bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are high-intensity zones and Modic changes mutually exclusive in symptomatic lumbar degenerative discs?
Authors: Marshman Laurence A. G. , Metcalfe Andrew V. , Krishna Manoj , Friesem Tai 
Published: February 2011

Object
Modic changes (MCs) and high-intensity zones (HIZs) potentially serve as variably sensitive markers for discogenic chronic low-back pain (CLBP). No study has hitherto assessed the phenomenon of MC-HIZ coexistence at a single level, and the goal in this study was to assess the nature and frequency of this phenomenon.

Methods
One hundred twenty consecutive patients with discogenic CLBP in whom lumbar MR imaging studies had demonstrated an HIZ, an MC, or both were included.

Results
This cohort (120 consecutive patients with 193 degenerative discs) had discogenic CLBP in at least 1 lumbar level associated with either an HIZ (77 discs), an MC (67 discs), or both (16 patients); there were 55 coexistent non-HIZ/non-MC degenerative discs. Painful MC-HIZ coexistence at 1 level occurred in 6 patients (5 of whom were female). If HIZs and MCs were random, independent entities, then MC-HIZ coexistence at 1 level would have been expected in 67 × 77/193 (that is, 27) discs. The observed frequency was therefore significantly lower (χ2 = 41, p < 0.001). There were no significant demographic differences between groups. The HIZ disc height (8 ± 0.2 mm) was significantly greater than the MC (6.6 ± 0.2 mm) or MC-HIZ (6.7 ± 0.2 mm) disc heights (p < 0.001).

Conclusions
In patients with discogenic CLBP associated with HIZ or MC lesions, MC-HIZ coexistence at 1 level was significantly rarer than expected even by chance; thus, despite both being manifestations of a seemingly common degenerative process, HIZ and MC more closely represent “either/or” phenomena. Because HIZ disc height was significantly greater, HIZs may develop earlier in the disc degenerative ontogeny. If any degenerative disc may only display an HIZ first, yet may ultimately display an MC instead, then HIZs must invariably regress as MCs supervene (or even vice versa). The MC-HIZ coexistence would therefore represent either a rare stable state (possibly more common in females) or a transitory state, as one lesion gradually replaces the other. Longitudinal studies would confirm or refute these hypotheses, although significantly larger sample sizes would be required.
Reliability and validity of the M. D. Anderson Symptom Inventory–Spine Tumor Module
Authors: Armstrong Terri S. , Gning Ibrahima , Mendoza Tito R. , Vera-Bolanos Elizabeth , Gilbert Mark R. , Rhines Laurence D. , Weinberg Jeffrey S. , Sanchez-Williams Gisela , Levin Victor , Burton Allen W. , Cleeland Charles 
Published: February 2011

Object
Tumors involving the spine have unique associated neurological symptoms. The occurrence of spine-related symptoms has been shown to predict treatment course and survival in several studies conducted in patients with solid tumors and consequent spinal cord dysfunction. Currently, no instrument that measures both neurological and cancer-related symptoms exists for patients with spine tumors. The objective of this study was to develop a reliable and valid self-reporting instrument for patients with spine tumors.

Methods
Patients with diagnosed tumors involving the spine (both primary and metastatic) participated in this study. Data collection tools included a patient-completed demographic data sheet, an investigator-completed clinician checklist, and the core M. D. Anderson Symptom Inventory to which were added 16 neurological symptoms (M. D. Anderson Symptom Inventory–Spine Tumor Module [MDASI-SP]). The authors evaluated the reliability and validity of the MDASI-SP in patients with spine tumors.

Results
One hundred twenty-six patients participated in the study. Participants were primarily white (73%) males (53%) with metastatic spine tumors (76%). They ranged in age from 18–81 years (median 56 years). Cognitive debriefing of the MDASI-SP was conducted showing the instrument was clear, concise, and easily understood by patients. The most severe core symptoms were pain, fatigue, numbness, disturbed sleep, and distress. The most severe spine module symptoms were spine pain, numbness, weakness in the legs, neck stiffness, and changes in bowel or sexual function. The mean symptom severity of items as well as a cluster analysis was used to reduce the number of total items to 18 (5 spine module items). Regression analysis showed that 57.4% of the variability in symptom interference with daily function was explained by the final instrument. Factor analysis was performed to determine the underlying constructs being evaluated by the symptom items. The 18-item MDASI-SP measures 4 underlying constructs including a disease, an autonomic, a constitutional/treatment, and an emotional factor. The internal consistency (reliability) of the MDASI-SP was 0.946, and the instrument was sensitive to disease severity based on the Karnofsky Performance Scale (KPS). The mean symptom severity was 1.52 for those with good KPS scores (80–100) versus 2.46 for those with poor scores (p < 0.01). The instrument was also sensitive to neurological status according to the Frankel grade (p < 0.001) and inpatient status (p < 0.01).

Conclusions
The 18-item MDASI-SP demonstrated validity and reliability in patients with spine tumors as a composite measure of disease-related symptoms. This instrument can be used to describe symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management.
Techniques for anterior cervical decompression for radiculopathy
Authors: Matz Paul G. , Ryken Timothy C. , Groff Michael W. , Vresilovic Edward J. , Anderson Paul A. , Heary Robert F. , Holly Langston T. , Kaiser Michael G. , Mummaneni Praveen V. , Choudhri Tanvir F. , Resnick Daniel K. 
Published: February 2011

Object
The objective of this systematic review was to use evidence-based medicine to identify the best techniques for anterior cervical nerve root decompression.

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to techniques for the surgical management of cervical radiculopathy. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer-review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results
Both anterior cervical discectomy (ACD) and anterior cervical discectomy with fusion (ACDF) are equivalent treatment strategies for 1-level disease with regard to functional outcome (Class II). Anterior cervical discectomy with fusion may achieve a more rapid reduction of neck and arm pain compared to ACD with a reduced risk of kyphosis, although functional outcomes may be similar. Anterior cervical discectomy with fusion is not a lasting means of increasing foraminal or disc height compared to ACD. Anterior cervical plating (ACDF with instrumentation) improves arm pain (but not other clinical parameters) better than ACDF in the treatment of 2-level disease (Class II). With respect to 1-level disease, plating may reduce the risk of pseudarthrosis and graft problems (Class III) but does not necessarily improve clinical outcome alone (Class II). Cervical arthroplasty is recommended as an alternative to ACDF in selected patients for control of neck and arm pain (Class II).

Conclusions
Anterior cervical discectomy, ACDF, and arthroplasty are effective techniques for addressing surgical cervical radiculopathy.
Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy
Authors: Heary Robert F. , Ryken Timothy C. , Matz Paul G. , Anderson Paul A. , Groff Michael W. , Holly Langston T. , Kaiser Michael G. , Mummaneni Praveen V. , Choudhri Tanvir F. , Vresilovic Edward J. , Resnick Daniel K. 
Published: February 2011

Object
The objective of this systematic review was to use evidence-based medicine to examine the efficacy of posterior laminoforaminotomy in the treatment of cervical radiculopathy.

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to posterior laminoforaminotomy and cervical radiculopathy. Abstracts were reviewed, and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations which contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results
Posterior laminoforaminotomy improves clinical outcome in the treatment of cervical radiculopathy resulting from soft lateral cervical disc displacement or cervical spondylosis with resulting narrowing of the lateral recess. All studies were Class III. The most frequent design flaw involved the lack of utilization of validated outcomes measures. In addition, few historical studies included a detailed preoperative analysis of the patients. As such, the vast majority of studies that included both pre- and postoperative assessments with legitimate outcomes measures have been performed since 1990.

Conclusions
Posterior laminoforaminotomy is an effective treatment for cervical radiculopathy.
Techniques for cervical interbody grafting
Authors: Ryken Timothy C. , Heary Robert F. , Matz Paul G. , Anderson Paul A. , Groff Michael W. , Holly Langston T. , Kaiser Michael G. , Mummaneni Praveen V. , Choudhri Tanvir F. , Vresilovic Edward J. , Resnick Daniel K. 
Published: February 2011

Object
The objective of this systematic review was to use evidence-based medicine to determine the efficacy of interbody graft techniques.

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical interbody grafting. Abstracts were reviewed and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgerons/Congress of Neurological Surgeons.

Results
Autograft bone harvested from the iliac crest, allograft bone from either cadaveric iliac crest or fibula, or titanium cages and rectangular fusion devices, with or without the use of autologous graft or substitute, have been successful in creating arthrodesis after 1- or 2-level anterior cervical discectomy with fusion (Class II). Alternatives to autograft, allograft, or titanium cages include polyetheretherketone cages and carbon fiber cages (Class III). Polyetheretherketone cages have been used successfully with or without hydroxyapatite for anterior cervical discectomy with fusion. Importantly, recombinant human bone morphogenic protein-2 carries a complication rate of up to 23–27% (especially local edema) compared with 3% for a standard approach.

Conclusions
Current evidence does not support the routine use of interbody grafting for cervical arthrodesis. Multiple strategies for interbody grafting have been successful with Class II evidence supporting the use of autograft, allograft, and titanium cages.
Management of delayed esophageal perforations after anterior cervical spinal surgery
Authors: Dakwar Elias , Uribe Juan S. , Padhya Tapan A. , Vale Fernando L. 
Published: February 2011

Object
Delayed esophageal perforation is an uncommon but well-known complication after anterior cervical spine surgery. To the authors' knowledge there is no consensus to the optimal management of these patients in the literature.

Methods
The authors performed a retrospective review of 5 cases involving patients who were referred to their institution for the management of delayed esophageal perforations after undergoing anterior cervical spine surgery for a variety of reasons.

Results
The primary presenting symptom in all 5 patients was dysphagia. All patients initially underwent primary closure of the perforation with a sternocleidomastoid muscle flap. One patient required multiple surgeries to correct the perforation and ultimately required a free flap.

Conclusions
The authors recommend a multidisciplinary approach that involves otolaryngological surgeons as well as spine surgeons. They recommend removal of all anterior hardware and believe that it is essential to the treatment of esophageal perforations. If the patient does not have evidence of fusion at the time of presentation, then posterior cervical instrumentation is a viable alternative.
Radiographic assessment of cervical subaxial fusion
Authors: Kaiser Michael G. , Mummaneni Praveen V. , Matz Paul G. , Anderson Paul A. , Groff Michael W. , Heary Robert F. , Holly Langston T. , Ryken Timothy C. , Choudhri Tanvir F. , Vresilovic Edward J. , Resnick Daniel K. 
Published: February 2011

Object
The objective of this systematic review was to use evidence-based medicine to identify the best methodology for radiographic assessment of cervical subaxial fusion.

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical fusion. Abstracts were reviewed and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results
Pseudarthrosis is best assessed through the absence of motion detected between the spinous processes on dynamic radiographs (Class II). The measurement of interspinous distance on dynamic radiographs of ≥ 2 mm is a more reliable indicator for pseudarthrosis than angular motion of 2° based on Cobb angle measurements (Class II). Similarly, it is also understood that the pseudarthrosis rate will increase as the threshold for allowable motion on dynamic radiographs decreases. The combination of interspinous distance measurements and identification of bone trabeculation is unreliable when performed by the treating surgeon (Class II). Identification of bone trabeculation on static radiographs should be considered a less reliable indicator of cervical arthrodesis than dynamic films (Class III).

Conclusions
Consideration should be given to dynamic radiographs and interspinous distance when assessing for pseudarthrosis.
Biomechanics of C-7 transfacet screw fixation
Authors: Horn Eric M. , Reyes Phillip M. , Baek Seungwon , Senoglu Mehmet , Theodore Nicholas , Sonntag Volker K. H. , Crawford Neil R. 
Published: February 2011

Object
The small diameter of the pedicle can make C-7 pedicle screw insertion dangerous. Although transfacet screws have been studied biomechanically when used in pinning joints, they have not been well studied when used as part of a C7–T1 screw/rod construct. The authors therefore compared C7–T1 fixation using a C-7 transfacet screw/T-1 pedicle screw construct with a construct composed of pedicle screws at both levels.

Methods
Each rigid posterior screw/rod construct was placed in 7 human cadaveric C6–T2 specimens (14 total). Specimens were tested in normal condition, after 2-column instability, and once fixated. Nondestructive, nonconstraining pure moments (maximum 1.5 Nm) were applied to induce flexion, extension, lateral bending, and axial rotation while recording 3D motion optoelectronically. The entire construct was then loaded to failure by dorsal linear force.

Results
There was no significant difference in angular range of motion between the 2 instrumented groups during any loading mode (p > 0.11, nonpaired t-tests). Both constructs reduced motion to < 2° in any direction and allowed significantly less motion than in the normal condition. The C-7 facet screw/T-1 pedicle screw construct allowed a small but significantly greater lax zone than the pedicle screw/rod construct during lateral bending, and it failed under significantly less load than the pedicle screw/rod construct (p < 0.001).

Conclusions
When C-7 transfacet screws are connected to T-1 pedicle screws, they provide equivalent stability of constructs formed by pedicle screws at both levels. Although less resistant to failure, the transfacet screw construct should be a viable alternative in patients with healthy bone.
Measurements and mapping of 282,420 nerve fibers in the S1–5 nerve roots
Authors: Hauck Erik F. , Schwefer Markus , Wittkowski Werner , Bothe Hans W. 
Published: February 2011

Object
The study aims to analyze nerve fiber types in the sacral nerve roots as a prerequisite for stimulation.

Methods
One-micrometer cross-sections of human ventral and dorsal S1–5 roots were stained with osmium and toluidine blue. The total fiber diameter and myelin sheath were measured in 282,420 nerve fibers.

Results
The analysis revealed the following 3 main nerve fiber types: Aα fibers (diameter 6–14 μm), Aγ fibers (diameter 2–4 μm), and B fibers (diameter < 2 μm). The B fibers were absent in S-1, present in some S-2 fascicles, and abundant from S-3 to S-5. The Aα fibers dominated the S-1 roots and most fascicles of S-2 roots. In the S3–5 roots, only a few Aα fibers were present. The relative occurrence of Aγ fibers increased from S-1 to S-5. In dorsal roots, Aγ fibers represented ~ 70% of all nerve fibers in every root and fascicle.

Conclusions
The B fibers represented efferent parasympathetic fibers. These fibers were concentrated in certain areas of the nerve roots, not randomly distributed. The Aα fibers innervate lower-extremity muscles and sphincters. The inverse correlation of Aα and Aγ fibers in the ventral roots from S-1 to S-5 is surprising. In dorsal roots, Aγ fibers may conduct pain, touch, and temperature signals. Highly selective fiber stimulation specific for type, location, and direction may improve sacral nerve stimulation for a spastic bladder in paraplegic individuals.
Traumatic spondylolisthesis of the axis: a biomechanical comparison of clinically relevant anterior and posterior fusion techniques
Authors: Chittiboina Prashant , Wylen Esther , Ogden Alan , Mukherjee Debi P. , Vannemreddy Prasad , Nanda Anil 
Published: February 2011

Object
Surgical management of unstable traumatic spondylolisthesis of the axis includes both posterior and anterior fusion methods. The authors performed a biomechanical study to evaluate the relative stability of anterior fixation at C2–3 and posterior fixation of C-1 through C-3 in hangman's fractures.

Methods
Fresh-frozen cadaveric spine specimens (occipital level to T-2) were subjected to stepwise destabilization of the C1–2 complex, replicating a Type II hangman's fracture. Intact specimens, fractured specimens, and fractured specimens with either anterior screw and plate or posterior screw and rod fixation were each tested for stability. Each spine was subjected to separate right and left rotation, bending, flexion, and extension testing.

Results
Anterior fixation restored stiffness in flexion and extension movements to values greater than those for intact specimens. For other movement parameters, the values approximated those for intact specimens. Posterior fixation increased the stiffness to above those values seen for anterior fixation specimens.

Conclusions
In cadaveric spine specimens subjected to a Type II hangman's fracture, both anterior fixation at C2–3 and posterior fixation with C-1 lateral mass screws and C-2 and C-3 pedicle screws resulted in a consistent increase in stiffness, and hence in stability, over intact specimens.
The effects of punctured nucleus pulposus on lumbar radicular pain in rats: a behavioral and immunohistochemical study
Authors: Zhang Kui-Bo , Zheng Zhao-Min , Liu Hui , Liu Xian-Guo 
Published: February 2011

Object
Application of the nucleus pulposus (NP) to the nerve root has been developed as a model of lumbar radicular pain. The relationship between disc degeneration and the induction of radicular pain, however, has not yet been fully explored. The authors of this study investigated pain-related behaviors and expression of tumor necrosis factor–α (TNF-α) in the dorsal root ganglion (DRG) to evaluate the effects of punctured NP on lumbar radiculopathy.

Methods
An anular needle puncture model of intervertebral disc degeneration in a rat tail was established. Normal and previously punctured NP tissues were obtained and placed on the L-5 nerve root following a hemilaminectomy. Behavioral tests including assessment of motor function, mechanical threshold, and thermal withdrawal latency were performed before and after surgery. The TNF-α immunoreactivity in L-5 DRG specimens was examined through immunohistochemical study.

Results
The punctured discs showed significant degeneration 2 weeks after intervention. Application of both normal and punctured NP induced mechanical hyperalgesia in the ipsilateral paw for 10 days after surgery, but hyperalgesia was more severe in the punctured NP group. No statistically significant within-group changes in thermal withdrawal latency over time were found. A significant increase in the expression of TNF-α–positive neurons in DRG specimens was observed in both NP graft groups.

Conclusions
Needle puncture led to degenerative changes in the rat tail disc, and the degenerated NP enhanced mechanical hyperalgesia induced by application of the NP to the lumbar nerve root. This model of disc degeneration and lumbar radicular pain is appropriate for evaluating the efficacy of biological treatments for degenerative disc diseases.