bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconsideration of the Definition of Chiari Malformation Type 1: A Position of Cerebellar Tonsil and Brainstem
Authors: Murakami Tomohiro , Inoue Michio , Matsumura Shigeki 
Published: May 2015

Introduction Chiari malformation type 1 (CM-1) is diagnosed by more than 3 or 5 mm caudal displacement of the cerebellar tonsils through the foramen magnum. This definition is a simple and easy method neuroradiological, but it is obscure which is 3 or 5 mm. The purpose of this study is to investigate the incidence of new outpatients diagnosed as CM-1 using this definition and to analyze their clinical symptoms and radiological features. Patients and Methods We had 3,787 new outpatients in our neurosurgical hospital in 2013. In whom, 3,533 patients examined head CT or MRI, and were studied retrospectively. We diagnosed Chiari malformation type 1 using more than 3-mm tonsillar herniation. Their clinical symptoms and the following measurements were analyzed: the distances from the pontomedullary junction (PMJ) to the basion (PMJ-Ba), PMJ to the basion–opisthion (PMJ–BO), the distances from the basion–opisthion to tip of the cerebellar tonsil, from BO to the obex (BO–obex), and from basion to opisthion, the clivoaxial angle, and the length of the clivus using T1-weighted sagittal images. Results There were 19 patients with CM-1 aged from 10 to 54 years (mean: 35.0 years) consisted of 6 men and 13 women. In whom, 10 patients with tonsillar herniation of less than 5 mm were determined as T3 group (T-3) and remaining 9 patients as T5 group (T-5). No patients had syringomyelia. All the patients had clinical symptoms or signs related to CM-1 except two patients in T3 after head injury. Headache was the most common symptom. The distances of PMJ–Ba, PMJ–BO, BO–obex, BO, the clivoaxial angle, and the length of the clivus were similar between both the groups. Conclusions The incidence of new diagnosis of CM-1 was 0.53%. Two patients in T3 group without symptoms associated with CM-1 were diagnosed incidentally. Chiari malformation type 1 should be diagnosed based on not only tonsillar herniation but also clinical symptoms and other MRI findings such as brain stem ptosis.
The Epidemiological Profile of a Middle-Aged Population with Low Back Pain in Southern Brazil
Authors: Falavigna Asdrubal , Bossardi Julia Bertholdo , Conzatti Lucas Piccoli , de Castilhos Isadora 
Published: May 2015

Introduction Low back pain (LBP) is the most prevalent musculoskeletal condition and the most common cause of disability in developed nations. The aim of this study is to assess the prevalence and the general characteristics of LBP in a middle-aged population living in southern Brazil. Materials and Methods Cross-sectional study developed in a city located in southern Brazil. Data were collected from 1,005 individuals at randomized public locations. A protocol was designed to evaluate the following the general characteristics of the population: age, gender, level of education, socioeconomic status, body mass index (BMI), occupation, smoking, physical activity, anxiety, and depression. After the initial evaluation, the individuals were asked if they had LBP at least once in their lifetime. Those who answered “yes” continued the questionnaire that evaluated pain intensity, characteristics, and related disability. Results The mean age was 33.74 years ( ± 14.76 years) and 61.6% of the participants were female. Overall, 72% of the participants had LBP at least once in their lives. The median of VAS intensity of pain was 4 (range, 2.0–5.25). Female gender ( p = 0.006) and anxiety ( p < 0.001) were higher in those with LBP. Conclusion LBP is a highly prevalent condition in a middle-aged population of the South Region of Brazil. The variables related to these symptoms are higher levels of anxiety and female gender.
The Effectiveness of the AOSpine Project of Education in Research: Changing Paradigms, Provoking Ideas, and Innovating the Mindful Practice
Authors: Falavigna Asdrubal , Silva Alvaro , Martins Delio , Jimenez Jose , Guyot Juan Pablo 
Published: May 2015

Introduction The way to increase innovation in mindful practice in a region without a culture in scientific investigation is through implementation of the Research Curriculum that is based on the competencies and learning outcome. No institutions have a Research Curriculum based on competence and learning outcome as guide to improve knowledge in research. The objective of this study is to describe the effectiveness of the project of education in research and the way to deliver this information effectively to those who aim to further improve their knowledge and participation in research. Materials and Methods the AO Research Curriculum uses the competency-based approach that aligns the following four components: (1) knowledge in research, (2) performing research, (3) specialized technical professional support, and (4) assessment to identify needs and track progress. The content of the curriculum was delivered using the most appropriate learning methods and techniques from the following four perspectives: (1) e-learning methods, (2) specific research symposiums, (3) precourses before AO activities, or as (4) specific lectures and structural presentations within the course, symposiums, or seminars. Research mentoring projects and joint publications are an objective way to measure the effectiveness of the project, as it represents the capacity to perform research. This protocol was applied in spine surgeons and university students. Results The survey of AOSpine Latin America members showed a low level of knowledge regarding research combined with a high motivation to learn. The organized competences, learning outcomes, and syllabus of the knowledge in Research promoted active learning and engagement of the members during AOSpine activities. These activities resulted in an increased membership, the participants were grateful when they understood the usefulness of research, and it was the best way to expand the AO product at the University, not only in the undergraduate courses, but also at the postgraduate levels as learning about tools in research and needs are the same for several areas (medicine, nursing, engineering, biology, and law). Conclusion The education in research project showed to be effective. The learning outcomes gained by the participants following completion of this project were recognized concerning where and how they can best obtain reliable information, perform a critical literature review, choose validated instruments to measure the patient's disease, obtain reliable feedback regarding the effectiveness of our surgical activity, and achieve a better understanding of the positive influence of the research on the medical routine. The “publication of results” is only a consequence of an attitude toward scientific investigation.
Thirteen Years of Scientific Production on Medline by Spine Surgeons in Latin America, Africa, Oceania, and Asia
Authors: Falavigna Asdrubal , da Silva Pedro Guarise , Wurzius Francine , Merlin Luiz Henrique , Radaelli Lucas , Guyot Juan Pablo , Dozza Diego , Martins Delio , Yoshiharu Kawaguchi , Botelho Ricardo Vieira , Teles Alisson Roberto , Silva Alvaro , Avila Jose Maria Jimenez , Defino Helton Luiz Aparecido , Riew K. Daniel 
Published: May 2015

Introduction Articles published on spine pathologies have been very useful, providing important information to improve diagnosis and choice of treatment. This information is even more important when it comes from the different continents, because it shows that information can be provided and applied by physicians worldwide to solve medical problems encountered daily. Materials and Methods A literature search of publications by spinal surgeons in Latin America, Africa, Oceania, and Asia on topics concerning the spine or spinal cord was performed using an online database; Pubmed.gov. The results were limited to articles published from January 2000 to December 2013. The variables studied were year of publication, scientific journal that published the papers, neurosurgical or orthopedic department where the study was done, the type of study, the main pathology studied, the Oxford classification, the journal impact factor (IF), and the type of articles that were entered on Excel sheet. Results A total of 43,711 articles were identified after the MEDLINE search. Most of the articles were excluded based on information provided in the title and abstract. This study comprised 5,846 articles published in the Medline database by Latin America, Africa, Oceania, and Asia spine surgeons from 2000 to 2013. During this period, 5,102 articles were published in Asia, 410 in Latin America, 138 in Africa, and 79 in Oceania. There was a correlation between the number of publications and the articles classified at the Oxford level of evidence 1, 2, and 3 with significant results and positive association. Conclusion This study showed a growth in the number of publications in the past 13 years by spinal surgeons in Asia, Latin America, Africa, and Oceania. It is necessary to discuss a way to increase quantity and quality of scientific publications, mainly by improving education in research.
Minimally Invasive Surgery for Metastatic Spine Disease
Authors: Kumar Naresh 
Published: May 2015

Background Metastatic spine disease (MSD) is a new epidemic and it can lead to significant morbidities such as disabling pain and neurological deficits. A multidisciplinary approach including medical oncologists, radiation oncologists, and spinal surgeons is mandatory as the treatment options are constantly evolving and are of much debate. Current evidence shows that best clinical outcomes are achieved by surgery, especially when it is combined with postoperative radiotherapy. This winning combination, however, is only successful when the two modalities are appropriately timed. Minimally invasive approaches in MSD have been producing good outcomes in terms of pain reduction and neurological improvement, comparable to open surgery. To make surgical management an appealing choice in MSD, surgical morbidity needs to be kept as low as possible, especially when planning oncological treatment around surgery. Methods We discuss the “epidemiology and incidence”; “clinical presentation of MSD” and treatment modalities. We derive that radiotherapy was established as a treatment modality in the 1980's. In this review, we discuss main treatment modalities such as radiotherapy and chemotherapy in brief to improve the understanding of evolution of surgical treatment. Open surgery for MSD has evolved from a conservative destabilizing operation such as laminectomy to front and back open surgery with instrumentation. We then trace that minimally invasive surgery has slowly evolved to find its place in the management of MSD. Results A variety of minimally invasive approaches in MSD have shown encouraging results for early wound healing, reduced intraoperative blood loss, and shortened hospital stay while producing good outcomes in terms of pain reduction and neurological improvement, comparable to open surgery. Evolving from this review, we also provide our treatment algorithm to operate on patients with MSD, which keeps in view with the clinical presentation and radiological appearance of spinal cord compression. We would then discuss the advancement of surgery from open to minimal invasive approach. We finally establish a treatment algorithm, which encompasses both open and MIS surgery. Conclusion We believe that MIS is beneficial in well-selected group of patients suffering from clinically significant instability with intractable back pain or motor deficits. Our treatment algorithm for symptomatic MSD is suggested as a guideline as these are high-risk cases and treatments should be individualized with respect to prognosis, premorbidity, and patients' choice. We can improve patient's quality of life through minimally invasive intervention. The introduction of MIS can be a game changer in the treatment of MSD because of the less perioperative morbidity and allowing earlier radiotherapy and/or chemotherapy.
Surgical Technique and Outcome in the Treatment of Spinal Ependymomas: A Retrospective Analysis of 23 Cases Treated
Authors: Zelletta Nicola , Iodice Savino , Di Benedetto Mariagrazia , Cecchini Giulio , De Tommasi Antonio 
Published: May 2015

Introduction Spinal ependymomas are from 3 to 6% of all tumors of the central nervous system and 15% of all spinal cord tumors. The WHO classifies ependymomas in the following four distinct subtypes: subependymoma, ependymoma myxopapillare, classic ependymoma, and anaplastic ependymoma. Spinal ependymomas are typically present in adults and include the following two subtypes: myxopapillary and classic. This review reports the data obtained on 23 patients treated for spinal ependymoma at our department of Neurosurgery from 2000 to 2012, describing the type of surgical treatment and clinical outcome with a mean follow-up of 4 years. Materials and Methods Among 53 cases of intramedullary tumors, 23 (43%) were ependymomas. The average age of patients with spinal ependymoma was 42.65 years with a range between 18 and 71 years. The main locations were cauda equina (70%), medullary cone (13%), and cervical region (13%). Neurological examination of each patient at the entrance, in the postoperative and last –follow-up was determined using the McCormick grading scales. All patients underwent surgical removal of the tumor and the McCormick grading was evaluated with multiple follow-up. The extent of resection and surgical results were evaluated with postoperative MRI. Results As evidenced in some tables, we performed gross-total removal (GTR) in 21 patients (91%) and subtotal removal (STR) in only 2 patients (9%). None of patient was treated with adjuvant radiotherapy and/or chemotherapy. There were no recurrences. No patient's follow-up showed signs of postoperative instability of the spine. Some particular surgical techniques in removal of this tumor are reported. Conclusion This study underlines some aspects of the surgical treatment of spinal ependymomas. Patients who underwent total removal had a clear neurological improvement. As evidenced in tables, patients who had McCormick II–III at the entrance improved significantly. To achieve good functional results, an early diagnosis and a prompt surgery are important. In case of a good surgical removal, postoperative radiotherapy is not indicated.
Mini-Invasive Treatment of Monolevel Dorsolumbar Metastatic Lesions by Radio Frequency Ablation and Augmentation: Preliminary Experience in a Series of 10 Cases
Authors: Guli' Carlo , Basile Luigi , Maugeri Rosario , Iacopino Gerardo Domenico 
Published: May 2015

Introduction Technological advances have allowed the development of several “minimally invasive” surgical techniques in the treatment of metastatic spinal tumors. The authors analyzed the effectiveness and impact on quality of life in the short and medium term using radiofrequency ablation and injection of PMMA in the treatment of chronic low back pain in a series of 10 patients suffering from a monolevel metastatic lesion of the dorsolumbar spine. Patients and Methods In 2013, at our Department, 10 patients affected by dorsolumbar monolevel metastatic lesion, in advanced disease, were selected to undergo treatment of transpedicle radio frequency ablation and injection of PMMA. Overall, nine patients were treated by percutaneous technique as they had an already known and suitably treated primary lesion, good performance status, chronic low back pain (mean low back VAS: 8.5), no neurological deficit. Only one patient came to our observation for the presence of low back pain and progressive weakness in the lower limbs, in the absence of already known primitive tumor. In this case, an open surgery with decompression, posterior fusion, and then ablation with augmentation was performed. Results Patients treated percutaneously showed an improvement in pain symptoms with a significant reduction in the VAS (post-op VAS: 3.5) in the absence of new-onset neurological deficit. The patient treated in “open surgery” had a reduction in pain with improvement of neurological function of the lower limbs making it possible walking. All the patients were sent to the oncologist for medical care. Conclusions The radiofrequency thermocoagulation with injection of PMMA seems a good strategy, as palliative treatment, in patients with metastatic advanced disease, with low back pain in the absence of significant neurological deficit when suffering from single level metastatic somatic lesion, ensuring both the effectiveness because of the neoplastic tissue ablation and the augmentation. This allows a gain of QOL in critically ill patients in terms of reduction of pain symptoms.
Surgical Outcomes of the Nondystrophic Scoliosis Secondary to Neurofibromatosis Type I versus Curve-Matched Adolescent Idiopathic Scoliosis
Authors: Jin Mengran , Liu Zhen , Zhu Zezhang , Wang Bin , Yu Yang , Qian Bang-Ping , Sun Xu , Zhu Feng , Qiu Yong 
Published: May 2015

Introduction Patients with nondystrophic scoliosis caused by NF-1 mostly require surgery. Although the radiographic findings in patients with nondystrophic scoliosis secondary to NF-1 are similar to those in patients with idiopathic scoliosis, evidence-based surgical guidelines, and long-term results are not as established as those for patients with AIS. The objective of this study is to compare the surgical outcomes of nondystrophic scoliosis secondary to neurofibromatosis type I (NF-1) and curve-matched adolescent idiopathic scoliosis (AIS) to identify the feasibility of treating nondystrophic NF-1 using the same principals as AIS and seek for potential surgical improvement. Patients and Methods A total of 19 adolescent patients with nondystrophic scoliosis secondary to NF-1 and 19 curve-matched patients with AIS were recruited into the study. Preoperative immediately and 6-month postoperative, and follow-up radiological data were reviewed and analyzed. The mean age of patients with NF-1 was 14.4 ± 1.3 years compared with 15.7 ± 3.1 years of patients with AIS. The main curves were 70.1 ± 14.4 and 75.9 ± 11.3 degrees for the patients with NF-1 and AIS, respectively. The minor curves were 37.4 ± 14.2 and 39.5 ± 13.4 degrees for the patients with NF-1 and AIS, respectively. The mean follow-up durations were 33.8 months (range, 24–60 months) and 31.6 months (range, 24–41 months) for the NF-1 and AIS groups, respectively. Results After surgery, the nondystrophic NF-1 group had less main curve correction (62.3 ± 15.5 vs. 68.9 ± 13.2%, p < 0.001), less apical vertebral translation (AVT) correction (−20.3 vs. −22.9 mm, p = 0.019), and less trunk shift (TS) correction (−7.8 vs. −16.0 mm, p < 0.001). On the sagittal plane, significantly more correction of sagittal vertical axis (SVA) (−19.3 vs. −10.0 mm, p = 0.041) was noted in the nondystrophic NF-1 group. A significant trend to worse was observed in NF-1 group during the follow-up period. At the final follow-up, significantly more loss of correction (5.4 vs. −0.8 degrees, p = 0.013) of the main curve was observed in the nondystrophic NF-1 group. Conclusion Current results suggest that satisfactory short-term surgical outcomes can be achieved in both NF-1 patients with non-dystrophic scoliosis and patients with AIS while sharing the same management strategy. However, the long-term result of nondystrophic scoliosis in patients with NF-1 is not identical to that of patients with AIS. Despite all this, it is fair to suggest that applying the surgical strategy of AIS in treating nondystrophic scoliosis secondary to NF-1 should be acknowledged.
Midline Minimally Open Interlaminar Lumbar Discectomy and Interspinous-Posterolateral Fusion as an Option to Treat Recurrent Lumbar Disc Herniations in Patients with Axial Instability
Authors: Tellez-Gtz Maximino 
Published: May 2015

Introduction Numerous techniques have been used to treat lumbar recurrent disc herniations. Most of them offer an in site reintervention with or without treating the segmental instability. Currently, the “TLIF” technique stands as the premier option to treat both the symptoms and the instability. Objective We present our series of cases using the Midline Open Interlaminar Lumbar Discectomy and interspinous-posterolateral fusion technique as an option to treat recurrent disc herniations and flexion–extension instability. We design this prospective study. Patients and Methods A total of 19 patients (14 men and 5 women) with recurrent lumbar disc herniation who presented with axial pain and radiculopathy; ages 36 to 62 years (mean, 46 years) were included in the study. The affected levels were L4–L5 n11, L5–S1 n8, and L3–L4 n1; all the patients were monitored transoperatively and classified using ODI, VAS, and MacNabb clinical outcome measurements. We used the Lans-ASPEN interspinous device for the interspinous fixation and calcium phosphate as a graft. All our cases were transoperatively monitored using SEPs and EMG. Results Surgical time was 85 to 180 minutes (mean 120 minutes), EBL 20 to 300 mL (mean 50 mL), hospital stay 24 hours, pre-VAS (mean 8.16), first week (mean 2.67), 4 weeks (mean 1.11), 6 months (0.58), 1 year (0.76); ODI pre-op (mean 41.28), post-op 6 months (mean 18.1); MacNabb; excellent 47%, and good 52.6%. Conclusion The Midline Minimally Open Interlaminar Lumbar Discectomy and interspinous-posterolateral fusion it is a safe, reproducible, and resolute technique for patients with recurrent lumbar disc herniation and flexion–extension instability. We also recommend using neurophysiology surveillance on a regular basis to reduce the risk of complications and increase the clinical improvement rate. All the postoperative neurophysiology readings were positive in amplitude (mV) comparing with the pre-op registry. However, further normalization of the data are required to consider it clinically relevant.