bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment for Degenerative Lumbar Spinal Stenosis, Experience at Cartagena Colombia
Authors: Santiago-Rubio Gabriel Eduardo , Herazo-Bustos Mariana Isabel , Medina-Carmona Wanda Lorena , Miranda-Machado Pablo Andres , Carmona-Lorduy Carlos Alberto 
Published: May 2015

Introduction The primary objective of the surgical treatment is to relieve patient's symptoms, reduce the disability, correct deformities, stabilize the column, diminish the fixed segments, protect neurological organs, and decrease rehabilitation time in patients where conservative treatment had failed. Aims: This study aims to compare the percentage of functional limitation and pain intensity in the presurgical and postsurgical period in patients with lumbar spinal stenosis with surgical treatment with decompressive laminectomy, transpedicular instrumentation, and arthrodesis, by the column surgery team in the Universidad de Cartagena in three hospitals in Cartagena city, Colombia between January 2008 and January 2013. Methods Descriptive, comparative longitudinal study of 30 records of patients with clinical and immunological diagnosis, where the Oswestry Disability Index and Visual Analogue Scale were applied in the presurgical and 3 months' postsurgical treatments. Results The most of the patients had canal defects in two or more levels (69.9%), mainly between L4–L5 (28 of 30 patients). Most of the patients needed instrumentation of two or more levels (79.9%). There were intrasurgical complications in three patients (13.3%), all were dural tears; it was only one case of fistula as postsurgical complication (3.3%). About postsurgical results, it was observed a median difference of visual analog scale between presurgical and postsurgical of 5.1 points, and the difference in the median and standard deviation. In the pre- and postsurgical Oswestry Disability Index of 33.3%, which indicates, in our study, all of the patients submitted to surgical treatment by this technique had relevant postsurgical clinical relevance according to the FDA definition (≥ 15% in the Oswestry Disability Index) during a postsurgical following of 18.6 + 11.8 months. Conclusion The decompressive laminectomy technique, transpedicular instrumentation, and arthrodesis was effective to accomplish a clinical relevant benefit in patients with degenerative lumbar spinal stenosis.
The Importance of 360-Degree Stabilization and Fusion in Lytic Spondylolisthesis. A Minimally Invasive Technique to Revision and Complete the Final Construction after Broken Screw
Authors: Arias Pesantez Carlos Fernando , Arias Solano Carlos Reinaldo 
Published: May 2015

Introduction The spondylolisthesis lytic is a very unstable pathology and a reduction with a 360-degree stabilization improve solid fusion, only a posterior approach is not enough, is possible to see a broken transpedicular screw. Patient and Methods: We present a case of a 36-year-old woman with a spondylolisthesis lytic grade 2 who underwent just a posterior screw fixation; 6 months after surgery she feels lumbar and radicular pain, the rx shows a left S1 broke screw. Results We present a minimally invasive anterior lumbar interbody fusion plus a revision by posterior way to achieve reduction and circumferential fixation with percutaneous transpedicular screws preserving the muscular and ligamentous posterior tension band. The surgical time was 70 minutes, the blood loos 50 mL, time to discharge 23 hours after surgery and the return to normal activities in 5 days. The VAS pre-op was 8 and post-op 2, oswestry disability index post-op was 4. Conclusion The spondylolisthesis lytic needs a 360-degree approach to produce safe stabilization and possibility of solid fusion and a minimally invasive techniques allow to preserve muscular and ligament injuries and help the patient to return to normal activities shortly.
Outcomes of Vancomycin Associated to Bone Graft to Prevent Deep Spinal Infection, 573 Consecutive Posterior Spinal Surgical Patients
Authors: Scheverin Nicolas , Steverlynck Alejandro , Castelli Roberto , Falavigna Asdrubal , Videla Nicolas , Sobrero Diego , Dinelli Dino 
Published: May 2015

Introduction Infections in spinal surgeries with instrumentation is a complication that not only increases the cost of treatment but also the morbidity and mortality of patients. The rates of surgical site infection in spinal surgery with instrumentation published vary from 2.8 to 6%. The most commonly isolated organism in this kind of surgery is Staphylococcus aureus and methicillin sensitive or resistant. Objective This study aims to assess whether vancomycin decreases infection rates when is associated with bone graft in patients undergoing fusion. Patients and Methods This study is a retrospective study on spinal surgeries with instrumentation performed from January 2011 to December 2013 on 573 patients, using 1 g of vancomycin-associated with bone graft in 205 patients. Results With the use of vancomycin associated to bone graft a reduction in the rate of infection of 4.8 to 1.4 was achieved. Conclusion We found that the use of 1 g of vancomycin added to the bone graft in the posterior spinal fusion is associated with lower rates of infection and we found this result statistically significant ( p < 0.03782).
Spinal Neurocysticercosis: A Case Report
Authors: Laos Plasier Eduardo 
Published: May 2015

Introduction Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system. In endemic areas, the incidence of the NCC was approximately 4% of the general population. Although cerebral NCC is common, only 1 to 5% of cases demonstrate the involvement of the spinal canal. Great neurological morbidity can occur if spinal NCC is not adequate and opportunely. Patient and Methods: Male 70 years' old, with a history of cerebral NCC confirmed, DVP carrier, comes to our hospital emergency, with time of 5 months' duration disease, begins with paresthesias in the lower limbs, progressive loss of sphincter control, decreased strength in members inferiors difficult ambulation to prevent it. On admission, the patient lucid, sensitive level D6, paraplegia, hyperreflexia in the lower limbs, and sphincters unchecked. Dorsal spine MRI shows cystic lesion of 22 × 11 × 8 mm at D5 intradural extramedullary back and left side, which determines medullar compression. Surgery is performed consisting of laminectomy and partial D4, D5, D6, and more microsurgical resection of multiple cysts. Results Histopathological examination confirmed cysticercosis. Patient in postoperatorio is stable but unchanged in neurologic status despite the images confirmed decompression. Patient's motor weakness in the lower extremities and urinary function did not improve. Conclusion Spinal NCC can occur through direct hematogenous dissemination from the gastrointestinal tract. Spinal NCC may also be shown through the circulation of CSF. Doctors treating spinal cysts with an unusual clinical course should include cysticercosis as a differential diagnosis. MRI with contrast is recommended ELISA serum study in the diagnosis of these cases. Although spinal NCC is relatively rare, representing a distinct clinical entity that can have devastating consequences for the patient. Because of the limited size of the spinal canal, the effect of the mass of these lesions is not well tolerated.
Diagnosis and Treatment Options for Cervical Spondylodiscitis
Authors: Servidio Mariano , Petracchi Matias , Valacco Marcelo , Sola Carlos , Gruenberg Marcelo 
Published: May 2015

Introduction Cervical spondylodiscitis can present through a variety of unspecific signs and symptoms usually associated with a delay diagnosis. The close anatomic relation of the infection process with the spinal cord at this mobile area leads to a serious medical situation. Its low incidence and the lack of papers with high level of evidence in the literature explain why there are no well-established treatment protocols. Our objective was to evaluate retrospectively the treatment of a consecutive series of 19 adult patients treated for cervical spondylodiscitis. Material and Methods 19 patients were evaluated with an average of 4 years of follow up. Eleven patients with a diagnosis of mechanical instability, neurologic compromise, or abscess formation were treated surgically; the remaining 8 were managed conservatively with external immobilization while all received intravenous antibiotics. Staphylococcus aureus, identified in 9 patients, was the most frequent etiologic agent. Results At final follow up all patients presented resolution of signs and symptoms of infection; a solid fusion was obtained in every case. In 5 patients with incomplete spinal cord compromise the remission was complete. Only 1 of the 5 patients with radicular compromise remains with paresthesias. Conclusion According to our selection guidelines, the combination of parenteral antibiotic treatment and external immobilization or surgery proved to be an adequate treatment in our small series of patients with cervical spondilodiscitis.
Spine Injuries from Diving Accidents: Our experience in Los Angeles, Chile
Authors: González Guerra Oscar , Saavedra Palma Tatiana , Canessa Aguila Gustavo , Segovia Mera Ramon , Avaria Ossandon Days , Medina Barra Luis 
Published: May 2015

Introduction In our country, amateur diving is a frequent summer activity in young people. Spinal injuries after diving in recreational context can lead to catastrophic consequences, mostly in young and economically active population. Patients and Methods We reviewed 34 patients hospitalized in our center who were admitted to the neurosurgery unit between 2006 and 2014, with spinal injuries because of driving accidents. Data were collected from their initial admission and from follow-up records. Statistical analysis was performed using Microsoft Excel 2010 and STATA v10. Results Of the total number of patients evaluated, 97% (33/34) sustained injuries. Mean age was 30 (SD, 15–54) years. All reported injuries occurred during summer. Alcohol consumption was present in 44% of cases. The most affected segment was cervical (88%), and the most common injuries were C4–C5 dislocation and fracture (18%) and C5–C6 dislocation and fracture (12%). Overall, 32% of patients presented severe neurological compromise (ASIA A, B, and C) at time of admission. Surgical treatment was required in 50% of cases, the majority using an anterior cervical approach. The other 50% underwent orthopedic management. NASCIS 2 methylprednisolone protocol was used in 18% of cases. Overall, 29% of patients received steroid therapy. Thirty-day mortality for the cohort was 8.8%, all ASIA A. Mean hospital stay was 22 (SD, 1–354) days. Conclusion Driving accidents in Los Angeles, Chile, while uncommon can result in spinal injuries with drastic consequences, including permanent physical disability, mortality, and a profound socioeconomic impact. In our experience, early surgical and orthopedic management resulted in best clinical results. The consumption of alcohol worsen the outcomes prevention strategies should be implemented to reduce the incidence and impact of this problem.
Vertebroplasty and Kyphoplasty. Complications, Avoidance, and Technical Notes in our 7 Years' Experience
Authors: Marcelo Markarian Pablo Lehrner , Moriones Silvia , Zilio Alberto , Galati Alejandro , Belchior Sebastian , Galante Jose , Sacher Fabio , Sole Horacio , Monti Alfredo 
Published: May 2015

Introduction The vertebroplasty (VP) and kyphoplasty (KP) are well known methods for the treatment of vertebral bodies fractures, due osteoporosis, primary, and metastatic tumor. The major complications are the cord and root compression, due cement leakage, epidural and subdural hematomas, and pulmonary emboli. These complications are most described in VP. In this retrospective study, the authors describe the way they find to avoid major complications with KP and a modification of de VP technique. Patients and Methods Between January 2007 and July 2014, 138 patients with 184 levels were treated in the three institutions. In 124 levels, KP was performed and in 60 levels VP. Balloon KP with pressure manometer was used. The VP were performed using de bone feelers and the cannulas of the KP set, without the insufflation of the balloon. A retrospective analysis of the cases was made and a review of the literature. Results A total of 102 patients (73.9%) were females and 36 patients (26.1%) were males. The 69% of the total of patients were single fractures and 31% were double level fractures. The etiology was 92% osteoporotic fractures, four patients (2.9%) underwent KP due multiple myeloma, five patients (3.6%) for hemangioma, and two patients (1.4%) for spinal metastasis. Pain relief was reported in all the patients with a media of VAS 8 of 10 in pre-op and VAS 2 of 10 in post-op. Neither major complications nor post-op infections were reported. Overall, 3 patients with cement leakage in the spinal canal, 14 patients with interbody disc space leakage, and 9 patients with lateral and anterior extravasations were described without symptoms. Conclusion The cement injection with the bone fillers provides more control in the cement infusion in the VP as well as in the KP, avoiding the leakage of cement in great quantity and preventing major complications.
Uncommon Intradural–Extramedullary Lesions Removed by Uniportal Minimally Invasive Technique. Clinical and Radiological Results: A Study with 12 Months of Follow-Up
Authors: Arias Pesantez Carlos Fernando , Peña Pablo 
Published: May 2015

Introduction Intradural extramedullary cervical lesions usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes standard fashion cut incision, open laminectomy, and some cases fusion. Patients and Methods We present four patients (one woman and three men) with symptoms including radicular pain and/or neurological deficit, due intradural extramedullary cervical lesion. All the patients underwent total resection with minimally invasive uniportal technique using a tree blade MAXCESS retractor system (Nuvasive, Inc.). We measured a VAS, Nurick scales pre-op, and with follow-up of 6 weeks, 3.6 and 12 months post-op. Surgical time, blood loss and time to discharge. All the patients underwent control MRI postoperatively. Results One patient neurenteric cyst, two patients: underwent neurocysticercosis, and the last epidermoid cyst. The VAS and Nurick scales were decreased over the time line. The surgical time was 140 minutes (mean), blood loss 30 mL (mean). All the patients were discharged at 47 hours mean, and return to daily activities 10 days (mean). Conclusion Intradural–extramedullary lesions can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization, disruption to local tissues, and return to daily activities suggest that this technique may present an alternative to traditional open resection.
Free-Hand Placement of C7 Pedicle Screws: A Cadaveric Study
Authors: Vialle Emiliano , Vialle Luiz Roberto , Herrera Luis 
Published: May 2015

Introduction This study aims to evaluate the accuracy of free-hand pedicle screws placement at seventh cervical (C7) vertebra. Methods The authors have exposed the cervicothoracic junction. Overall, nine adult cadavers (seven males and two females) preserved in formalin from the Faculty of Medicine, locating the C7 vertebra based on anatomical parameters. According to previous publications, the entry point for the C7 pedicle was determined as 3 to 4 mm lateral and 5 to 6 mm superior to the center of the lateral mass, and the pedicle was drilled manually and instrumented with 3.5 mm. After the screws placement, of the screws we removed, the C7 vertebrae were removed for radiographic analysis. Results The authors were able to adequately locate the C7 entry point in 12 pedicles (66.6% accuracy), finding a great variability both laterally (2–5 mm) and cranially (3–10 mm). The angulation in the coronal plane was correct in 13 pedicles (72.3%), despite the incorrect location of the entry point. Angle values in the coronal plane ranged from 38 to 62 degrees. In the sagittal plane angulation, two screws were placed in the C6–C7 disc. The midtransversal diameter of the 18 pedicles ranged from 4 to 7 mm. Conclusion The location of the entry point for placement of C7 pedicle screws with pure free-hand technique is very variable because of the anatomical differences and the authors recommend guidance for increased safety and accuracy.
Anthropometry of the Vertebral Pedicles of the Thoracic Spine without Pathology in Mexican Patients of a Public Institution in the Metropolitan Area
Authors: Garcia Su·Rez Adrian , Cabrera Escamila Jorge Arturo , Elizalde Eulalio 
Published: May 2015

Introduction The anatomy of the pedicles is complex and vary according to the region valued. For proper placement of a transpedicular screw requires a high knowledge of the anatomy of the pedicle and the different surgical techniques for placement. Tomography is the best radiological tool for measuring various parameters of the pedicles. The purpose of this study was to determine, through tomography, thoracic pedicle anthropometry of the Mexican population and its variations according to sex, with the aim of providing irrefutable anatomical information for the development of techniques, materials, and tools more specific to our population pedicle fixation. Methods This study is a descriptive, retrospective, and observational study. The source collection and measurement were performed on CT chest scan of Unit Trauma Hospital “Dr. Victorio de la Fuente Narv·ez,” between January 2012 and June 2013, on computer tomographic Siemens Somatom and General Electric of 16 cuts, which were made in Mexican patients without lesions in the thoracic spine, with an age range of 18 and 60 years, who had axial, sagittal, and coronal to no more than 3 mm in T1 to T12 levels in the left and right pedicles. The sample size was calculated using tables Hulley, given a universe of 1,620 thoracic CT, with a confidence level of 95% amplitude interval 0.15, an expected ratio of 0.15, and a β 0.20, determined a sample of 122 scans. Measurements (axial and sagittal diameter, coronal morphology, axial, and sagittal angulation) were performed by two observers and the involvement of a third when discordance of more than 10% between the first two was found. Data analysis was performed with SPSS version XVII, using descriptive statistics and weighted Kappa. Results The pedicles were of smaller diameter T5, with 2.03 ± 0.94 mm in men and 1.66 ± 0.77 mm in women. The smallest sagittal diameter was found in T2, with 1.95 and 10.15 ± 9.27 ± 2.60 mm, respectively. The angle was increased axial T1, averaging 32.70 ± 4.37ʃ. The sagittal angle of thoracic pedicle showed greater angles from T4 to T10. Predominated teardrop at T1–T3, the elongated drop in T4–T5 and T11–T12, and kidney-shaped in T6–T10. Conclusions Women may be less than the male population values. From T3 to T9 pedicles are smaller than the diameter of the screws that are included in the market. Therefore, anteroposterior, lateral, and axial assessment of each vertebral body to the pedicle screws placement necessary; we also seek new screw placement techniques as described in-out-in, and use technology such as neuronavigation, to continue to benefit from the biomechanical properties of transpedicular instrumentation both to the surgeon and the patient.
Magnitude, Location, and Factors Related to Regional and Global Correction Loss in Long Adult Deformity Constructs: Report of 183 Patients with 2-Year Follow-Up
Authors: Ames Christopher , Lafage Virginie , Scheer Justin , Kelly Michael , Hostin Richard , Hart Robert , Klineberg Eric , Protopsaltis Themistocles , Deviren Vedat , Sciubba Daniel , Bess Shay , Shaffrey Christopher , Schwab Frank , Smith Justin 
Published: May 2015

Introduction Adult deformity patients (pts) have previously been shown to lose spino-pelvic correction over time especially in the sagittal plane. The goal of this study was to analyze the source of this correction loss and specifically to quantitate the change that occurs in fused verses unfused segments. Variables examined include presence of interbody fusion, rod diameter, rod material, age, and pre-op sagittal alignment. Materials and Methods A retrospective review of a multicenter, prospective ASD database was conducted. Inclusion criteria were age ≥ 18 years, ASD, no revisions between > 6 weeks and < 2 years postop. Spinal pelvic parameters, thoracic kyphosis (TK:T2–T12) and lumbar lordosis (LL:L1–S1) were both measured overall as well as within and outside the instrumented segments. Overall, SVA, PT, Pi-LL change, and TK and LL change between 6 weeks and 2 years post-op was calculated. Of these pts, the amount of TH loss and TL loss within and outside of the instrumented segments was also determined as well as a percentage of the total loss for each region. Results A total of 183 pts met criteria. Between 6 weeks and 2 years post-op 61.7% of pts lost SVA (4.4 ± 4.3 cm), 65.0% lost PT (4.7 ± 4.0 deg), and 40.4% lost PI–LL (16.2 ± 9.3 deg). Overall, 63.9% had TH loss (8.0 ± 8.9 deg) and 56.8% had LL loss (5.8 ± 4.5 deg). Overall, 41.5% lost > 2 cm SVA. Of the pts with > 2 cm SVA loss, 60.5% had LL loss, and of those, 82.6% was within instrumented segments. Of the pts with LL loss, 13.8% had > 10 deg loss. Pts with an interbody fusion have a 2.3 times ( p = 0.0076) likelihood of having any LL loss, but the interbody fusion was protective against > 10 deg change (7.1%). Pts ≥ 65 years' old are 9.4 times ( p < 0.0001) more likely to have LL loss than pts ≤ 45 years' old (4.4%). Pts with pre-op C7 SVA > 5 cm are 2.4 times ( p = 0.0035) more likely to have LL loss. Conclusion Loss of initial regional and global sagittal correction is common in ASD surgery and also occurs inside the instrumented segments between 6 weeks and 2 years postop. Older age and pre-op sagittal deformity are risk factors for overall loss of correction and for loss of correction within the instrumented segments. In our study, interbody fusion was only protective for LL loss > 10 deg.