bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hangman Fracture: Treatment with Fluoroscopically Guided Transcutaneous Pedicle Screws
Authors: Ciancio Alejandro Morales , De Battista Juan Carlos , Sicoli Alfredo D. , Gonzalez Masanés Nicholas 
Published: May 2015

Introduction Hangman fracture is the second most frequent axis fracture, alter odontoid fracture. The most widely used classification is that of Levine and Edwards, based on lateral X-ray. Type I are those fractures with < 3 mm displacement. Type II fractures are those with > 3 mm displacement. Type IIa show little or no displacement, but a severe angle. Type III fractures are those with severe displacement, angle, and unifacet or bifacet dislocation. In several cases, Hangman fracture is associated with other lesions which require priority attention. Patient and Methods: We present the case of a 46-year-old female patient who suffered from polytrauma because of a car accident. She was driving using her seatbelt, but no airbag was available in the car. On entry to the hospital, she presented Glasgow 15/15, Asia E, diabetes antecedents, HTA, and BMI 69.4 kg/m . Also, femur and right ankle fracture plus C2 traumatic spondylolisthesis type IIa. Neurological tests were normal. There was acute cervical and right lower limb pain. Initially, “damage control” was performed: stabilization of extraspinal lesions with external tutor in femur and ankle osteodesis. Since the patient presented morbid obesity, and due to the need of stabilizing her CD fracture, closed reduction and percutaneous osteosynthesis with bilateral fluoroscopically guided pedicle screw. It is absolutely necessary to have a clear front and lateral visualization of the cervical spine to plan the screw trajectory and the incision. Results A correct closed reduction of the fracture was attained. We projected each screw trajectory through radioscopy. An incision was done at C6 level and minimally invasive surgery was practiced, using two bilateral cannulated pedicle screws with correct fracture compression. Postoperatory X-ray and TAC showed correct position of both screws and fracture reduction. The patient had a satisfactory global evolution, with total relief of cervical pain, withdrawal of cervical orthosis, and precocious movement. In X-ray controls at 30, 60, and 90 days, correct fracture reduction was observed. TAC performed 6 months after the accident showed fracture consolidation. Conclusion We consider that, in certain selected cases, fluoroscopically guided percutaneous surgery is a good alternative when trying to give patients the best solution available. In our case, the patient received its benefits since she continued her orthopedical rehabilitation of other associated lesions without any inconvenience for the cervical surgery, with great pain relief, avoiding deep approach through the body midline; receiving minimal scars and with correct fracture reduction and consolidation. Patient selection is relevant to such an intervention. The learning curve is slow, so one must be used to the conventional technique to then do percutaneous technique.
Minimal Invasive Surgery in Patients with Degenerative Lumbar Pathology. Initial Experience
Authors: Fleiderman José , Lecaros Javier , Munjin Aleksandar , Larraín Cristián 
Published: May 2015

Introduction The transforaminal lumbar interbody fusion (TLIF) is used traditionally as treatment of the degenerative lumbar disease (DLD), obtaining good results. Nowadays, minimal invasive surgery (MIS) TLIF is being used as a treatment to this pathology, with the purpose of reducing damage in soft tissues, as well as, the operative time and patient recovery. The objective of this study is to measure the in-hospital and surgical parameters of a case series, which had lumbar degenerative pathology surgery using the MIS TLIF technique. Patients and Methods Data of seven patients were collected, who had surgery by the same surgeon at Hospital del Trabajador (Santiago de Chile) during 2013 under the MIS TLIF technique. The operative time, ambulation start, hospital stay, CT fusion, and complications were measured. Results The M/H ratio was 6/1; with an average age of 44.28 ± 10.33 SD. Nine levels (L4–L5: 3 L5–S1: 6) were obtained of the seven patients, who had surgery by DLD under MIS TLIF technique. Two of them were a two-level fusion. The operative time was 169 (range, 145–205) minutes for a one-level fusion and 311 (range, 296–325) minutes for a two-level fusion. The ambulation start was the next day with a hospital stay of 3 (range, 2–3) days. All the surgical levels got a total or partial fusion under CT, with a CT follow-up of 6.91 ± 2.05 SD months. Two cases had a L5 transient paresis. Conclusions The MIS TLIF technique obtained good results of fusion under CT with minor complications. It demonstrates short operative time, early ambulation start with short hospital stay in the patients who had EDL surgery.
Analysis of Influences between Pain Marker and Epidural Fibrosis for Multiple Repeated Spinal Surgeries in Sprague Dawley Rat
Authors: Kim Y. 
Published: May 2015

Introduction Epidural fibrosis is one of the source of postoperative pain which is occurred by repeated surgeries. However, it was not known between epidural fibrosis caused by repeated spinal surgery and pain-related protein which is released at the dorsal root ganglion that makes spinal pain syndrome. Using rat spinal surgery epidural fibrosis and adhesion model, we investigate the role of spinal epidural adhesion caused by repeated epidural fibrosis, and we checked the dural thickness of the extent of epidural fibrosis and learn the proportional extent. And, we investigate on rat ganglion expression of MAPK/ERK by direct measurement of the amount of pain-related protein by using of immunohistochemistry and western blot. Material and Methods We divided the repeated surgery Sprague Dawley rat in three groups in 3 weeks' interval. Group A was first spinal laminectomy surgery group, and group B was two repeated surgery at the interval of 3 weeks, and finally Group C is three repeated surgery group at an interval of 3, 6, and 9 weeks. We humanely killed rat and checked dural thickness at each group and gathered spinal cord and performed immunohistochemistry p38, ERK, and JNK on each group. Finally, we checked western blot to check the expression of phosphorylated ERK, p38, and JNK. The checked expression levels were compared. Results Groups A, B, and C significantly increased the thickness of epidural fibrosis. The immunohistochemistry and western blot results of ERK and p38 expression was increased in serial controls A, B, and C. But, JNK expression increases from group A at a different pattern. By western blot, phosphorylation of ERK, p38 also increased in serial pattern control A, B, and C. Conclusion Repeated epidural spinal surgery while increasing the thickness of the ganglion stimulation of pain-related factors causing pain and neurogenic cause was determined to be capable of providing.
Sagittal Balance Before and after Pregnancy. Nature Course and Influence of Performed Spine Surgery Method
Authors: Polis Bartosz , Polis Lech , Nowoslawska Emilia 
Published: May 2015

Introduction The amount of spine surgeries grow each year. Spine diseases usually associated with advanced age start to appear in much younger patients. The matter of sagittal balance plays a crucial role in modern spine surgery. Knowledge of pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and spino-sacral angle (SSA) is mandatory in any modern spine procedure. However, so well understood spine parameters are almost never associated with pregnancy. Materials and Methods In our study, we decided to measure all the important spine parameters in a group of young women before pregnancy (healthy and women after spine surgical procedures on L4–S1) and after delivery. One of the most important questions is how to operate a young women properly in the reproductive period (discectomy vs. posterior transpedicular stabilization and PLIF/TLIF fusion). The study includes 90 women (30 in each group). Overall, 30 healthy with no syndromes before and after surgery, 30 who underwent microdiscectomy on L4–S1 level, and 30 who underwent posterior transpedicular and TLIF/PLIF fusion on L4–S1 level. All women had a sagittal balance spine measurements before and after pregnancy (pelvic incidence, pelvic tilt, sacral slope, and spino-sacral angle). The parameters have been comprised and proper conclusions were drawn. Results In all operated women before the surgical procedure, sagittal balance was changed. After pregnancy only in fused group, proper sagittal balance was retained. In the other groups (discectomy and healthy), sagittal balance was impaired after delivery. Conclusions Sagittal balance changes during natural pregnancy course. Posterior transpedicular stabilization with PLIF/TLIF fusion performed before pregnancy characterized better long-term follow-up than pure discectomy. Also, reoperation proportion was significantly lower in the fused group. In women in reproductive period, surgical procedures based on fusion and sagittal balance correction seems to be a method of choice.
The Effect of Complications and Reoperation on Recovery Kinetics in 149 Adult Spinal Deformity Patients with 2-Year Follow-Up: An Area under the Curve Analysis
Authors: Ames Christopher , Scheer Justin , Mundis Gregory , Klineberg Eric , Hart Robert , Kelly Michael , Deviren Vedat , Burton Douglas , McCarthy Ian , Bess Shay , Schwab Frank , Shaffrey Christopher , Lafage Virginie , Smith Justin 
Published: May 2015

Introduction Complication rates in adult spinal deformity (ASD) surgery are high and the effects on overall recovery are not well understood. Current methods of reporting outcomes are limited to static outcome time points perhaps diminishing the health impact of the entire recovery experience. This study aims to identify the effect of complications on the kinetics of the recovery process (recovery kinetics) by examining the effect of HRQOL over time via an area under the curve analysis (AUC). Materials and Methods A retrospective review of a multicenter, prospective ASD database. Inclusion criteria, ≥ 18 years, ASD. Complication number, type, and need for reoperation (reop) were recorded. Patients (pts) were stratified as having no complication (NOCOMP) and any complication (COMP). HRQOL collected included Oswestry Disability Index (ODI), Short Form-36 (SF-36), and Scoliosis Research Society-22 (SRS22) at baseline, 6 weeks, 1 and 2 years post-op. All HRQOL was normalized to each pts' baseline scores as a comparison relative to where the pts started. An AUC was then calculated across the entire 2 years. Standard HRQOL, normalized HRQOL, and AUC means were compared between the groups. Results A total of 149 pts were included (COMP: 84 and NOCOMP: 45). There were no significant HRQOL differences at any time point between the groups ( p > 0.05 for all). However, after normalizing the HRQOL, COMP had significantly lower SRS mental scores at 1 year (1.1 ± 0.2 vs.1.2 ± 0.3, p = 0.0002) and 2 years (1.1 ± 0.3 vs. 1.3 ± 0.4, p = 0.0003). COMP had significantly lower SRS Mental AUC than NOCOMP (3.2 ± 0.5 vs. 3.5 ± 0.6, p = 0.0023). Overall, 28 (19%) pts had a reop. There were no significant differences between any HRQOL 2-year AUC values between pts with complications requiring reop and those with no reop ( p > 0.05 for all). Conclusion Static HRQOL analysis would suggest there is no difference between complication groups. Area under the curve (AUC) analysis suggests there is a significantly protracted mental recovery phase associated with patients that have at least one complication and the addition of reop does not affect the recovery kinetics.
Risk of Development of New Onset Postoperative Cervical Deformity in Thoracolumbar Adult Spinal Deformity and Effect on Clinical Outcomes at 2-Year Follow-Up
Authors: Soroceanu Alex , Passias Peter , Boniello Anthony , Scheer Justin , Schwab Frank , Shaffrey Christopher , Kim Han Jo , Protopsaltis Themistocles , Mundis Gregory , Gupta Munish , Klineberg Eric , Lafage Virginie , Smith Justin , Ames Christopher 
Published: May 2015

Introduction A high prevalence of residual cervical deformity (CD) has been identified following surgical treatment of adult spinal deformity (ASD). Development of the new onset CD is less understood and its clinical impact unclear. This study quantifies the incidence of new onset CD after ASD surgery, identifies predictors of development, and determines the impact outcomes. Materials and Methods Retrospective review of a prospective multicenter database yielded 215 patients (pts) with complete 2-year follow-up and full length X-rays including the cervical spine. CD was defined by T1S–CL > 20 degrees, C2C7 SVA > 40 mm, or C2C7 kyphosis > 10 degrees. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new CD. The impact of CD on health-related quality of life (HRQL) and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders. Results Of the 215, 88 pts with ASD did not have CD at baseline and 42 of them (47.7%) developed CD at 2 years' postoperatively. Univariate analysis revealed that pts who developed new CD in the postoperative period had a higher incidence of diabetes (14.29 vs. 2.17%, p = 0.036) increased preoperative C2C7 SVA ( p = 0.04) and C2 slope ( p = 0.038) and smaller diameter rods used at surgery ( p = 0.0328). Independent predictors of new CD at 2 years included diabetes (OR, 10.49; p = 0.046) and increased preoperative TS–CL (OR, 1.08/deg, p = 0.027). Ending instrumentation below T4 was a negative predictor of CD (OR, 0.31; p = 0.019). Pts with and without CD experienced improvements in 2-year SF-36 ( p = 0.0001), ODI ( p = 0.0001), and SRS ( p = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction ( p = 0.28). Conclusion Overall, 47.7% of pts without preoperative CD develop new postoperative CD after ASD surgery. Independent predictors of new onset CD at 2 years include diabetes, higher preoperative TS–CL, and ending instrumentation above T4. Significant improvements in HRQL scores occurred despite the development of postoperative CD.
Geographic and Ethnic Variation in Radiographic Disability Thresholds: Analysis of North American and Japanese Operative Adult Spinal Deformity Populations
Authors: Ames Christopher , Matsumoto Morio , Hosogane Naobumi , Smith Justin , Protopsaltis Themistocles , Yamato Yu , Matsuyama Yukihiro , Taneichi Hiroshi , Lafage Renaud , Ferrero Emmanuelle , Shaffrey Christopher , Schwab Frank , Lafage Virginie 
Published: May 2015

Introduction Regression analysis of adult spinal deformity (ASD) databases in North America (NA) has yielded radiographic disability thresholds for sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence to lumbar lordosis (PI–LL), which have been used in formulating the Schwab–SRS ASD classification. These thresholds are often used as correction goals for surgery planning, but it is unclear whether these thresholds vary in other geographic regions or ethnicities. This is the first comparison of radiographic disability thresholds between NA and Asian populations of ASD. Patients and Methods Retrospective, multicenter case series of 595 operative patients with ASD with baseline radiographs and Oswestry disability index (ODI) from 11 sites across USA ( n = 402) and Japan (JPN, n = 193). Patients were compared at baseline in ODI, ODI need for improvement (ODIni, calculated from age/ethnic normative values), and radiographs. Linear regression was used to define thresholds for disability. Results Differences existed in mean age (USA 52.5 ± 22.5 years vs. JPN was 56.5 ± 15.4 years, p = 0.012) and revisions (USA 48% vs. JPN 2%, p < 0.001), but not gender (USA 85% women and JPN 80% women). At baseline, there were no differences in sagittal parameters except PI, which was significantly smaller in the JPN cohort. Linear regression revealed differences in radiographic parameters corresponding to ODI of 30 to 40. JPN had higher PI–LL and PT for ODI 30 and 40 but similar SVA thresholds. Significant differences existed in Schwab classification curve type (JPN with more double curves, p < 0.001) and PT (JPN with lower grade) but not in PI–LL modifier. JPN had a significantly lower ODI (USA 43.7 vs. JPN 36.2, p < 0.001), without a significant difference in ODIni. Conclusion At baseline, patients in both cohorts had a similar sagittal deformity but different morphology. Disability thresholds for SVA appear to be maintained across ethnicities but with differences in pelvic morphology (PI–LL and PT). The JPN cohort had significantly smaller PI and multiple coronal curves compared with the USA cohort. Despite similar sagittal malalignment, the JPN cohort had a significantly lower ODI without a significant difference in ODIni.
Area under the Curve: Analysis of Approach-Related Recovery Time in 165 Operative Cervical Spondylotic Myelopathy Patients with a 2-Year Follow-Up
Authors: Challier Vincent , Smith Justin , Shaffrey Christopher , Kim Han Jo , Arnold Paul , Liu Shian , Scheer Justin , Chapman Jens , Protopsaltis Themistocles , Lafage Virginie , Schwab Frank , Massicotte Eric , Yoon S. Tim , Fehlings Michael , Ames Christopher 
Published: May 2015

Introduction Much debate about postoperative outcomes regarding surgical approaches for cervical spondylotic myelopathy (CSM) exists in the literature with no clear evidence of superiority. We propose a novel method for assessing health-related quality of life (HRQOL) outcomes by taking into account each patient's baseline at postoperative time points and analyzing the “area under the curve” (AUC), a proxy for suffering time. Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 165 patients met the following inclusion criteria: symptomatic CSM, age older than 18 years, and 2-year follow-up with modified Japanese Orthopaedic Association (mJOA) and neck disability index (NDI). The anterior approach group (AAG) ( n = 110) and posterior approach group (PAG) ( n = 55) were compared at baseline, 1 year, and 2 years for each HRQOL. This comparison was repeated with normalization, using the patient's baseline as the anchor, followed by an integration and comparison of AUC. Results and Conclusion: For the first time, AUC analysis was applied to evaluating patients with CSM. Nonnormalized HRQOLs demonstrated the AAG started higher and met better standards at all times points compared with the PAG. Normalized mJOA demonstrated the PAG actually did better at 2 years, whereas NDI suggested that the AAG did better, although this was not significant. AUC analysis further supported the superiority of the PAG, with statistical significance at 1 and 2 years' time points, suggesting that patients who undergo the posterior approach may suffer less in the first 2 years of their postoperative course.
Clinical Results of Laminoplasty for Cervical Myelopathy Caused by Disc Herniation with Developmental Canal Stenosis
Authors: Fukao Shigeharu , Kidooka Minoru 
Published: May 2015

Introduction Anterior discectomy and spinal fusion have had acceptable surgical results, but many complications have been reported, especially adjacent segment degeneration and bone graft complications. To compare the surgical results of laminoplasty with those of anterior spinal fusion in patients with myelopathy caused by the cervical disc herniation, and to make a treatment strategy for cervical disc herniation depending on these results. Patients and Methods A total of 10 patients with cervical disc herniation were examined in this study, who underwent laminoplasty without resection of the herniated disc. The mean age was 60 years. As a control group, 31 patients (mean age, 53.4 years) who underwent anterior spinal fusion were examined. All patients in the laminoplasty group also had developmental spinal canal stenosis in which the anteroposterior canal diameter was less than 13 mm. The mean follow-up was 2.5 years in the laminoplasty group and 3.2 years in the anterior fusion group. Neurological and radiological results were examined. The severity of myelopathy was evaluated according to the Neurosurgical Cervical Spine Score (NCSS). Surgical outcomes were evaluated by the NCSS for determining the recovery rate. Results The recovery rate averaged 46% in laminoplasty and 48% in anterior spinal fusion. There were no significant differences between the groups. Cervical lordosis angle was diminished postoperatively without a significant difference between the two groups. In the laminoplasty group, one patient with kyphotic deformity after laminoplasty had transient motor weakness, and one patient underwent anterior spinal fusion after laminoplasty according to myelopathy caused by the cervical disc herniation. Follow-up magnetic resonance imaging showed regression of the size of the herniated disc in 5 of the 10 patients in the laminoplasty group. Conclusion Laminoplasty for patients with narrowed spinal canals showed favorable surgical results. Laminoplasty should be employed for cervical myelopathy caused by disc herniation in particular with developmental spinal canal stenosis to avoid secondary myelopathy.
Relevance of Signs and Symptoms in the Prognosis of Patients with Lumbar Disc Herniation
Authors: Falavigna Asdrubal , Righesso Orlando , Teles Alisson Roberto , da Silva Pedro Guarise , Cardoso Suelen , Chalá Fernanda 
Published: May 2015

Introduction Lumbar disc herniation (LDH) is currently a prevalent pathology which leads to physical, psychological, and social limitations for the patient. The most frequent signs and symptoms are lumbocyatalgia, motor and sensitive disorders, and Lasègue sign. In patients with LDH refractory to medical treatment, discectomy is the standard procedure to improve the symptoms. The objective of this study is to study the prognostic relevance of signs and symptoms in patients with LDH refractory to medical treatment. Materials and Methods a systematic review was performed in the main biomedical databases, searching for articles that studied the percentage of improvement and prognostic value of the preoperative signs and symptoms of patients with LDH. The signs and symptoms evaluated were lumbar pain, leg pain, motor and sensitive disorders and Lasègue sign. Results Some authors found that the preoperative low back pain was a negative predictor of outcome after LDH surgery whereas others did not find a correlation with prognosis. The more intense the leg pain the better were the results as the duration of the symptoms was less than a mean time of 6 months. The sensitive deficit in the leg and Laségue sign were usually reported as positive prognostic factors. The different study designs and instruments to assess the outcome explained some disagreement observed in the literature. Conclusion The literature shows that the success rate in surgery of patients with LDH refractory to medical treatment is correlated with the absence of lumbalgia, the presence of cyatalgia over up to 6 months, the sensitive deficit present alone or associated with MD, and the presence of a positive Lasègue sign during the preoperative period.