bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benchmarking Child and Adolescent Mental Health Organizations
Authors: Brann Peter , Walter Garry , Coombs Tim 
Published: February 2011

Objective: This paper describes aspects of the child and adolescent benchmarking forums that were part of the National Mental Health Benchmarking Project (NMHBP). These forums enabled participating child and adolescent mental health organizations to benchmark themselves against each other, with a view to understanding variability in performance against a range of key performance indicators (KPIs). Method: Six child and adolescent mental health organizations took part in the NMHBP. Representatives from these organizations attended eight benchmarking forums at which they documented their performance against relevant KPIs. They also undertook two special projects designed to help them understand the variation in performance on given KPIs. Results: There was considerable inter-organization variability on many of the KPIs. Even within organizations, there was often substantial variability over time. The variability in indicator data raised many questions for participants. This challenged participants to better understand and describe their local processes, prompted them to collect additional data, and stimulated them to make organizational comparisons. These activities fed into a process of reflection about their performance. Conclusions: Benchmarking has the potential to illuminate intra- and inter-organizational performance in the child and adolescent context.
Posterior transpedicular corpectomy and reconstruction of the axial vertebra for metastatic tumor
Authors: Ames Christopher P. , Wang Vincent Y. , Deviren Vedat , Vrionis Frank D. 
Published: February 2011

Management of metastatic disease is a significant challenge in modern spinal surgery. Previously, radiation therapy alone was the most commonly employed treatment. Recent data, however, suggest that surgical decompression in addition to radiation therapy improves functional recovery compared with radiation therapy alone.
Metastatic disease most commonly affects the thoracic spine. Over the past decade surgical treatment has changed significantly for thoracic disease, shifting from transthoracic resection and reconstruction to single-stage posterolateral approaches that allow transpedicular resection and reconstruction. In posterolateral approaches, patients are spared the morbidity associated with transcavitary approaches while receiving the benefit of radical resection and circumferential reconstruction in a single-stage procedure.
The authors report 3 cases in which a similar posterior transpedicular technique, adapted for the cervical spine, was used for intralesional resection of metastatic tumors of the axis.
Shoulder balance after surgery in patients with Lenke Type 2 scoliosis corrected with the segmental pedicle screw technique
Authors: Li Ming , Gu Suxi , Ni Jianqiang , Fang Xiutong , Zhu Xiaodong , Zhang Zhiyu 
Published: February 2011

Object
The authors evaluated the effectiveness of Lenke Type 2 criteria in scoliosis correction with the segmental pedicle screw (PS) technique, with emphasis on shoulder balance.

Methods
Twenty-five consecutive patients with Lenke Type 2 scoliosis (structural double thoracic curves, sidebending Cobb angle > 25°, or T2–5 kyphosis > 20°) who underwent segmental PS instrumentation were included in this study. At surgery, the patients were an average of 14.1 years of age, and the average duration of follow-up was 2.9 years. For radiological evaluation of the patients, preoperative, postoperative, and the latest available follow-up radiographs were used. The difference between right and left shoulder heights was determined to assess shoulder balance. All patients were treated with fusion of both the proximal and distal curves.

Results
The mean preoperative proximal thoracic curve of 43° was corrected to 21° postoperatively, a 51.2% correction. The preoperative lower thoracic curve of 61° was corrected to 23°, for a 62.3% correction. The preoperative shoulder height difference of −5.92 ± 12.52 mm (range: −31 to +14 mm, negative designating a lower left shoulder) was improved to 1.52 ± 8.12 mm. Postoperatively, no patient had significant or moderate shoulder imbalance, 4 patients had minimal shoulder imbalance, and 21 patients had balanced shoulders.

Conclusions
Although Lenke Type 2 criteria were developed wth Cotrel-Dubousset instrumentation, they are successfully applied to determining thoracic fusion when segmental PS instrumentation is used.
Spontaneous occlusion of a spinal arteriovenous malformation: is treatment always necessary?
Authors: Panciani Pier Paolo , Fontanella Marco , Crobeddu Emanuela , Schatlo Bawarjan , Bergui Mauro , Ducati Alessandro 
Published: February 2011

Knowledge of spinal cord arteriovenous malformations (AVMs) has recently been improved by studies on pathophysiology, neuroimaging, and genetic data. Nevertheless, the natural history of these lesions remains poorly understood.
The authors present the case of an angiographic regression of a nidal-type spinal AVM at T-12 to L-1 in a 46-year-old woman with no risk factors. The natural course of untreated lesions is reviewed and discussed. To the best of the authors' knowledge, this is the first study that reports an angiographically proven complete spontaneous occlusion of a spinal AVM.
Application of a new hydrogel dural sealant that reduces epidural adhesion formation: evaluation in a large animal laminectomy model
Authors: Preul Mark C. , Campbell Patrick K. , Garlick David S. , Spetzler Robert F. 
Published: February 2011

Object
The aim of this study was to evaluate the application and effects of a novel, nonswelling, polyethylene glycol-based hydrogel adhesion barrier and sealant in a canine laminectomy model of CSF leakage and adhesion formation.

Methods
After full-width L-2 and L-5 laminectomies, 1-cm midline durotomies were created and sutured closed, except for the last 1–2 mm on the cranial end to create spontaneous CSF leakage. All 5 control animals received no further treatment. Experimental animals received hydrogel at both durotomy sites via either the Dual Liquid applicator (5 animals) or MicroMyst gas-assisted sprayer (5 animals). Sealing of the CSF leak was confirmed by Valsalva maneuver. At 2 months, 2 animals from each group were killed to evaluate dural healing and epidural adhesion formation. The remaining animals were similarly evaluated 4 months after surgery. One animal died at 66 days due to a cause unrelated to hydrogel treatment.

Results
In hydrogel-treated animals, all leaking durotomies were sealed intraoperatively. All animals recovered uneventfully. There were no treatment-related health effects. MicroMyst hydrogel application was more controlled, slower, and significantly less thick (p = 0.0094) than Dual Liquid application. All 5 control animals developed subcutaneous CSF accumulations under the incision within days of surgery, compared with only 1 of 10 hydrogel-treated animals (p = 0.002). At 2 and 4 months, control laminectomy sites showed extensive, dense epidural adhesions blending with neodura, compared with hydrogel-treated sites (p < 0.0001 and p = 0.0234, respectively). At 2 months in hydrogel-treated animals, gel filled the epidural space and no epidural adhesions were noted (p < 0.0001 relative to controls). At 4 months, the hydrogel was absorbed. The hydrogel space was filled with scant, loosely organized connective tissue.

Conclusions
Hydrogel prevented CSF leakage and mitigated epidural scarring without affecting healing of the dura or laminectomy site. The safety profile of the hydrogel appears favorable due to its synthetic composition, polyethylene glycol chemistry, minimal local tissue response, and lack of neurological deficits. Controlled application of such hydrogel materials may reduce the incidence of postoperative leaks, prevent adhesion formation and thus improve recovery from spinal surgery, and improve identification of tissue planes for reoperations.
Comparison of thoracolumbosacral orthosis and no orthosis for the treatment of thoracolumbar burst fractures: interim analysis of a multicenter randomized clinical equivalence trial
Authors: Bailey Christopher S. , Dvorak Marcel F. , Thomas Kenneth C. , Boyd Michael C. , Paquett Scott , Kwon Brian K. , France John , Gurr Kevin R. , Bailey Stewart I. , Fisher Charles G. 
Published: February 2011

Object
The authors compared the outcome of patients with thoracolumbar burst fractures treated with and without a thoracolumbosacral orthosis (TLSO).

Methods
As of June 2002, all consecutive patients satisfying the following inclusion criteria were considered eligible for this study: 1) the presence of an AO Classification Type A3 burst fractures between T-11 and L-3, 2) skeletal maturity and age < 60 years, 3) admission within 72 hours of injury, 4) initial kyphotic deformity < 35°, and 5) no neurological deficit. The study was designed as a multicenter prospective randomized clinical equivalence trial. The primary outcome measure was the score based on the Roland-Morris Disability Questionnaire assessed at 3 months postinjury. Secondary outcomes are assessed until 2 years of follow-up have been reached, and these domains included pain, functional outcome and generic health-related quality of life, sagittal alignment, length of hospital stay, and complications. Patients in whom no orthotic was used were encouraged to ambulate immediately following randomization, maintaining “neutral spinal alignment” for 8 weeks. The patients in the TLSO group began being weaned from the brace at 8 weeks over a 2-week period.

Results
Sixty-nine patients were followed to the primary outcome time point, and 47 were followed for up to 1 year. No significant difference was found between treatment groups for any outcome measure at any stage in the follow-up period. There were 4 failures requiring surgical intervention, 3 in the TLSO group and 1 in the non-TLSO group.

Conclusions
This interim analysis found equivalence between treatment with a TLSO and no orthosis for thoracolumbar AO Type A3 burst fractures. The influence of a brace on early pain control and function and on long-term 1- and 2-year outcomes remains to be determined. However, the authors contend that a thoracolumbar burst fracture, in exclusion of an associated posterior ligamentous complex injury, is inherently a very stable injury and may not require a brace.
Functional and clinical evaluation for the surgical treatment of degenerative stenosis of the lumbar spinal canal
Authors: Yaşar Bariş , Şimşek Serkan , Er Uygur , Yiğitkanli Kazim , Ekşioğlu Emel , Altuğ Tibet , Belen Deniz , Kars Zafer H. , Bavbek Murad 
Published: February 2011

Object
This study was designed to evaluate the efficacy of decompressive surgery for degenerative lumbar spinal stenosis (LSS) on a functional and clinical basis.

Methods
A prospective analysis and follow-up of 125 consecutive patients with degenerative LSS between 2000 and 2006 were performed. All patients underwent surgery for lumbar stenosis. Functional evaluations of the patients were performed using a treadmill, the visual analog scale, and the Oswestry Disability Questionnaire (ODQ). These parameters were recorded before surgery and the 3rd month and 1st and 2nd years after treatment. The first symptom time (FST), maximal walking duration (MWD), and thecal sac cross-sectional area (CSA) before and after surgery were also recorded. Statistical relations between variables were calculated.

Results
As patient ages increased, the CSA of the thecal sac decreased. Decompressive surgery reached the target according to the difference between the preoperative and postoperative thecal sac CSA. A correlation between the CSA of the thecal sac and FST, and between the CSA of the thecal sac and MWD could not be established. There was a significant correlation between the FST and MWD, and a negative correlation could be established between the MWD and the ODQ score. Surgery led to significant decreases in the ODQ score. Maximal improvement was observed in the 3rd month after decompressive surgery.

Conclusions
The treatment for LSS should be decided using functional criteria; radiological criteria may not correlate with the severity of the disease. Improvements following lumbar decompression surgery continued within 1 year of treatment according to the ODQ and did not change significantly thereafter.
Electromyography in the detection of mechanically induced spinal motor tract injury: observations in diverse porcine models
Authors: Skinner Stanley A. , Transfeldt Ensor E. 
Published: February 2011

Object
Porcine spinal cords were mechanically injured at the thoracic level while recording muscle-derived electrically stimulated transcranial motor evoked potentials (TcMEPs) and electromyography (EMG) readings from the same electrode derivations. The authors postulated that midthoracic spinal cord injury caused by diverse methods can trigger hindlimb EMG activity. Early detection of hindlimb EMG activity may permit avoidance of motor conduction block (TcMEP loss).

Methods
Twelve pigs underwent midthoracic spinal cord exposure. Spinal cord sectioning was performed to define dorsal column versus lateral spinal cord contribution to muscle-derived electrically stimulated spinal cord motor evoked potentials (SC MEPs) and TcMEPs (in 2 pigs). A bipolar needle stimulator was placed within intramedullary sites to 1) acquire electrically stimulated motor evoked potentials in the hindlimbs, and 2) induce mechanically stimulated hindlimb EMG activity at sites responsive to electrical stimulation (in 2 pigs). Transcranial MEPs and EMG recordings were observed during spinal cord distraction (in 3 pigs), slow and rapid extradural spinal cord compression with a metal caliper (in 3 pigs), and rapid extradural spinal cord compression with a spring-loaded clip (in 2 pigs).

Results
Lateral cord (but not dorsal column) sectioning abolished both SC MEPs and TcMEPs. Intramedullary electrical and mechanical stimulation within the lateral (but not dorsal) cord elicited ipsilateral hindlimb MEPs and EMG activity (“EMG injury discharge”), respectively. Distraction inconsistently produced EMG injury discharges concomitant with TcMEP loss. Rapid extradural spinal cord compression with a metal caliper or spring-loaded clip consistently induced EMG injury discharges (in 4 of 4 pigs); slow compression did not elicit EMG activity. Brief extradural spring-loaded clip compressions (1–2 seconds) elicited EMG injury discharges without TcMEP loss; 14-second clip compression effected EMG injury discharges and TcMEP loss, which recovered after clip removal.

Conclusions
Electromyographic activity (referred to as “EMG injury discharges” in the present study) can be elicited both by intramedullary manipulation and rapidly applied transaxial spinal cord compression. Preliminary observations suggest that these EMG injury discharges precede and may anticipate TcMEP loss. Presumably, rapid deformation of spinal motor tracts (which appear to lie within the lateral porcine spinal cord) generates descending volleys which can bring to firing threshold lumbar motor neurons (and recording of EMG injury discharges). Intraoperative neuromonitoring of high-risk spinal surgeries at the spinal cord level may benefit from the addition of EMG recording to tests of spinal cord motor conduction such as TcMEP. Further clinical trials are required to examine EMG efficacy in this context.
A remotely controlled model of spinal cord compression injury in mice: toward real-time analysis
Authors: Kouyoumdjian Pascal , Lonjon Nicolas , Prieto Monica , Haton Henri , Privat Alain , Asencio Gérard , Perrin Florence E. , Gaviria Manuel 
Published: February 2011

Object
To date, there has been no efficient therapeutic approach to spinal cord injuries (SCIs). This may be attributable, at least in part, to difficulties in forming predictive and accurate experimental animal models. The authors' previous studies have identified 2 relevant conditions of such a model. The first condition is the ability to compare data derived from rat models of SCI by developing mouse models of SCI that permit access to a large range of transgenic models. The second condition is that the exploration of the consequences of each mechanism of spinal trauma requires modeling the different etiologic aspects of the injury.

Methods
To fulfill these 2 conditions a new model of mouse spinal cord compression injury was devised using a thread-driven olive-shaped compressive device. The authors characterized early motor, sensory, and histological outcomes using 3 olive diameters and different compression durations.

Results
A gradual and reproducible functional severity that correlated with lesion extension was demonstrated in 76 mice. To further substantiate the characterization of this model, a noncompetitive N-methyl-d-aspartate antagonist was administered in 30 mice, which demonstrated the involvement of excitotoxicity in this model.

Conclusions
The study demonstrated that spinal olive-compression injury in the mouse is a reproducible, well-characterized, and predictable model for analyzing early events after SCI. The nonmagnetic and remotely controlled design of this model will allow completion of the lesion while the animal is in the MR imaging apparatus, thus permitting further real-time MR imaging studies that will provide insights into the characterization of early events in the spatial and temporal evolution of SCI. Moreover, this model lays the foundation for future in vivo studies of functional and histological outcomes following SCI in genetically engineered animals.
Osteoinductive bone graft substitutes for lumbar fusion: a systematic review
Authors: Agarwal Rajender , Williams Kendal , Umscheid Craig A. , Welch William C. 
Published: February 2011

Object
Autograft and allograft, the standard approaches for lumbar fusion procedures, have important disadvantages. Bone graft substitutes such as recombinant human bone morphogenetic proteins (rhBMP-2 and rhBMP-7) have emerged as viable alternatives. The authors conducted a systematic review to compare the efficacy and safety of osteoinductive bone graft substitutes using autografts and allografts in lumbar fusion.

Methods
A search for prospective controlled trials was conducted on MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases. Data were extracted for key outcomes including radiographically demonstrated nonunion, Oswestry Disability Index, operating time, blood loss, and length of hospital stay. The quality of randomized controlled trials was assessed using the Jadad scale. Meta-analyses were performed when feasible, and heterogeneity was assessed using the Q statistic and the I2 statistic.

Results
Seventeen of 732 potential studies met the inclusion criteria, with 9 examining rhBMP-2, 3 examining rhBMP-7, 3 examining demineralized bone matrix, and 2 examining autologous growth factor. Recombinant human BMP-2 significantly decreased radiographic nonunion when compared with autologous iliac crest bone graft (AIBG) in a meta-analysis (relative risk 0.27, 95% CI 0.16–0.46). Stratification of meta-analyses by the type of surgical procedure performed yielded similar results. Funnel plots suggested publication bias. Trials of rhBMP-2 suggested reductions in the operating time and surgical blood loss, with less effect on the length of hospital stay. There was no difference in radiographic nonunion with the use of rhBMP-7 when compared with AIBG (relative risk 1.02, 95% CI 0.52–1.98). Neither rhBMP-2 nor rhBMP-7 demonstrated a significant improvement on the Oswestry Disability Index when compared with AIBG. The limited data on demineralized bone matrix and autologous growth factor showed no significant improvement in radiographic outcomes.

Conclusions
Recombinant human BMP-2 may be an effective alternative to AIBG in lumbar fusion. Data are limited for other bone graft substitutes.
In vitro evaluation of a ball-and-socket cervical disc prosthesis with cranial geometric center
Authors: Barrey Cédric , Mosnier Thomas , Jund Jérôme , Perrin Gilles , Skalli Wafa 
Published: February 2011

Object
Few biomechanical in vitro studies have reported the effects of disc replacement on motion and kinematics of the cervical spine. The purpose of this study was to analyze motion through 3D load-displacement curves before and after implantation of a ball-and-socket cervical disc prosthesis with cranial geometric center; special focus was placed on coupled motion, which is a well-known aspect of normal cervical spine kinematics.

Methods
Six human cervical spines were studied. There were 3 male and 3 female cadaveric specimens (mean age at death 68.5 ± 5 years [range 54–74 years]). The specimens were evaluated sequentially in 2 different conditions: first they were tested intact; then the spinal specimens were tested after implantation of a ball-and-socket cervical disc prosthesis, the Discocerv, at the C5–6 level. Pure moment loading was applied in flexion/extension, left and right axial rotation, and left and right lateral bending. All tests were performed under load control with a 3D measurement system.

Results
No differences were found to be statistically significant after comparison of range of motion between intact and instrumented spines for all loading conditions. The mean range of motion for intact spines was 10.3° in flexion/extension, 5.6° in lateral bending, and 5.4° in axial rotation; that for instrumented spines was 10.4, 5.2, and 4.8°, respectively. No statistical difference was observed for the neutral zone nor stiffness between intact and instrumented spines. Finally, the coupled motions were also preserved during axial rotation and lateral bending, with no significant difference before and after implantation.

Conclusions
This study demonstrated that, under specific testing conditions, a ball-and-socket joint with cranial geometrical center can restore motion in the 3 planes after discectomy in the cervical spine while maintaining physiological coupled motions during axial rotation and lateral bending.