Wound Infection after Spinal Lumbar Fusion
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Bassanesi Francisco 
Published: May 2015

Introduction Deep wound infection (DWI) is a complication associated with poorer outcome and increased costs. The DWI rates increased in the last decade especially because of the use of spinal instrumentation. Although this condition is important for the surgical outcome, there is still no agreement about the about the need to remove the instrumentation. The objective is to describe the authors' experience in managing DWI without the removal of instrumentation after performing a procedure on the lumbar spine and the clinical and functional long-term course of these patients. Patients and Methods A prospective cohort study with the patients who presented deep infection of the surgical wound. All the patients with a clinical suspicion of this complication were submitted to an aggressive protocol of wound opening, collection of material for a microbiological examination, exhaustive washing, debridement, implementation of a continuous washing system, primary suturing of the wound, and treatment with antibiotics IV and then orally. The instrumentation was not removed from any patient. The patients were evaluated radiologically, clinically, functionally, and by blood test examination, white blood cell count, erythrocyte sedimentation rate, and C-reactive protein, during the follow-up. Paired analyses were performed using the Wilcoxon test to evaluate changes in the instrument scores. Results The mean age was 59.31 ( ± 13.17) and most of the patients were female (94.7%; 18/19). At least one comorbidity was observed in 68.4% of the patients, the most frequent being obesity, present in 26.3% of the patients. The mean period for the identification of DWI was 2 weeks and 57.9% underwent only one wound exploration. Staphylococcus aureus was the most common microorganisms ( n = 13 cases, 68.4%). Blood tests showed a significant decrease of the WBC, ESR, and CRP 6 weeks' posttreatment when compared with pretreatment values. Comparing the 6 weeks' posttreatment evaluation and the final evaluation, a significant reduction of ESR and CRP was also observed. Conclusion Patients with DWI after posterior lumbar spinal instrumentation fusion can be treated without removal of the instrumentation through an aggressive protocol of wound exploration, extensive washing, debridement of necrotic tissue, closed irrigation system during 5 days, and proper antibiotic therapy. The WBC, ESR, and CRP blood tests were not useful to predict the need for surgical reinterventions. Despite the complication, the patients presented improvement with respect to pain, functional capacity, and preoperative quality of life.
Minimally Invasive Scoliosis Surgery in Lenke 5 Adolescent Idiopathic Scoliosis: A Preliminary Result
Authors: Zhu Zezhang , Liu Zhen , Zhu Wei-Guo , Qian Bang-Ping , Wang Bin , Sun Xu , Yu Yang , Zhu Feng , Qiu Yong 
Published: May 2015

Introduction Minimally invasive spine surgery has been introduced in the treatment of multilevel pathology, such as adult lumbar degenerative disorders. Recently, the concept of minimally invasive scoliosis surgery (MISS) was put forward and applied to the correction of scoliosis. However, few studies have reported the utilization of MISS technique in adolescent idiopathic scoliosis (AIS). The objective of this study is to assess the outcomes of posterior MISS in Lenke 5 AIS. Patients and Methods A total of seven patients were included who underwent posterior MISS from November 2012 to July 2014. There were six females and one male, with an average age of 17 years (range, 15–18 years). The operation time and intraoperative blood loss were recorded. The following radiographic parameters were evaluated before surgery, immediately after surgery, and at the last follow-up: curve magnitude, apical vertebral translation (AVT), apical vertebral rotation (AVR), trunk shift, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The accuracy of pedicle screw placement was assessed according to postoperative CT scans. Screw perforation > 2 mm of either pedicular or vertebral cortex was considered at potential risk, and medial pedicle perforation > 4 mm or contour of aorta was considered at high risk. Results The average operation time was 4.4 hours (range, 2.0–6.5 hours) and intraoperative blood loss was 225 mL on average (range, 100–400 mL). A total of 66 screws were inserted in the seven patients. The Cobb angle of thoracolumbar/lumbar curve was 40 to 65 degrees (mean, 46.3 degrees) before surgery. Immediately after surgery, the correction rate of main curve was 76.4% on average (range, 70.0–87.8%), and an obvious improvement was noted in terms of AVT, AVR, trunk shift, TK, and TLK. All the patients were followed up for 8.4 months (range, 3–21 months) on average. At the last follow-up, the average loss of correction of the main curve was 1.9% (range, 0–6.0%). Except the increase of SVA (from −31.1 to −7.3 mm), no obvious changes of AVT, AVR, trunk shift, TK, TLK, and LL were observed during the follow-up. According to CT evaluation, 56 screws (84.9%) were fully contained within the cortical boundaries of the pedicle, 10 screws (15.1%) breached pedicle walls whereas 5 screws (7.5%) were at potential risk. No wound infection, implant failure, and neurologic complications were found after surgery. Conclusion A minimally invasive posterior approach, although technically challenging, is a feasible and safe option for patients with Lenke 5 AIS. However, long-term data are needed before routine use.
Nucleoplasty for the Treatment of Low Back Pain Caused by Degenerative Disc Disease
Authors: Manukovsky Vadim , Tiulikov Konstantin , Litvinenko Igor , Korostelev Konstantin , Badalov Vadim 
Published: May 2015

Introduction Puncture methods—Nucleoplasty by coblation and radio frequency denervation—have recently been widely used for the treatment of pain syndrome caused by intervertebral disc protrusion. The purpose of this study was to assess the effectiveness of nucleoplasty and radio frequency denervation of intervertebral joints as advanced minimally invasive surgical techniques for alleviating pain in the case of intervertebral disc disease, spondylarthrosis, and other vertebroneurologic diseases accompanying degenerative disc disease. Methods Since 2010, 70 patients with lumbar disc protrusion and signs disc-radicular conflict underwent nucleoplasty by cold plasma. All patients had a history of back pain or/and leg pain for not less than 3 months and were followed up after undergoing minimally invasive procedures for a year. Visual Analog Scale, Oswestry Disability Index (ODI), and Treatment Satisfaction Scale were used for evaluation. A total of 50 patients of control group also with protrusion of intervertebral disc were treated therapeutically. Results No complications were noted. At 12-month follow-up, all the operated patients showed the decrease of pain syndrome intensity according to the Visual Analogue Scale ( p < 0.0001), and decrease ODI compared with patients treated therapeutically ( p < 0.001). Treatment Satisfaction scores were higher as compared with the patients of the control group. Conclusions Nucleoplasty allowed us to successfully treat patients affected by lumbar disc protrusion who treated therapeutically not less than 6 weeks without effect. Minimally invasive electrosurgical techniques appeared to be safe and effective in the treatment of carefully selected patients suffering from low back and leg pains caused by a degenerative-dystrophic process. Nucleoplasty technique is more effective in younger patients. Procedures performed at several levels also result in marked clinical improvement. the primary advantages of these techniques were their safety and efficacy, minimal invasiveness, and the absence of a peridural scar. They do not complicate further microsurgical intervention.
Lumbar XLIF and Bilateral Percutaneous Pedicle Screw Fixation Performed all in Lateral Position
Authors: Buric Josip 
Published: May 2015

Introduction Evaluation of the feasibility, technical difficulty, and clinical results in performing combined lumbar XLIF and bilateral percutaneous pedicle screw fixation done all in lateral position. Lumbar XLIF and bilateral percutaneous pedicle fixation is a valuable minimally invasive approach for achieving a useful and solid lumbar circumferential fusion in selected cases. Nonetheless, until today a change of the position of the patient on the operating table from lateral to prone was used. Theoretically, performing both approaches in the same position would significantly reduce the time of surgery. Patients and Methods A total of 10 consecutive patients were submitted to a circumferential fusion done in the same, lateral, and position. There were six female and four male patients, mean age 52 years. Low back pain and degenerative disc disease were the main patient's complaint and pathology, respectively. Patients were followed up for surgery length and walk out of bed timing and compared with the patients done previously with change of position. Clinical outcome was evaluated with VAS and ODI scores. Results Four patients performed a two-level circumferential fusion (L3–L5) whereas six patients performed the procedure on a single level (four on L4–L5 and two on L3–L4). Mean surgical time was 79 ( ± 14) minutes (29 for XLIF and 50 for pedicle fixation) and 114 ( ± 21) minutes (54 for XLIF and 60 for pedicle fixation) for 1 and 2 level circumferential fusion, respectively. Average time lap between the XLIF part and pedicle screw part of the procedure was 4 minutes. As compared with the usual approach with the change of position, approximately 20 minutes were saved. There was no significant difference in walk out of bed timing as well as no difference was found for clinical outcome scores (VAS and ODI). No additional complications were noted in this group of patients as compared with the patients operated previously with the change of position. Conclusion Lumbar circumferential fusion with XLIF and bilateral percutaneous pedicle screw fixation performed in lateral position seems a useful modification of the classical method done in two different positions. The main advantage is time saving. Technical challenge in performing the procedure in lateral position is slightly more demanding because of the different patient orientation; however, the learning curve is short and after a few cases, the timing of the approaches between prone and lateral position equals. No differences on clinical outcomes and complication rates were noted.
Magnetic Resonance Imaging association with the preoperative Neurological Status and its Predictive Value of the Postoperative Recovery in Patients with Cervical Spondylotic Myelopathy
Authors: Zaater Ahmed , Mashhour Shady 
Published: May 2015

Introduction This is a prospective observational study of consecutive patients undergoing surgery with cervical spondylotic myelopathy (CSM), to assess the association of the quantitative assessment of preoperative magnetic resonance imaging (MRI) with the preoperative neurological status and postoperative neurological recovery. The factors of predictive value to the neurological recovery in patients with CSM postoperatively are of great interest. Currently, the significance of MRI signal changes in relation to prognosis in the literature is conflicting and inconsistent. Patients and Methods A 50 consecutive patients with CSM were studied preoperatively and postoperatively after 1 year. Modified Japanese Orthopedic Association (mJOA) was recorded preoperatively and 1 year after surgery. Using univariate and multivariate analysis, the relation of the preoperative status and postoperative recovery to quantitative MRI measurements preoperatively were assessed. Results Low T1 signal change preoperatively was associated with a lower preoperative mJOA ( p = 0.021). Focal high T2 signal was associated with lower preoperative mJOA scores ( p = 0.62). Preoperative focal T2 signal had a significant association with poorer postoperative recovery rate ( p = 0.032). Conclusion MRI signal changes can predict preoperative neurological status and postoperative recovery. The presence of hypointense T1 signal and focal hyperintense T2 signal on MRI are indicators of poorer outcome.
A Field Survey of Spinal Cord Injury in Bodyboarders
Authors: Yanagawa Youichi , Ishikawa Kouhei , Omori Kazuhiko , Obinata Mariko , Osaka Hiromichi , Oode Yasumasa , Kubota Atsushi , Sakuraba Keishoku 
Published: May 2015

Introduction During the summer, a large number of tourists visit Izu Peninsula, and our hospital is the only hospital capable of treating patients with acute-phase spinal cord injuries on Izu Peninsula. Among the various marine sports, bodyboarding was the leading cause of spinal cord injury in subjects transported by the physician-staffed emergency helicopters in Izu peninsula.1 Hence, we investigated the number of players of surfing, bodyboarding, and obtained information using a questionnaire in a field. Material and Methods From July 26, 2014 to August 5, 2014, we asked bodyboarders at the beaches and our hospital on Izu Peninsula to complete a questionnaire. The items on the questionnaire were as follows: sex, age, hometown, years of experience, owner of the bodyboard, history of head injury, history of dysesthesia of the extremities, background of the event if the answer was yes for a history of head injury or dysesthesia, and whether the bodyboarder was aware of the possibility of spinal cord injury while bodyboarding. The subjects were divided into two groups based on whether they did or did not experience dysesthesia during bodyboarding. And, we also counted the number of bodyboarders and surfers at several beaches on Izu Peninsula by eyesight, during the top season of summer from August 17, 2014 to August 23, 2014. Results We obtained answers from 24 bodyboarders. During this period, the number of bodyboarders was clearly fewer than that of surfers. There were no significant differences in terms of sex, hometown, years of experience, owner of the bodyboard, and knowledge of the possibility of spinal cord injury while bodyboarding. Meanwhile, the age of the subjects in the Dysesthesia group ( n = 4) was older than that of the Control group ( n = 20, p < 0.05). All of the subjects in the Dysesthesia group felt dysesthesia of the upper extremities when their head hit the sea bottom while being buffeted by waves. During this summer season, there was the only case of spinal cord injury induced by bodyboarding, and there were no cases of spinal cord injury induced by surfing. Concerning the results of number for each sport, there were 498 surfers and 643 bodyboarders during the top season of summer. The ratio of players of the two sports was 1 to 1.3, whereas the ratio of patients with spinal cord injury was 1 to 14 over a 5-year period.1 Most of them had cervical spinal stenosis. Conclusion Bodyboarders are more likely to experience spinal cord injury than surfers. A middle-aged or older people, who may have signs of cervical spinal canal stenosis, such as neck pain or dysesthesia of the extremities, should avoid bodyboarding to avoid spinal cord injury. Reference Omori K, Kondo A, Oode Y, Itoi A, Sakuraba K, Yanagawa Y. Factors related to trauma secondary to bodyboarding water sport. J Emerg Trauma Shock
Flowcytometric Evaluation of the Safety of Intraoperative Salvaged Blood Filtered with Leucocyte Depletion Filter in Spine Tumor Surgery
Authors: Kumar Naresh 
Published: May 2015

Background Intraoperative cell salvage (IOCS) has not been widely adopted in oncological surgery because of hypothetical concern of reinfusion of malignant cells. We conducted the study to evaluate the feasibility of IOCS in combination with leukocyte depletion filter (LDF) in metastatic spine tumor surgery (MSTS) using quantitative flow cytometry tumor detection technique. Methods Patients with known primary epithelial tumor, operated for metastatic spinal disease, were recruited. Blood samples were collected at five different stages during surgery: two stages from patient vein during induction and at the time of maximum tumor manipulation, three stages from the operative blood before IOCS processing, after IOCS processing, and after IOCS–LDF processing. Of the samples taken at each stage, 5 mL were analyzed for tumor cells using flow cytometry. Results Of the 12 patients recruited, only 11 could be finally analyzed. Flow cytometry analysis of their samples showed that 8 of 11 patients had tumor cells in the unfiltered salvaged blood. In filtered salvaged blood, the tumor cell count was zero in the majority of samples (8/11 patients) whereas three patients' samples had a few tumor cells. The difference between the mean tumor cell quantity in the samples taken from stages A and E was significant ( p = 0.04). Similarly, the difference between the mean quantities of tumor cells in the samples in stages B and E was significant ( p = 0.01). However, there were no significant differences between the mean quantities of tumor cells when comparing the samples from either stages A and B, stages D and E, or stages C and E. Conclusion IOCS–LDF was shown to be effective in removing tumor cells from blood salvaged during MSTS. If there were any tumor cells found, the quantity was significantly less than that in patient's circulation. The results of this study supported that fact that IOCS–LDF treated blood in MSTS is safe for transfusion.