bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-Stage Posterior Vertebral Body Resection and Reconstruction Using Expandable Cage for Unstable Mid and Lower Lumbar Burst Fractures
Authors: Kim Se-Hoon , Choi Jong-Il , Kim Bum-Joon , Ha Sung-Kon , Kim Sang-Dae , Lim Dong-Jun 
Published: May 2015

Introduction Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. The purpose of this study is to examine the efficacy and safety of corpectomy and expandable cage placement via a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Patients and Methods A total of 11 patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurologic status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, while functional outcome was analyzed using a visual analog scale (VAS) for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. Results The preoperative neurologic status was ASIA grade E in two patients, grade D in five patients, grade C in two patients, and grade B in two patients. Postoperatively, neurologic stability was demonstrated in three patients (27%), and eight patients (73%) showed improvement in the ASIA grade. The mean preoperative VAS score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 588 mL. Regarding surgical complications, one patient experienced a dural tear and one patient demonstrated cage subsidence. Conclusion The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.
Microsurgical Unilateral Approach Bilateral Decompression in Symptomatic Lumbar Spinal Canal Stenosis: Midterm Results in 89 Patients
Authors: Cheung Ka-Kin 
Published: May 2015

Introduction Surgical decompression is the gold standard in the treatment of symptomatic lumbar spinal canal stenosis (LSCS) without clinically significant instability. With the advent of microsurgical techniques and better accessories such as the tubular retractor system (TRS), unilateral approach bilateral decompression (UABD) has been advocated as the decompressive technique of choice because of the preservation of anatomically important stabilizing structures. This retrospective study evaluates the midterm results of UABD performed with and without the TRS in a regional hospital. Patients and Methods From April 2008 till November 2013, 89 patients with symptomatic LSCS without clinical instability had UABD performed. On the basis of the surgeons' preference, 56 cases were operated with the TRS employed. The mean follow-up was 30.8 months. Clinical outcomes were evaluated by the Visual Analogue Scale (VAS), Japanese Orthopaedic Association lumbar spine score (JOA score), Oswestry Disability Index (ODI), and Roland Morris Disability Quotient (RMDQ). Complications, rate of reoperation, and patient's subjective satisfaction were also evaluated. Results A total of 150 levels were decompressed (average, 1.7 levels per patient). The average operation time and blood loss per level was 99.4 minutes and 67.9 mL, respectively. The mean postoperative hospital stay was 4.5 days. The average leg VAS, JOA score, ODI, and RMDQ improved from 7.1, 15.5, 48.3% and 13.1 to 3.3, 22.1, 35.4% and 11.5, respectively, at final follow-up. The subjective satisfaction was 64%. Given the choice, 92% of these patients would choose to have the same procedure again. There were no statistical significant difference between the TRS and no TRS group in age; sex; side of approach; the preoperative, postoperative, and improvement in leg VAS, JOA score, ODI, and RMDQ; follow-up duration; operation time; and subjective satisfaction. Blood loss (67 vs. 178.4 mL, p = 0.09) and postoperation hospital stay (3.9 vs. 5.7 days, p = 0.003) were both in favor of the TRS. Overall, five incidental durotomies in the TRS group (8.9%) and 3 (9%) in non-TRS group were registered, giving rise to a total 9% of the incidental durotomy rate. All of these eight cases were treated conservatively and none of them needed any further procedures as a remedy. Otherwise, no remarkable perioperative morbidities had been recorded. Within the evaluation period, two cases from the TRS group need re-decompression with instrumented fusion because of symptomatic recurrence, equivalent to an overall 2.2% reoperation rate. Conclusion Microsurgical UABD generates satisfactory clinical outcomes in selected patients with symptomatic LSCS without clinical instability. No apparent clinical benefit was found in employing the TRS other than an average 1.8 day short postoperative hospital stay.
Prospective Study of Open Lumbar Discectomy in Different Stages of Disc Prolapse
Authors: Kumar Manoj , R. Heggunda Anoop , Shivannna Deepak 
Published: May 2015

Introduction Lumbar disc herniation has been recognized as an important cause of low back pain. Intervertebral disc prolapse occurs predominately in L4–L5 and L5–S1 level. It includes three stages mainly protrusion, extrusion, and sequestration. Results of operative treatment for disc lesion vary depending on the level of lesion and duration of symptoms, this study aims to assess the outcome of discectomy in the different stages of disc lesion. Patients and Methods A prospective study was done in 40 patients diagnosed with lumbar intervertebral disc prolapse. Demographic data, history, clinical examination, and details of investigations and intervention in the form of open lumbar discectomy/fenestration were recorded in the study proforma. Clinical follow-up was done at 2 weeks, 3 months, 6 months, and 1 year intervals regarding pain, disability, and the functional outcome were evaluated with VAS, Modified ODI score, and SF-36 questionnaire. Results In our series of 40 patients, 8 (20%) were in 21 to 30 years, 18 (45%) in 31 to 40 years, 5 (12.5%) in 41 to 50 years, 8 (20%) in 51 to 60 years, 1 (2.5%) in 61 to 70 years age groups. Overall, 47.5% of patients had disc protrusion, 40% had extrusion, and 12.5% had sequestration. Overall, 60% were males and 40% were females. Overall, 75% of patients had L4–L5 disc lesion, 12.5% had L5–S1 lesion, 10% had both L4–L5, L5–S1 lesion, and 2.5% had L3–L4 lesion. Fenestration was done in 82.5% patients and laminectomy done in 17.5%. Postoperatively, neurological deficits and SLRT improved. There were statistically significant reduction of pain, improvement in disability, and a better functional outcome at the end of 1 year as assessed by VAS, modified ODI score, and SF-36 questionnaire in all the three stages of disc lesion; however, the improvement was better in stage 1 and stage 2 compared with stage 3. Complications included superficial wound infection, neurological deficit, and failed back syndrome. Conclusion Open lumbar discectomy by fenestration/laminectomy is a safe, effective and reliable surgical procedure in all stages of intervertebral disc prolapse, the outcome is better in stage 1 and stage 2 lesions than in stage 3 lesions.
A Prospective Study to Assess Efficacy of Directly Observed Treatment Short Course Intermittent Regimen in Different Stages of Spinal Tuberculosis
Authors: Kumar Manoj , Shivraj N. 
Published: May 2015

Introduction Management of tuberculosis spine still possesses many challenges. Availability of antitubercular drugs has changed the outcome. However, present recommendation by the WHO of Directly Observed Treatment Short course (DOTS) has sound scientific basis, but the optimum duration is still controversial. We conducted a prospective study on a consecutive series of patients with spinal tuberculosis treated with Category I Revised National Tuberculosis Control Program (RNTCP) regime based on DOTS strategy from January 2011 to June 2014 to evaluate the efficacy and to come to a conclusion regarding optimum duration of treatment. Patients and Methods A prospective study of 60 consecutive patients of spinal tuberculosis treated with Category I RNTCP based on DOTS strategy. All the patients were followed for a minimum of 1 year. Surgical intervention was done in patients presenting with significant neurological deficits. Patients diagnosed clinicoradiologically and histopathologically ( n = 8) were enrolled in the study. The outcome was graded into excellent, good, fair, and poor based on clinical, laboratory including return of ESR to normal and correction of lymphocytosis and radiological like a return to normal bone density and sclerosis, bony ankylosis, and disappearance of marrow edema on MRI. Results In 60 cases, 63.4% ( n = 34) males and 36.7% ( n = 26) females. Overall, 10% ( n = 6) were with predestructive lesion, 53.3% ( n = 32) were in the early destructive phase, 30% ( n = 18) with mild angular kyphosis and 6.67% ( n = 4) with moderate angular kyphosis. Outcome of our study were excellent in 46.67% ( n = 28), good in 36.67% ( n = 22), fair in 10% ( n = 6), and poor in 6.67% ( n = 4). Duration to cure spinal tuberculosis 6 months 30% ( n = 18), 9 months 56.67% ( n = 34), and 12 months 13.33% ( n = 8). Conclusion The duration of treatment for cure of spinal tuberculosis was 100% ( n = 6) in predestructive and 37.5% ( n = 12) in early destructive phases was 6 months, 62.5% ( n = 20) early destructive, and 77.76% ( n = 14) mild kyphotic phases were 9 months and 22.2% ( n = 4) mild destructive and 100% ( n = 4) moderate kyphotic phases was 12 months. Favorable outcome and short duration of chemotherapy is needed in patients treated early.
Comparison of 9 versus 12 Months' Antitubercular Drug Regimen in Pott Spine: A Prospective Study
Authors: Mohapatra Bibhudendu 
Published: May 2015

Objective This study aims to evaluate and compare the outcomes of two antitubercular chemotherapy regimen prescribed for 9 months (group A) and 12 months (group B) on patients with Potts spine without neurological deficit. Study Design A prospective study in which 59 patients were included, who were prescribed either of the regimes. The outcome measures were noted immediately after the completion of the treatment, at 6 and 12 months. The variables were evaluated on the basis of clinical, hematological, and radiological criteria, which included pain, Hb, ESR, CRP, and kyphotic angle. A mixed model ANOVA was used to compare group A and group B across different times of assessment (0, 6, and 12 months posttreatment) for each variable separately. The level of significance was p < 0.05. Also, the differences from baseline at 6 and 12 months were compared across groups. As the data were not normally distributed, Mann Whitney U test was used. The p value was adjusted for multiple comparisons to be less than 0.05/2 or 0.025. Result Both the groups were demographically comparable. Pain (ODI) was found to be improved in both the groups, but on comparison 12-month regime was found to have reduced pain scores than 9-month regime during 6-month follow-up (ODI: group A 19.2 and group B 17.3) but in the 12-month follow-up showed no statistical difference in pain score (ODI: group A 13.9 and group B 12.6). There was no neurological deterioration in both groups. CRP improved in both the groups (group A 7.31 and group B 7.03) and no statistical significant difference was found between the two regimes. There was an increment in Hb levels and kyphotic angle in both the groups, but the comparison could not be drawn between the two groups for both the variables as baseline values were not comparable whereas ESR reduced in both the groups but because of the significant difference at baseline, none of the groups could be compared. To make the groups comparable, a nonparametric analysis was used which showed a statistically significant deterioration of kyphotic angle in group A (0.6 degree) than in group B (0.2 degree) at the end of 1-year follow-up, but it was not found to be significant clinically. Also, statistically significant results were obtained for Pain scores with better improvement of pain with –group A than group B (group A 14 and group B 10) but again the improvement was clinically nonsignificant. Conclusion After 1-year follow-up of patients who had completed their antitubercular treatment, we can conclude that there was no additional benefit of prescribing antitubercular therapy for 12 months over 9 months in patients of Potts spine (1 or 2 level) without any neurological deficit. Long-term follow-up is needed to further establish the advantage of 9-month regime over 12-month regime.
Evaluation of Anterior Cervical Fusion without Posterior Instrumentation in Quadriplegic Patients with Transected Spinal Cord
Authors: El Fiki Ahmed 
Published: May 2015

Introduction Traumatic quadriplegia is one of most serious conditions of cervical spine trauma, in almost all cases where the spinal cord is transected there is instability in three columns of vertebral column. Thus, 360-degree fusion is needed. Patients and Methods A total of 12 patients with traumatic cervical spine fracture with transected spinal cord were operated only by anterior cervical fusion with anterior plating during the period from July 2011 to December 2013. Intraoperative cervical traction was done, 11 patients iliac bone graft was used after anterior decompression. Results All cases were reduced adequately and posterior fusion was not done, only Philadelphia neck collar kept for 3 months. Time of surgery was reduced. Three months' follow-up showed that there was no recent obvious radiological instability. Hospital stay was reduced and consequently bed-ridden hospital acquired infections were reduced. Conclusion Anterior fusion in traumatic cervical fractures with transected spinal cord is time saving and suitable for patients with complete quadriplegia and if spinal shock is present. Provided that, it was reduced with intraoperative cervical traction. But long-term follow-up is necessary.
Unstable C1 Ring Fractures Managed with Primary Internal Fixation without Fusion: A Retrospective Review
Authors: Bellabarba Carlo , Bransford Richard , Shatsky Joshua 
Published: May 2015

Introduction While the majority of C1 fractures are treated nonoperatively with external immobilization, there is a subset of C1 fractures known to be unstable. In addition, current literature-based outcomes of nonoperatively managed C1 ring fractures have not been completely favorable, and therefore, leave room for treatment alternatives. Our goal was to evaluate a series of unstable C1 fractures treated with primary internal fixation without fusion (ORIF) to assess clinical and radiographical outcomes. Patients and Methods A retrospective review of all patients with C1 fractures between September 2002 and November 2012 identified 10 consecutive patients from a level I trauma center (Harborview Medical Center, Seattle, Washington United States) who were treated with primary internal fixation without fusion. EMR charts and radiographs were reviewed. The surgical technique consisted of a posterior cervical approach to C1 arch and open reduction utilizing bilateral C1 lateral mass screws connected transversely with a rod. Primary outcome measures included radiographical reduction, maintenance of reduction, ROM, and complications. Pre- and postoperative CT scans were utilized to assess reduction. Results A total of 10 patients with mean age of 53 years were identified to have undergone primary C1 ORIF. The cohort consisted of eight males and two females of which eight unilateral sagittal split–type fractures and two Jefferson burst–type fractures were identified. Mean follow-up was 13 months. Of the 10 patients, there were 2 associated complications, 1 errant screw requiring return to the operating theater for reposition, and 1 osteonecrosis of the lateral mass though the fracture healed. Preoperative lateral mass displacement averaged 7.3 mm and postoperative displacement had a mean of 2.4 mm with a p value after reduction of < 0.002. No patient had serious complication resulting in neurologic deficit or vascular injury associated with the procedure. No patient went on to develop the previously described “cock-robin” deformity from subluxation of the lateral mass with settling of the occiput onto the C2 lateral mass and no patient had subsequent C1–C2 instability as defined by an ADI greater than 3 mm on flexion and extension films. Conclusion Patients with unstable C1 ring fractures can be successfully managed with primary open reduction and internal fixation with a transversely oriented construct using C1 lateral mass screws. Open reduction and internal fixation offers a viable treatment alternative to conservative management or fusion by restoring cervical alignment with C1 reduction and anatomical realignment. Internal fixation of the atlas without fusion prevents progressive, painful deformity, and the need for complex occipitocervical reconstruction procedures that have been reported with nonoperative management of these injuries.
The Effect of C1 Bursting Fracture on Comparative Anatomical Relationship between the Internal Carotid Artery and the Atlas
Authors: Kim Il Sup , Hong Jae Taek , Kim Moon Seok , Kim Joon Yeong 
Published: May 2015

Purpose When C1 arch displaced laterally in C1 bursting fracture, anatomical change between displaced bone and surrounding neurovascular structures can make placing C1 screw more challenging. This study was to describe the effect of the C1 bursting fracture on the location of the internal carotid artery (ICA) around the atlas. Methods The authors analyzed the morphology of the atlas and the ICA in 15 patients with C1 bursting fracture and compared the anatomical parameters with control group (77 patients) without any bone fractures or pathologies. All patients were evaluated with CT angiography for the assessment of anatomical parameter. The laterality of the ICA was classified into the following four groups: group 1 (lateral to the C1 lateral mass), group 2 (lateral half of the lateral mass), group 3 (medial half of the lateral mass), and group 4 (medial to the lateral mass). The distances of the ICA from the midline, anterior tubercle, and ventral surface of the C1 lateral mass were compared between two groups. The distance between the lateral margin of the longus capitis muscle and the inner edge of the transverse foramen was also measured. Results Medially located ICA (laterality groups 2 and 3) was more common in the C1 bursting fracture group than control group (76.7 vs. 42.8%). There were no significant differences between two groups for the distance from the midline, the distance from the anterior tubercle, and the distance from the ventral surface of the C1 lateral mass, respectively. The distance of the longus capitis muscle to transverse foramen was 2.52 ± 2.09 and 4.15 ± 3.09 mm in each group, and there was statistically significant difference ( p < 0.01). Conclusion Lateral displacement of the bony structure of C1 bursting fracture changes the relative location of the ICA medially, which increase the injury risk during the bicortical C1 screw insertion. These data suggest that CT angiography or enhanced CT scans may be essential study for C1 bursting fracture. These preoperative imaging studies can give information to choose the ideal fixation technique and the proper trajectory of the screws.
Percutaneous Vertebroplasty: A New Technique Minimizing Cement Leak
Authors: Elnoamany Hossam 
Published: May 2015

Introduction Since the introduction of vertebroplasty to clinical practice, the cement leak is considered the most frequent and hazardous complication. In literature, the cement extravasation ranged from 26 to 97% of the time. This study discussed a new technique for injecting cement in the affected vertebra. Patients and Methods A total of 123 patients were treated by vertebroplasty using the current technique. The package of the cement powder and the solvent was divided into five equal parts. Each part of the powder and the solvent was mixed as a single dose and injected to the affected vertebra. The duration between subsequent injections was 10 minutes. Each injection is formed of 1 to 1.5 mL of cement. Results This new technique gives the surgeon enough time to make multiple separate injections with the same package. The time interval between injections makes cement harden enough and makes it not pushed by the next cement injection. This technique of injection gives time to the injected cement to seal off the cracks and cavities in the vertebra and subsequently leads to a highly significant decreased in cement leak ( p < 0.001) compared with the literature. Conclusion This study demonstrates a previously unreported technique for vertebroplasty that adds more safety to the procedure by significantly decreasing cement leak. It also gives the surgeon much more relaxation time and self-confidence during performing the procedure.
Accuracy of Pedicle Screw placement in Revision Spine Surgery using Robotic Guidance
Authors: Bederman Samuel S. , Jain Nick , Woolwine Spencer , Kiester P.D. , Bhatia Nitin 
Published: May 2015

Introduction Pedicle screw instrumentation in revision spinal surgery can be challenging because of the altered anatomy and existing instrumentation. Malpositioned pedicle screws can result in surgical complications that may lead to persistent pain, dysfunction, and morbidity. Robotic-guided screw placement has been shown to be accurate in the setting of primary surgery, however, less is known about its accuracy in revision situations. The purpose of this study was to identify the accuracy rate of pedicle screws placed via robotic guidance in revision spine surgery. Patients and Methods Patients who underwent revision spinal instrumentation with robotic guidance during a 3-year period (2011–2014) at our institution were identified and included in the study if they had postoperative CT scans of the operated levels. Screw insertion was identified in revision levels and included for analysis if they were categorized as screw redirection, prior fusion without instrumentation, prior laminectomy, or a spinal level adjacent to a previously operated level. Postoperative CT scans were reviewed for pedicle screw accuracy by independent radiologists. Results A total of 36 patients met inclusion criteria (average age 61.6 years, 13 males and 26 females). Of the 682 total pedicle screws placed, 229 were placed in revision levels. Overall, 220 (96.1%) of the 229 revision screws were confirmed to be accurate by postoperative CT. Of the nine screws that were malpositioned, none were clinically significant nor required revision surgery. Of the nine malpositioned screws, there were five lateral breaches, and four medial breaches. One patient required revision surgery for cage migration at a similar level as a misplaced screw, however, pedicle screws were not revised. Conclusion Robotic-assisted pedicle screw placement in revision spinal surgery provides accuracy similar to other techniques in primary cases. In cases of previous laminectomy or fusion, robotic guidance can provide benefit to surgeons in navigating altered bony anatomy. Larger studies are needed to confirm these findings.