bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitative changes in gait parameters after central corpectomy for cervical spondylotic myelopathy
Authors: Moorthy Ranjith K. , Bhattacharji Suranjan , Thayumanasamy Ganesh , Rajshekhar Vedantam 
Published: May 2009

Object.In this study, quantitative gait analysis is used to describe the changes in the kinematic and kinetic parameters of gait after central corpectomy in patients with cervical spondylotic myelopathy (CSM).Methods.Six men with CSM that was categorized preoperatively as Nurick Grade 3 or 4 were assessed using quantitative gait analysis. The values of various kinematic and kinetic parameters, physiological cost index, and range of motion (ROM) in the lower-limb joints were computed preoperatively as well as at follow-up review 12 months or more postoperatively. Patients also received scores based on the Nurick and Japanese Orthopaedic Association (JOA) lower-limb functional scales pre- and postoperatively.The mean Nurick grade improved from 3.3 to 2 (p = 0.02) and the mean JOA lower-limb score improved from 4.2 to 6 (p = 0.02). The forward ground reaction force showed a statistically significant increase from 10.8 ± 4.1% body weight to 12.1 ± 3.6% body weight (p = 0.04). There was a significant improvement in the ROM at the knees, from 48.6 ± 7.7° to 54.2 ± 5.2° (p = 0.03). There was an increase in the mean walking speed, stride length, percentage of single-limb support time, vertical and backward ground reaction forces, and ROM at the hips in the postoperative gait analysis. These results indicate an improved stability of gait as well as greater flexibility in the knee after decompression of the spinal cord. These changes correlated with an improvement in the functional status of patients with CSM after central corpectomy.Conclusions.Gait analysis can be used as a quantitative tool in the pre- and postoperative evaluation of patients with CSM.
Dural ossification associated with cervical ossification of the posterior longitudinal ligament: frequency of dural ossification and comparison of neuroimaging modalities in ability to identify the disease
Authors: Mizuno Junichi , Nakagawa Hiroshi , Matsuo Naoki , Song Joonsuk 
Published: May 2009

Object. The authors' goal in this study was to understand the frequency and pattern of dural ossification (DO, and to evaluate the effectiveness of neuroimaging modalities used to identify this disease in association with ossification of the posterior longitudinal ligament (OPLL).
Methods. One hundred eleven patients with OPLL underwent anterior procedures. Of these patients, 17 (15.3%) had associated ossification of the dura mater. There were 10 cases of DO in the 94 patients with segmental OPLL and seven in the 17 patients with nonsegmental OPLL (seven continuous and 10 mixed-type OPLL). Retrospective evaluation of DO was performed by examining plain x-ray films, polytomography studies, computerized tomography (CT) scans, and magnetic resonance (MR) images. A positive correlation was found between the type of OPLL and the frequency of DO (p < 0.01).
The DO was classified into the following three types according to shape: 1) isolated type, 2) double-layer type, and 3) en bloc type, based on its relationship with OPLL. There were 10 lesions of the double-layer type, four en bloc type, and three isolated type; the double-layer pattern of DO was the most common. All DOs as well as OPLLs (17 cases) were identified using bone-window CT scanning. Polytomography was used successfully to identify all 12 OPLLs, whereas DO was recognized in seven of the 12 cases. Magnetic resonance imaging could not identify DO (none of the 17 cases), although OPLL was identified on MR imaging in 12 of the 17 cases.
Conclusions. Three patterns of DO associated with OPLL, that is, isolated, double-layer, and en bloc types, were confirmed by retrospective analysis of neuroimaging findings. Nonsegmental OPLL was likely to be accompanied by DO. Bone-window CT scanning was most useful for identification of DO as well as OPLL, whereas MR imaging was ineffective in recognizing DO.
A three-dimensional collagen matrix as a suitable culture system for the comparison of cyclic strain and hydrostatic pressure effects on intervertebral disc cells
Authors: Neidlinger-Wilke Cornelia , Würtz Karin , Liedert Astrid , Schmidt Carla , Börm Wolfgang , Ignatius Anita , Wilke Hans-Joachim , Claes Lutz 
Published: May 2009

Object. To study intervertebral disc cell mechanobiology, the authors developed experimental systems that allow the application of cyclic strain and intermittent hydrostatic pressure (IHP) on isolated disc cells under equal three-dimensional (3D) culture conditions. The purpose of the study was to characterize disc cell proliferation, viability, morphology, and gene expression in 3D collagen matrices.
Methods. The effects of cyclic strain (1, 2, 4, and 8% strain; 1 Hz) and IHP (0.25 MPa, 0.1 Hz) on gene expression (real-time polymerase chain reaction) of anabolic and catabolic matrix proteins were investigated and compared with those derived from mechanically unstimulated controls. Intervertebral disc cells proliferated in the collagen gels (mean viability 91.6%) and expressed messenger RNA for collagen I, collagen II, aggrecan, matrix metalloproteinase (MMP)—2, and MMP-3. Morphologically, both spindle-shaped cells with longer processes and rounded cells were detected in the collagen scaffolds. Cyclic strain increased collagen II and aggrecan expression and decreased MMP-3 expression of anulus fibrosus cells. No significant difference between the four strain magnitudes was found. Intermittent hydrostatic pressure tended to increase collagen I and aggrecan expression of nucleus cells and significantly decreased MMP-2 and -3 expression of nucleus cells, whereas aggrecan expression of anulus cells tended to decrease.
Conclusions. Based on these results, the collagen matrix appeared to be a suitable substrate to apply both cyclic strain and IHP to intervertebral disc cells under 3D culture conditions. Individual variations may be influenced by the extent of degeneration of the disc specimens from which the cells were isolated. This experimental setup may be suitable for studying the influence of degeneration on the disc cell response to mechanical stimuli.
A novel dynamic model for experimental spinal cord compression
Authors: Marquardt Gerhard , Setzer Matthias , Theisen Alf , Dettmann Edgar , Seifert Volker 
Published: May 2009

Object. The goal of this study was to develop a novel dynamic model for experimental spinal cord compression that closely approximates neoplastic epidural compression of the spinal cord in humans.
Methods. In 30 New Zealand white rabbits, the thoracic spine was exposed via a posterior approach. On each side of one vertebral lamina a small hole was drilled caudal to the articular process. A silicone band was passed through these holes, forming a loop. The spinal dura mater was exposed via an interlaminar approach. The loop was brought into contact with the dura mater and fixed in its position encircling 270° of the circumference of the spinal cord. Thereafter, the loop was gradually tightened at set times by pulling at the ends of the band and fixing them again in their new position. The spinal cord was thus increasingly compressed in a circular and dynamic manner.
Neurological deficits of various degrees were created in all animals in the compression group, and the compressive effect of the loop was reliably demonstrated on MR imaging. After decompression of the spinal cord, the neurological deficits were reversible in the majority of animals, and MR imaging revealed either no signal changes or only circumscribed ones within the cord. In contrast, MR images obtained in animals that did not recover revealed the occurrence of extensive chronic myelopathy.
Conclusions. This novel model features reproducibility of paresis and neurological recovery. It is a dynamic model simulating circular tumor growth and is characterized by its easy, straightforward, and cost-saving applicability.
A novel surgical treatment of lumbar disc herniation in patients with long-standing degenerative disc disease
Authors: Wenger Markus , Markwalder Thomas-Marc 
Published: May 2009

Object. In patients with long-standing lumbar degenerative disc disease (DDD) conventional surgical therapy of a herniated disc may worsen back pain due to further destabilization of the affected motion segment. In recent years, total-disc arthroplasty has been introduced to treat DDD while maintaining segmental mobility. To the best of the authors' knowledge, this is the first report involving lumbar disc herniation and long-standing DDD submitted to combined anterior microdiscectomy with sequestrectomy and total-disc arthroplasty.
Methods. Fourteen patients with long-standing DDD and a recently herniated disc underwent total anterior lumbar microdiscectomy, with removal of the herniated disc, and total-disc arthroplasty. There were nine women and five men whose mean age was 39.6 years (range 22–56 years) in whom back and leg pain had been present for a mean of 75.4 (range 9–360) and 9.4 (range 0.33–36) months, respectively. Thirteen patients underwent L5—S1 and one underwent L4–5 surgery. In all cases the procedure and the postoperative courses were uneventful. After a mean follow-up period of 12.5 months (range 3.9–21.1 months), outcome was excellent in 11 and good in three patients.
Conclusions. The aforementioned surgical treatment of a recently herniated lumbar disc in patients with long-standing DDD yielded very favorable early results.
Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein
Authors: Boakye Maxwell , Mummaneni Praveen V. , Garrett Mark , Rodts Gerald , Haid Regis 
Published: May 2009

Object. The authors reviewed clinical and radiographic outcomes in patients who had undergone anterior cervical discectomy and fusion (ACDF) involving the placement of polyetheretherketone (PEEK) spacers filled with recombinant human bone morphogenetic protein (rhBMP)—2.
Methods. Data obtained in 24 cases were retrospectively evaluated. The follow-up period ranged from 12 to 16 months (mean 13 months). Fifteen patients presented with radiculopathy, eight with myeloradiculopathy, and one with quadriparesis. Single-level ACDF was performed in 12 patients, two-level ACDF in nine, and three-level ACDF in three. Clinical outcomes were assessed using Odom criteria, and fusion was assessed by examining flexion—extension radiographs and computerized tomography scans in cases in which arthrodesis was questionable. Follow-up data were available for 23 patients. One patient died of medical complications unrelated to surgery 4 weeks after ACDF. Clinical outcomes were rated as good/excellent in 22 patients (95%) and fair in one (5%). Solid radiographically documented fusion, with evidence of solid bridging bone and no instability on flexion—extension x-ray films, was present in all cases. Complications included transient recurrent laryngeal nerve injury in one case, transient C-5 paresis in one, cerebrospinal fluid leakage in one, and transient dysphagia in two.
Conclusions. Analysis of the results indicated that ACDF involving an rhBMP-2—filled PEEK spacer leads to good clinical outcomes (by Odum criteria) and solid fusion (even in multilevel cases) while avoiding the complications associated with harvesting iliac crest bone grafts.
Multimodal assessment after surgery for cervical spondylotic myelopathy
Authors: King Joseph T. , Moossy John J. , Tsevat Joel , Roberts Mark S. 
Published: May 2009

Object. Investigators reporting decompressive surgery to treat patients with cervical spondylotic myelopathy (CSM) have described inconsistent benefits. In the present study the authors used three types of outcomes instruments to assess the results of CSM surgery.
Methods. The authors collected prospective baseline and 6-month follow-up data in a cohort of 62 patients with CSM. Data collection included those pertaining to demographics; symptoms; physical findings; myelopathy severity; health status measured with the Short Form—36; and health values according to the standard gamble, time trade-off, visual analog scale, and willingness to pay. Rank-order methods were used to compare surgical and nonsurgical patients, and multivariate regression techniques adjusting for baseline characteristics were performed to examine the effects of surgery.
During the study period, 28 patients underwent surgery, 34 did not, and there were no baseline differences between the two groups in demographics, symptoms, myelopathy scores, health status, or health values (p ≥ 0.120 in all domains); there was a greater prevalence of hand intrinsic muscle atrophy (p = 0.035) and Hoffmann sign (p = 0.006) in the surgery-treated group. Neither raw comparisons nor regression analyses showed a consistent surgery-related benefit. There were sporadic associations between worse outcomes and older patients, higher income, Babinski sign, longer duration of CSM symptoms, hand clumsiness, lower-extremity numbness, and multilevel surgery (p ≤ 0.049 for all).
Conclusions. Analysis of results obtained in the 62 patients with CSM failed to show a surgery-related benefit despite the use of three classes of outcomes instruments. Patient demographics, symptoms, physical signs, and the surgical approach may explain some of the variation in outcomes in patients with CSM.
CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life
Authors: Degen Jeffrey W. , Gagnon Gregory J. , Voyadzis Jean-Marc , McRae Donald A. , Lunsden Michael , Dieterich Sonja , Molzahn Inge , Henderson Fraser C. 
Published: May 2009

Object.The authors conducted a study to assess safety, pain, and quality of life (QOL) outcomes following CyberKnife radiosurgical treatment of spinal tumors.Methods.Data obtained in all patients with spinal tumors who underwent CyberKnife radiosurgery at Georgetown University Hospital between March 2002 and March 2003 were analyzed. Patients underwent examination, visual analog scale (VAS) pain assessment, and completed the 12-item Short Form Health Survey (SF-12) before treatment and at 1, 3, 6, 8, 12, 18, and 24 months following treatment.Fifty-one patients with 72 lesions (58 metastatic and 14 primary) were treated. The mean follow-up period was 1 year. Pain was improved, with the mean VAS score decreasing significantly from 51.5 to 21.3 at 4 weeks (p < 0.001). This effect on pain was durable, with a mean score of 17.5 at 1 year, which was still significantly decreased (p = 0.002).Quality of life was maintained throughout the study period. After 18 months, physical well-being was 33 (initial score 32; p = 0.96) and mental well-being was 43.8 (initial score 44.2; p = 0.97). (The mean SF-12 score is 50 ± 10 [standard deviation].) Adverse effects included self-limited dysphagia (three cases), diarrhea (two cases), lethargy (three cases), paresthesias (one case), and wound dehiscence (one case).Conclusions.CyberKnife radiosurgery improves pain control and maintains QOL in patients treated for spinal tumors. Early adverse events are infrequent and minor. The authors await long-term follow-up data to determine late complications and tumor control rates.
Surgical management of metastatic disease of the lumbar spine: experience with 139 patients
Authors: Holman Paul J. , Suki Dima , McCutcheon Ian , Wolinsky Jean-Paul , Rhines Laurence D. , Gokaslan Ziya L. 
Published: May 2009

Object.The surgical treatment of metastatic spinal tumors is an essential component of the comprehensive care of cancer patients. In most large series investigators have focused on the treatment of thoracic lesions because 70% of cases involve this region. The lumbar spine is less frequently involved (20% cases), and it is unclear whether its unique anatomical and biomechanical features affect surgery-related outcomes. The authors present a retrospective study of a large series of patients with lumbar metastatic lesions, assessing neurological and pain outcomes, complications, and survival.Methods.The authors retrospectively reviewed data obtained in 139 patients who underwent 166 surgical procedures for lumbar metastatic disease between August 1994 and April 2001. The impact of operative approach on outcomes was also analyzed.Among the wide variety of metastatic lesions, pain was the most common presenting symptom (96%), including local pain, radicular pain, and axial pain due to instability. Patients underwent anterior, posterior, and combined approaches depending on the anatomical distribution of disease. One month after surgery, complete or partial improvement in pain was demonstrated in 94% of the cases. The median survival duration for the entire population was 14.8 months.Conclusions.The surgical treatment of metastatic lesions in the lumbar spine improved neurological and ambulatory function, significantly reducing axial spinal pain; results were comparable with those for other spinal regions. Analysis of results obtained in the present study suggests that outcomes are similar when the operative approach mirrors the anatomical distribution of disease. When lumbar vertebrectomy is necessary, however, anterior approaches minimize blood loss and wound-related complications.
Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience
Authors: North Richard B. , LaRocca Vito R. , Schwartz Jacob , North Catherine A. , Zahurak Marianna , Davis Randy F. , McAfee Paul C. 
Published: May 2009

Object.Refinement of surgical techniques, especially anterior approaches, for the management of spinal metastases has improved patient outcomes, despite the fact that a complete analysis of the prognostic factors that would inform patient selection has not been undertaken. The authors sought to identify such prognostic factors for neurological outcome and life expectancy in patients with spinal metastases.Methods.The authors used Kaplan—Meier techniques, log-rank comparisons, and a multivariate model stratified by tumor type to identify prognostic factors for duration of ability to walk and survival in patients who underwent surgical treatment for spinal metastases during a decade when all current treatment options were available.Preoperatively, 53 (87%) of the 61 patients in the study population suffered neurological symptoms (for example, weakness) and 52 (85%) were ambulatory. Postoperatively, 59 (97%) were ambulatory. Most patients who survived 6 months (81%) remained ambulatory, as did 66% of those alive at 1.6 years. The median postoperative survival was 10 months. The risk factors for loss of ambulation were preoperative loss of ambulatory ability, recurrent or persistent disease after primary radiotherapy of the operative site, a procedure other than corpectomy, and tumor type other than breast cancer. Prognostic factors for reduced survival were surgical intervention extending over two or more spinal segments, recurrent or persistent disease after primary radiotherapy involving the operative site, diagnosis other than breast cancer, and a cervical spinal procedure.Conclusions.The results of this analysis allowed the authors to create a simple prognostic factor scoring system that can be applied to individual patients. The positive experience derived from this study supports an expanded role for the surgical treatment of metastatic spinal disease.
Positive feedback loop of interleukin-1β upregulating production of inflammatory mediators in human intervertebral disc cells in vitro
Authors: Jimbo Kotaro , Park Jin Soo , Yokosuka Kimiaki , Sato Kimiaki , Nagata Kensei 
Published: May 2009

Object.Interleukin-1β (IL-1β) induces neurological symptoms in intervertebral disc herniation (IDH). Recently, the existence of a positive feedback loop of IL-1β, which encourages an inflammatory reaction or degeneration in the cells of tendon, has been reported. The authors hypothesized that there is a positive feedback loop of IL-1β in the cells of IDH.Methods.Eight human intervertebral disc specimens were harvested during spinal surgery for lumbar disc herniation. The cells were stimulated in serum-free medium with or without exogenous IL-1β. The messenger RNA (mRNA) was extracted for reverse-transcription polymerase chain reaction (PCR) and real-time PCR to quantify the mRNA of endogenous IL-1β, IL-6, cyclooxygenase-2 (COX-2), and matrix metalloproteinases (MMPs). The cells were then stimulated in serum-free medium with or without exogenous IL-1β, and then exogenous IL-1β was removed. After 2, 4, and 6 days, the medium was collected, and enzyme-linked immunosorbent assay was used to measure the protein concentration of endogenous IL-1β. The mRNA expressions of endogenous IL-1β, IL-6, COX-2, and MMPs were increased significantly depending on the concentration of exogenous IL-1β. The protein concentration of endogenous IL-1β was increased over time.Conclusions.There was a positive feedback loop of IL-1β in the cells of IDH. Furthermore, the productions of IL-6, COX-2, MMP-1, and MMP-3 were upregulated as a result of the increasing concentration of IL-1β in a positive feedback loop of IL-1β. The authors concluded that this positive feedback loop of IL-1β upregulated the production of mediators and thus can cause cessation of symptoms in IDH.
Chondroblastoma of the lumbar spine
Authors: Vialle Raphaël , Feydy Antoine , Rillardon Ludovic , Tohme-Noun Carla , Anract Philippe , Colombat Magali , De Pinieux Gonzague , Drapé Jean-Luc , Guigui Pierre 
Published: May 2009

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful.
Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.