bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanical Effect Characterization in Posterior Monosegmental Instrumentation in Burst Fractures: Biomechanical Analysis
Authors: Agon Rendon Mauricio Alexander , Avila Jose Maria Jimenez , Perez Oscar Atanacio , Avalos Nancy , Barba Herrera Mariana Shizuko , Fuentes Rita , Garcia Gonzalez Alejandro 
Published: May 2015

Introduction Different treatment options and approaches have been applied to treat thoracolumbar burst fractures. From an anterior to a combine 360-degree approach, none has proven to be a gold standard for this type of fracture. Considering the four principles for proper spinal patient management (stability, function, alignment, and biology), different treatment options arouse to treat thoracolumbar bust fractures. Short posterior instrumentations with an intermediate pedicle screw, which acts as an anchorage point, counterbalancing anterior forces and favoring the lumbar lordosis strength. And monosegmental instrumentation are been applied to preserve as much spine segments as possible, allowing mobility and maintaining spine stability. The objective of this study is to determine the biomechanical effects of posterior monosegmental constructs in burst fractures by a characterization analysis. Material and Methods Otherwise healthy swine thoracolumbar vertebrae were used to apply an axial load to simulate a burst fracture. Initial force, end force, and total displacement were analyzed. Posterior monosegmental instrumentation was performed in the thoracolumbar segment. Healthy swine vertebrae were used as control group. A CT scan was done in the instrumented segment. The images then were converted for biomechanical analysis using meshing and reconstruction software. Results Initial compression force: 34.92 N. End force: 1.44 kN. Total displacement: 11.27 mm. Healthy and instrumented specimens initial compression force: 2.311 and 2.657 kN, respectively. Young module in healthy and instrumented specimens was 123,276 versus 159.749 MPa. Maximum load applied 2.126 kN/m. Mean displacement was 5.30272 mm. Discussion There is much more resistance against deformation, even when the specimen is fractured. SolidWorks software is a useful tool for biomechanical testing. When comparing simulated results with live compression tests there is a 17.3% chance of error during the maximum load test
Primary Vertebral Lymphoma: Two Cases and Literature Review
Authors: Simon Reddy , Silva Juan , Jara Juan , Portillo Thamara 
Published: May 2015

Introduction Spinal non-Hodgkin lymphomas (NHL) seldom affect spinal cord as first presentation, as there are mostly extradural initially. Usually presented in dorsal region, they are mostly high degree, aggressive, type B on diagnosis. We report two cases with spinal cord compression as first clinical manifestation. Patients and Methods The case reports of two cases of primary vertebral lymphoma from our service were presented. Results A 65 year-old-man had months-long back pain with sudden sphincter-sparing paraparesis; magnetic resonance imaging (MRI) showed prevertebral mass in T3 with vertebral body fracture and medullary compression. HIV testing was positive. Urgent decompressive surgery with tumor resection and stabilization yielded good recovery of motor function. A 69-year-old woman had 3 months of exercise-induced back pain and 10 days of paraplegia before coming to our service. MRI showed epidural invasion with medullary compression. Laminectomy and tumor resection were performed but without neurologic recovery. Burkitt lymphoma was diagnosed in both the cases. Conclusion We report two cases of aggressive NHL presenting as acute spinal cord compression requiring urgent surgical intervention. One of them on a background of undiagnosed HIV infection.
Outcomes in Anterior Cervical Discectomy with Anchored Intersomatic Cage
Authors: Scheverin Nicolas , Roberto Castelli , Videla Kopp Nicolas , Sarotto Anibal , Sobrero Diego , Dino Dinelli , Steverlynck Alejandro 
Published: May 2015

Introduction The anchored cervical intersomatic cages made in PEEK is a new promising alternative to anterior cervical locking plates with autologous iliac bone graft for anterior cervical discectomy and fusion. The advantage of such devices is the lack of profile and can provide the stability needed to achieve the arthrodesis. Objectives This study aims to evaluate the outcomes and fusion rates of the anchored intersomatic cage for achieving a stable arthrodesis and compare this result with established fixation methods. The hypothesis is that this device would be associated with low short-term complications and dysphagia, and could achieve a solid fusion and maintains the pain relief. Patients and Methods This was a comparative study in a single center, 50 patients were enrolled; 25 patients who underwent anterior cervical discectomy and fusion with autologous bone graft and locking plate and 25 patients with cervical intersomatic cage with heterologous bone graft. The clinical features Neck and Pain Disability Index; radicular pain, neck pain, and patient satisfaction were evaluated with VAS; and dysphagia scores were recorded preoperative and postoperative. Radiographs evaluated the height of intervertebral disc, implant position, and cervical Cobb angle. All patients had a minimum follow-up of 12 months. Results In all the patients, we found that a stable arthrodesis was achieved; the neck pain and radicular pain significantly reduces after surgery, without change after 1 year of follow-up. We do not have any chronic dysphagia and only one patient complained of minor dysphagia that improved in 2 weeks. Conclusions The cervical-anchored intersomatic cages are new surgical alternative with good functional outcomes, low-complication rates, and better postoperative patient comfort. We think that this is a preliminary assessment and prospective randomized trials are necessary to confirm this observation.
Chondrodysplasia Punctata: Clinical and Imaging Impact on Spine
Authors: Sayago Luis Rene , Francheri Ida Alejandra , Tello Carlos A. , Noel Mariano A. , Galaretto Eduardo , Remondino Rodrigo G. , Bersusky Ernesto 
Published: May 2015

Study Design This study is a retrospective study. Objective This study aims to identify spinal deformities caused by chondrodysplasia punctata (CDP) in spine and assess our surgical treatment experience. Introduction CDP is a skeletal dysplasia characterized by stippled epiphyses. It has a wide spectrum of clinical manifestations. The classic vertebral involvement is dysplastic kyphoscoliosis and cervical instability which leads to extremely difficult surgical technique, associated with a high rate of complications, basically based on its great potential for progression and its early onset. Patients and Methods We evaluated six patients operated because of CDP (two, of those, had surgery in another health care institution) and all clinical and imaging results were assessed. Physical examinations, clinical charts, X-rays, MRIs, and CT scans were recorded, as well as demographics and spine deformity patterns. Results In total, five were females and one was male. The mean age at first clinical examination was 4 years and 7 months. Patient's mean follow-up within our hospital was 4 years and the other two patients, 5 years and 8 months. Dysplastic kyphoscoliosis was the most common deformity pattern founded (two patients needing additional surgeries), and one cervical instability. Surgical treatment consisted in instrumented fusion by posterior approach, considering growing rods technique when needed. Conclusion CDP produces large kyphoscoliosis angular values and usually has an early onset. We encourage definitive fusion to prevent neurological complications. CDP deformity surgical treatment is tied to poor results.
Direct Vertebral Rotation versus Derotation Technique in Lenke Type 1 Idiopathic Scoliosis
Authors: Melero Patricio , Schwember Rommy , Lopez Sebastian 
Published: May 2015

Introduction To date, most of scoliosis corrections are made by derotation and translation of the road from the concave side. The coplanar alignment (VCA) technique recovers the normal anatomy of the spine in its three dimensions, correcting rotation, translation, and restoring the surgical outcomes of VCA against derotation maneuver in selective fusions of patients with Lenke 1 idiopathic scoliosis. Patients and Methods Prospective trial of 21 patients with Lenke 1 idiopathic scoliosis. Fusion levels were determined according to Lenke criteria. In group A (10 patients), the VCA was used; and in group B (11 patients), we perform derotation maneuvers. Multiple radiographic variables were analyzed and SRS-22 was also measured. Results Both the groups were similar in terms of preoperative demographic and radiological variables. Coronal Cobb correction rate was 66.5% in group A and 70.06% in group B. There were no differences in postoperative thoracic kyphosis (group A: 29degrees/group B: 30 degrees, p = 0.9438), but we found a significant difference in the correction of apical translation (group A: 14.5 mm vs. group B: 17 mm, p = 0.0069). None of the groups presented vascular or neurological complications. The SRS-22 score improved significantly after 1-year follow-up without differences between the groups. Conclusion In treating Lenke 1 idiopathic scoliosis with selective fusion, both techniques provide good clinical and radiological results. The only advantage of VCA lies in allowing a better correction of apical translation.
Minimally Invasive Uniportal Multilevel Cervical Decompression versus Laminoplasty in Treatment for Cervical Stenosis. Clinical and Radiological Results
Authors: Arias Pesantez Carlos Fernando 
Published: May 2015

Introduction There are many options to decompress the cervical spine on posterior way, the open door laminoplasty is an effective procedure to get the goal in multilevel disease; however, the muscular injury is a big problem in traditional surgery, the minimally invasive procedures can achieve optimal decompression without muscle injury with less pain and improvement in short time. Patients and Methods We present a study with 20 patients, 10 of them underwent traditional open door laminoplasty and the other patients underwent minimally invasive uniportal multilevel minimally invasive decompression. We use VAS, neck disability index, and Nurick clinical scale with follow-up of 12 months. Results On laminoplasty, VAS pre-op mean was 8 and 5 on 12 months; for MIS decompression VAS pre-op mean was 9 and 2 on 12 months. Neck disability index on the first group was mean 19 pre-op and 15 post-op 12 months and MIS group was 20 pre-op and 10 post-op 12 months. The Nurick clinical scale on laminoplasty and patients with MIS show improvement of one level on both groups. The surgical time, blood loss, hospital discharge, and return to daily activities shows superiority on MIS group. Conclusion Our conclusions about the minimally invasive procedures can achieve the similar results than traditional procedures without muscular injury and let a better time to recovery and return to daily activities.
Subsidence in Single Level Cervical Disc Arthroplasty
Authors: Berg Andrew , Killen Maire-Clare , Khan Shoaib , Reddy Guru , Friesem Tai 
Published: May 2015

Introduction Motion preservation with cervical disc arthroplasty implants has consistently been shown, in numerous randomized controlled trials, to produce equivalent or superior clinical outcomes to anterior cervical decompression and fusion. Therefore, there has been a call, within the spinal surgery community, to compare outcomes between arthroplasty implants. Although it is important to evaluate positive outcomes, it is also of vital importance to analyze complications and assess the potential influence of different implant designs on complications. We have experience in a large series of using several different arthroplasty implants. We have reviewed our series and have identified implants that have subsided. We provide a commentary on these cases. Material and Methods A retrospective review of all single-level anterior cervical decompression and disc arthroplasty cases, performed at the authors' institution, between 2006 and 2012 was conducted. Postoperative X-rays were assessed for any degree of subsidence compared with immediate postoperative X-rays. Cases with evidence of subsidence were studied for potential implicated factors. Results A total of 157 cases were reviewed consisting 64 PRESTIGE LP Cervical Disc System (Medtronic, Minnesota, United States), 51 NUNEC Cervical Arthroplasty System (RTI Surgical, Inc., United States), 35 Discocerv (Scient'x-Alphatec Spine, Arras, France), and 7 other implants in small numbers. Overall, 11 (7%) cases showed evidence of implant subsidence—two (3%) PRESTIGE LP, five (10%) NUNEC, and four (11%) Discocerv. In the cases that subsided, there were three males and eight females. There was a following variety of location of subsidence: anterior, posterior and complete surface of the implant, superior, and inferior. Seven of the cases did not fully cover the disc space in the anteroposterior plane. Three cases appeared to have been impacted into osteophytes posteriorly but subsidence was not necessarily in this location. The majority of cases appeared to have abnormal motion/spondylotic changes in adjacent levels, raising the possibility of abnormal forces being placed through the replaced level. Conclusion Cervical disc arthroplasty implant subsidence may be influenced by implant design, patient factors, and surgical technique. In this series, because of the small number of cases that showed subsidence, we cannot draw any firm conclusions. This report nevertheless should serve as an important stimulus for discussion and development regarding modifiable factors implicated in complications such as device subsidence.
Modified Posterior Vertebral Column Resection for the Treatment of Vertebral Infections in Elderly Patients
Authors: Enercan Meric , Erturer Erden , Gokcen Bahadir , Kahraman Sinan , Sanli Tunay , Ozturk Cagatay , Alanay Ahmet , Hamzaoglu Azmi 
Published: May 2015

Introduction Modified posterior vertebral column resection (PVCR) technique described in this study enables resection of infected material, decompression of the spinal canal, restoration of the anterior column, and posterior stabilization at the same time. Multilevel resections (two or more) can be performed with low-complication rates. Patients and Methods A total of 24 elderly patients (16 females and 8 males average age of 73.8 years [range, 68–83 years]) with pulmonary comorbidity were included. Etiologic diagnoses were spinal tuberculosis in 10 patients and nonspecific spondylodiscitis in 14 patients. Surgical technique included placement of fenestrated titanium pedicle screws, followed by hemilaminectomy, unilateral pediculectomy, decompression of the spinal canal by subtotal vertebrectomy, and anterior column support by expandable cage. One level above and one level below prophylactic vertebroplasty were performed. Results There were 6 single level, 17 two level, and 1 four level resections. The mean operation time was 2.5 hours and the average blood loss was 670 mL. Average follow-up was 47 months (range, 14–80 months). Average resected level was 1.9 (range, 1–4). The mean preoperative local kyphosis angle 32.7∞ was decreased by 67.8%. Overall, 14 patients with partial neurologic deficit (10 patients ASIA grade D and 4 patients ASIA grade C) had significant improvement. The major complications were post-op deep infection in three patients (12.5%) and death because of the cardiac failure in one (4%) patient. The minor complication rate was 29.1% with three hematomas and four dural tears. None of the remaining patients required revision surgery for recurrence of infection or implant failure or pseudoarthrosis. Conclusion Modified PVCR seems to be good alternative to anterior or combined A + P approaches in treatment of vertebral infections in elderly patients with pulmonary comorbidity, as technique enables multilevel resections (two or more) with low-recurrence and low-complication rates.
The Effect of Patient Age on Recovery Kinetics in 149 Adult Spinal Deformity Patients with 2-Year Follow-Up: A Novel Area under the Curve Analysis
Authors: Scheer Justin , Smith Justin , Mundis Gregory , Klineberg Eric , Hart Robert , Kelly Michael , Deviren Vedat , Nguyen Stacie , McCarthy Ian , Bess Shay , Schwab Frank , Shaffrey Christopher , Lafage Virginie , Ames Christopher 
Published: May 2015

Introduction Elderly patients (pts) with adult spinal deformity (ASD) have worse baseline health-related quality of life (HRQOL) measures than younger patients. Current methods of reporting outcomes are limited to static time points perhaps diminishing the health impact of the entire postoperative recovery experience. This study aims to identify the effect of age on the 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 was included. The inclusion criteria included patients with ASD and ≥ 18 years. Patients were stratified by the following age groups: ≤ 45, 46 to 64, 65 to 74, ≥ 75 years. HRQOL collected included Oswestry Disability Index (ODI), Short Form-36 (PCS/MCS), and Scoliosis Research Society-22 (SRS22) at baseline, 6 weeks, 1 and 2 years, postoperatively. All HRQOL was normalized to each patients' baseline scores as a comparison relative to where the patients started. An AUC was then calculated across the entire 2 years. Standard HRQOL and AUC means were compared between the groups. Results A total of 149 pts met inclusion criteria (≤ 45:32, 46 to 64:67, 65 to 74:38, ≥75:12). Older patients had significantly worse pre-op ODI, PCS, SRS activity, pain, and total compared with their respective younger age groups ( p < 0.05 for all) with the exception of 65 to 74 versus ≥ 75 and 46 to 64 versus 65 to 74 ( p > 0.05 for all). All age groups significantly improved all HRQOL at 2 years compared with pre-op ( p < 0.05 for all) except SRS mental and MCS for all age groups and ODI and SRS activity for ≤45 ( p > 0.05). However, normalized 2-year AUC HRQOL for the younger pts was worse than their respective older age groups for ODI, PCS, SRS activity, pain, and total. Conclusion On the basis of the static HRQOL analysis, all the age groups improved HRQOL at 2 years following surgery with older pts having worse pre-op HRQOL than younger pts. AUC analysis, however, suggests that the recovery kinetics is significantly worse for younger pts than the older pts.
Spinal Pelvic Radiographic Thresholds for Regional Lumbar Disability are Age Dependent: Analysis of Multicenter Database of 833 Patients
Authors: Smith Justin , Lafage Virginie , Scheer Justin , Shaffrey Christopher , Lafage Renaud , Klineberg Eric , Gupta Munish , Hostin Richard , Kebaish Khaled , Bess Shay , Schwab Frank , Ames Christopher 
Published: May 2015

Introduction The sagittal plane is the primary driver of disability in patients with ASD and spinopelvic radiographic thresholds have been established for pelvic tilt (PT), pelvic incidence (PI), and lumbar lordosis mismatch (PI–LL), and C7 sagittal vertical axis (SVA) in which disability occurs based on an ODI of ≥ 40. However, the patients' age was not accounted for in determining these thresholds and ODI has been shown to vary with age. The objective was to determine new thresholds based on age. Patients and Methods This is a multicenter, prospective study of consecutive patients with ASD. Inclusion criteria included patients with ASD with the age > 18 years. Patients were stratified into the following age groups: ≤ 45, 46 to 64, 65 to 74, and ≥75 years. Multivariate linear regressions were conducted for baseline PT, PI-LL, and SVA with baseline ODI and age on all patients. On the basis of the previous studies, an ODI of 40 was used as the threshold for disability. Individual patient thresholds were calculated based on their age. The thresholds were averaged across the age groups. Results A total of 833 patients were included (396 operative and 437 nonoperative). Patients with only sagittal deformity for the age groups were the following: ≤ 45 (18.8%), 46 to 64 (19.4%), 65 to 74 (40.1%), and ≥ 75 (50%). Age alone significantly predicted ODI ( r2 = 0.17, p < 0.0001). Regressions for PT ( r2 = 0.27, p < 0.0001), PI-LL ( r2 = 0.27, p < 0.0001, SVA ( r2 = 0.32, p < 0.0001) including age were all predictive of ODI. Thresholds for the entire cohort were the following: PT = 21.9 ± 4.7 degrees, PI-LL = 11.6 ± 7 degrees, SVA = 6.7 ± 2.5 cm. Thresholds for the age groups were the following: PT (deg): ≤ 45 (15.3 ± 2.3), 46 to 64 (22.6 ± 1.5), 65 to 74 (26.2 ± 0.8), ≥ 75 (29.1 ± 0.8). PI-LL (deg): ≤ 45 (1.7 ± 3.5), 46 to 64 (12.5 ± 2.2), 65 to 74 (18 ± 1.2), ≥ 75 (22.4 ± 1.3). SVA (cm): ≤ 45 (3.3 ± 1.2), 46 to 64 (7.1 ± 0.8), 65 to 74(9.0 ± 0.4), and ≥ 75 (10.5 ± 0.4). Conclusion Spinopelvic radiographic thresholds correlated to moderate-to-severe regional low back disability increase as patients age. These results suggest that preoperative surgery planning and patient counseling should consider the patients' age. Further study of Schwab–SRS sagittal modifier correction goals for individual age groups is warranted.
Comparison of Best versus Worst Clinical Outcomes for Adult Spinal Deformity Surgery: A Prospective, Multicenter Assessment with Minimum 2-Year Follow-Up
Authors: Smith Justin , Shaffrey Christopher , Lafage Virginie , Schwab Frank , Protopsaltis Themistocles , Klineberg Eric , Gupta Munish , Hostin Richard , Ming-Fu Kai , Soroceanu Alex , Hart Robert , Burton Douglas , Bess Shay , Ames Christopher 
Published: May 2015

Introduction Adults with spinal deformity typically present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for ASD based on a prospective, multicenter patient population. Patients and Methods This is a multicenter, prospective analysis of consecutive patients with ASD electing for op or non-op care at enrollment. Inclusion criteria are age > 18 years and ASD. Propensity scores were used to match an op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI–LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met criteria, including 286 op and 403 non-op, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS ( p < 0.001) and had worse deformity based on pelvic tilt, PI–LL, and C7SVA ( p < 0.002). Before reaching minimum 2-year follow-up, 38 non-op patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up, all HRQL measures assessed significantly improved for op patients ( p < 0.001), but none of these measures improved significantly for non-op patients ( p > 0.11). Overall, 97 matched op–non-op pairs were identified based on propensity scores. At last follow-up, the 97 matched op patients had significant improvement in all HRQL measures assessed ( p < 0.001), but the 97 matched non-op patients lacked significant improvement in any of the HRQL measures ( p > 0.20). Paired op–non-op analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed ( p < 0.001), except SF36 MCS ( p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, non-op treatment appears to at best maintain presenting levels of pain and disability.