bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of thoracic nerve root preservation in posterior transpedicular vertebrectomy with anterior column cage insertion: a cadaveric study
Authors: Nourbakhsh Ali , Chittiboina Prashant , Vannemreddy Prasad , Nanda Anil , Guthikonda Bharat 
Published: November 2010

Object
Transpedicular thoracic vertebrectomy (TTV) is a safe alternative to the more standard transthoracic approach. A TTV is most commonly used to address vertebral body fractures due to tumor or trauma.
Transpedicular reconstruction of the anterior column with cage/bone traditionally requires unilateral thoracic nerve root sacrifice. In a cadaveric model, the authors evaluated the feasibility of transpedicular anterior column reconstruction without nerve root sacrifice. If feasible, this may be a reasonable approach that could be extended to the lumbar spine where nerve root sacrifice is not an option.

Methods
A TTV was performed in 8 fixed cadaveric specimens. In each specimen, an alternate vertebra (either odd or even) was removed so that single-level reconstruction could be evaluated. The vertebrectomy included facetectomy, adjacent discectomies, and laminectomy; however, the nerve roots were preserved. The authors then evaluated the feasibility of inserting a titanium mesh cage (Medtronic Sofamor Danek) without neural sacrifice.

Results
Transpedicular anterior cage reconstruction could be safely performed at all levels of the thoracic spine without nerve root sacrifice. The internerve root space varied from 18 mm at T2–3 to 27 mm at T11–12; thus, the size of the cage that was used also varied with level.

Conclusions
Cage reconstruction of the anterior column could be safely performed via the transpedicular approach without nerve root sacrifice in this cadaveric study. Removal of the proximal part of the rib in addition to a standard laminectomy with transpedicular vertebrectomy provided an excellent corridor for anterior cage reconstruction at all levels of the thoracic spine without nerve root sacrifice.
Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery
Authors: Uchida Kenzo , Nakajima Hideaki , Yayama Takafumi , Miyazaki Tsuyoshi , Hirai Takayuki , Kobayashi Shigeru , Chen Kebing , Guerrero Alexander Rodriguez , Baba Hisatoshi 
Published: November 2010

ObjectThe surgical approach and treatment of thoracolumbar osteoporotic vertebral collapse with neurological deficit have not been documented in detail. Anterior surgery provides good decompression and solid fusion, but the surgery-related risk is relatively higher than that associated with the posterior approach. In posterior surgery, the major problem after posterior correction and instrumentation is failure to support the anterior spinal column, leading to loss of correction of kyphosis. The aim of this study was to evaluate the efficacy of reinforcing short-segment posterior fixation with vertebroplasty and to compare the outcome with those of posterior surgery without vertebroplasty and anterior surgery, retrospectively.MethodsThe authors studied 83 patients who underwent surgical treatment for a single thoracolumbar osteoporotic vertebral collapse with neurological deficit. Twenty-eight patients treated by posterior surgery combined with vertebroplasty (Group A), 25 patients treated by posterior surgery without vertebroplasty (Group B), and 30 patients treated by anterior surgery (Group C) were followed up for a mean postoperative period of 4.4 years. Neurological outcome, visual analog scale pain score, and radiographic results were compared in the 3 groups.ResultsPostoperative (4–6 weeks) and follow-up neurological outcome and visual analog scale scores were not significantly different among the 3 groups. Postoperative kyphotic angle was significantly reduced in Group B compared with Group C (p = 0.007), whereas the kyphotic angle was not significantly different among the 3 groups at follow-up. The mean ± SD loss of correction at follow-up was 4.6° ± 4.5°, 8.6° ± 6.2°, and 4.5° ± 5.9° in Groups A, B, and C, respectively. The correction loss at follow-up in Group B was significantly higher compared with Groups A and C (p = 0.0171 and p = 0.0180, respectively).ConclusionsThe results suggest that additional reinforcement with vertebroplasty reduces the kyphotic loss and instrumentation failure, compared with patients without the reinforcement of vertebroplasty. Vertebroplasty-augmented short-segment fixation seems to offer immediate spinal stability in patients with thoracolumbar osteoporotic vertebral collapse; the effect seems equivalent to that of anterior reconstruction.
What happens to Modic changes following lumbar discectomy? Analysis of a cohort of 41 patients with a 3- to 5-year follow-up period
Authors: Rahme Ralph , Moussa Ronald , Bou-Nassif Rabih , Maarrawi Joseph , Rizk Tony , Nohra Georges , Samaha Elie , Okais Nabil 
Published: November 2010

ObjectThe natural history of Modic changes (MCs) in the lumbar spine is often marked by conversion from one type to another, but their course following lumbar discectomy remains unknown. The authors sought to study the impact of surgery on the natural history of these lesions.MethodsForty-one patients treated with lumbar microdiscectomy between 2004 and 2005 were enrolled in this study and underwent clinical evaluation and repeat MR imaging after a median follow-up of 41 months (range 32–59 months). Preoperative and follow-up MR images were reviewed and the type, location, and extent of MCs at the operated level were recorded and compared.ResultsThe study population consisted of 27 men and 14 women with a mean age of 54 years (range 24–78 years). During the follow-up period, the prevalence of MCs increased from 46.3% to 78%, and 26 patients (63.4%) had Type 2 lesions at the operated level. Of the 22 patients without MCs, 4 (18.2%) converted to Type 1 and 9 (40.9%) to Type 2. Of the 5 Type 1 lesions, 3 (60%) converted to Type 2, and 2 (40%) remained Type 1 but increased in size. In contrast, none of the 14 Type 2 changes converted to another type, although 10 (71.4%) increased in extent. There were no reverse conversions to Type 0.ConclusionsFollowing lumbar discectomy, most patients develop Type 2 changes at the operated level, possibly as a result of accelerated degeneration in the operated disc. Neither the preoperative presence of MCs nor their postoperative course appears to affect the clinical outcome.
Biomechanical comparison of posterior cervicothoracic instrumentation techniques after one-level laminectomy and facetectomy
Authors: Eleraky Mohammed , Setzer Matthias , Baaj Ali A. , Papanastassiou Ioannis , Conrad Bryan P. , Vrionis Frank D. 
Published: November 2010

Object
Posterior instrumentation is the preferred method of fixation in the unstable cervicothoracic junction (CTJ). Several posterior rod constructs of different diameters and configurations are available for instrumentation across the CTJ. The objective of this study was to compare the biomechanical stability of various posterior instrumentation techniques that cross the CTJ after a 2-column injury through the complete removal of the posterior elements at C-7.

Methods
Eight fresh-frozen human cadaveric spines (C3–T4) were used. After the intact spine analysis, each specimen was destabilized (C-7 laminectomy and bilateral facetectomies) and reconstructed as follows: Group 1, C5–T2 posterior instrumentation with a 3.5-mm rod; Group 2, C5–T2 posterior instrumentation with a transitional rod (3.5–5.5 mm); and Group 3, C5–T2 posterior instrumentation with a side-to-side rod connector (3.5–5.5 mm). All reconstructed groups were tested with posterior instrumentation using the Cervifix system (Synthes, Inc.). The authors hypothesized that Group 2 would be the most stable.

Results
Following laminectomy, facetectomy, and the application of instrumentation, there was a decrease in the range of motion in all treatment groups compared with the intact spine. This trend was observed in all 3 planes of motion, but was only significant on right/left lateral bending and flexion (for the transitional rod only). Although the instrumented spines were stiffer than the intact spine in right/left axial rotation, flexion, and extension, these differences did not reach statistical significance. Based on observations during testing, it was evident that in the implanted spines, most of the motion that did occur was localized at the segments adjacent to the instrumented levels.

Conclusions
Based on the results of this investigation, the biomechanical stability of the transitional rod, side-to-side connector (“wedding band”), and 3.5-mm rods appears to be similar.
Venous thromboembolism after spine surgery: changes of the fibrin monomer complex and D-dimer level during the perioperative period
Authors: Yoshioka Katsuhito , Kitajima Isao , Kabata Tamon , Tani Mineko , Kawahara Norio , Murakami Hideki , Demura Satoru , Tsubokawa Tsunehisa , Tomita Katsuro 
Published: November 2010

ObjectThe goal of this study was to determine the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) after spine surgery. Another purpose was to clarify the rapid changes of the fibrin monomer complex (FMC) and D-dimer levels during the perioperative period of spine surgery for early diagnosis of venous thromboembolism (VTE).MethodsThe participants were 72 patients who underwent spine surgery between September 2007 and March 2008. The FMC and D-dimer levels were measured 6 times: 1) at induction of general anesthesia; 2) just after implantation or during surgery; 3) immediately following surgery; 4) 1 day after surgery; 5) 3 days postsurgery; and 6) 7 days after surgery. All patients received mechanical prophylaxis, including compression stockings and intermittent pneumatic compression devices, and all were examined with duplex ultrasonography assessments of both lower extremities and with lung perfusion scintigraphy 7–10 days after surgery. If DVT or PE was suspected, the patient underwent multidetector CT venography.ResultsThere were no patients with clinical signs of DVT and PE, but 6 (8.3%) showed VTE, among whom 5 had DVT and 3 had PE. Patients with VTE had significantly higher FMC levels 1 day after surgery, compared with those without VTE (55.9 ± 17.2 μg/ml vs 11.1 ± 2.89 μg/ml; p < 0.01). Patients with VTE had significantly higher D-dimer levels 7 days postsurgery, compared with those without VTE (12.5 ± 2.95 μg/ml vs 4.3 ± 0.39 μg/ml; p < 0.01). Receiver operating characteristic analysis showed that the FMC result was more useful than the D-dimer assay for diagnosis of VTE. When the cutoff value was set to 20.8 μg/ml for FMC, sensitivity was 100% and specificity was 86.3%.ConclusionsIn this study the prevalence of VTE after spine surgery was 8.3%. The FMC measured 1 day after spine surgery is considered to be useful as an indicator of VTE.
Assessment of sexual dysfunction before and after surgery for lumbar disc herniation
Authors: Akbaş Naz B. , Dalbayrak Sedat , Külcü Duygu G. , Yılmaz Mesut , Yılmaz Tevfik , Naderi Sait 
Published: November 2010

ObjectSexuality is an important aspect of human life. Sexual activity may be affected in lumbar disc herniation through different mechanisms. The aim of this study is to evaluate patients' sexual problems and sexual behavior patterns before and after surgical treatment of lumbar disc herniation.MethodsForty-three patients were included in the study (mean age 41.4 years). A visual analog scale, the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, and a sexuality assessment questionnaire developed for this study were administered to the patients to evaluate pain and sexual dysfunction.ResultsFifty-five percent of the men and 84% of the women reported experiencing sexual problems after the onset of low-back pain. The most common sexual problems were decreased sexual desire (18%) and premature ejaculation together with erectile dysfunction (18%) for the male patients, and decreased sexual desire (47%) for the female patients. The frequency of sexual intercourse before the operation was reduced in 78% of cases compared with the pain-free period. Postoperatively, the patients first attempted sexual intercourse a mean of 26.5 days after surgery. The frequency of intercourse was found to have increased (p = 0.01), while description of any type of sexual problem had decreased (p = 0.005) significantly.ConclusionsLumbar disc herniation has negative effects on sexual life, and not enough attention is given to the patients' sexual problems by the physicians. Decreased sexual desire and decreased sexual intercourse are the most commonly reported problems. Taking time during examination and giving simple recommendations may improve sexuality and life quality of the patients.
Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement
Authors: Ishikawa Yoshimoto , Kanemura Tokumi , Yoshida Go , Ito Zenya , Muramoto Akio , Ohno Shuichiro 
Published: November 2010

Object
The authors performed a retrospective clinical study to evaluate the feasibility and accuracy of cervical pedicle screw (CPS) placement using 3D fluoroscopy-based navigation (3D FN).

Methods
The study involved 62 consecutive patients undergoing posterior stabilization of the cervical spine between 2003 and 2008. Thirty patients (126 screws) were treated using conventional techniques (CVTs) with a lateral fluoroscopic view, whereas 32 patients (150 screws) were treated using 3D FN. Screw positions were classified into 4 grades based on the pedicle wall perforations observed on postoperative CT.

Results
The prevalence of perforations in the CVT group was 27% (34 screws): 92 (73.0%), 12 (9.5%), 6 (4.8%), and 16 (12.7%) for Grade 0 (no perforation), Grade 1 (perforation < 1 mm), Grade 2 (perforation ≥ 1 and < 2 mm), and Grade 3 (perforation ≥ 2 mm), respectively. In the 3D FN group, the prevalence of perforations was 18.7% (28 screws): 122 (81.3%), 17 (11.3%), 6 (4%), and 5 (3.3%) for Grades 0, 1, 2, and 3, respectively. Statistical analysis showed no significant difference in the prevalence of Grade 1 or higher perforations between the CVT and 3D FN groups. A higher prevalence of malpositioned CPSs was seen in Grade 2 or higher (17.5% vs 7.3%, p < 0.05) in the 3D FN group and Grade 3 (12.7% vs 7.3%, p < 0.05) perforations in the CVT group. The ORs for CPS malpositioning in the CVT group were 2.72 (95% CI 1.16–6.39) in Grade 2 or higher perforations and 3.89 (95% CI 1.26–12.02) in Grade 3 perforations.

Conclusions
Three-dimensional fluoroscopy-based navigation can improve the accuracy of CPS insertion; however, severe CPS malpositioning that causes injury to the vertebral artery or neurological complications can occur even with 3D FN. Advanced techniques for the insertion of CPSs and the use of modified insertion devices can reduce the risk of a malpositioned CPS and provide increased safety.
Spine stability after implantation of an interspinous device: an in vitro and finite element biomechanical study
Authors: Anasetti Federica , Galbusera Fabio , Aziz Hadi N. , Bellini Chiara M. , Addis Alessandro , Villa Tomaso , Teli Marco , Lovi Alessio , Brayda-Bruno Marco 
Published: November 2010

ObjectInterspinous devices are widely used for the treatment of lumbar stenosis. The DIAM spinal stabilization system (Medtronic, Ltd.) is an interspinous implant made of silicone and secured in place with 2 laces. The device can be implanted via posterior access with the sacrifice of the supraspinous ligament (SSL) or via lateral access with preservation of the ligament. The aim of the present work was to evaluate the role of the laces, the SSL, and the device size and positioning to determine the device's ability in reducing segmental lordosis and in stabilizing motion.MethodsBiomechanical tests were performed in flexion and extension on 8 porcine spines implanted with the DIAM either with or without the laces and the SSL. A finite element model of the human L4–5 spine segments was also created and used to test 2 sizes of the device implanted in 2 different positions in the anteroposterior direction.ResultsImplantation of the DIAM induced a shift toward kyphosis in the neutral position. Laces, the SSL, and device size and placement had a significant influence on the neutral position, the stiffness of the implanted spine, and the positions of the instantaneous centers of rotation.ConclusionsThe shift of the neutral position toward kyphosis may be beneficial in reducing symptoms of spinal stenosis such as radicular pain, sensation disturbance, and loss of strength in the legs. The authors recommend preservation of the SSL and the use of the fixation laces, given their relevant mechanical role. Choosing the proper device size and placement should be achieved by using a correct surgical technique.
Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury
Authors: Carlson Andrew P. , Ramirez Pedro , Kennedy George , McLean A. Robb , Murray-Krezan Cristina , Stippler Martina 
Published: November 2010

Object
Patients with mild traumatic brain injury (mTBI) only rarely need neurosurgical intervention; however, there is a subset of patients whose condition will deteriorate. Given the high resource utilization required for interhospital transfer and the relative infrequency of the need for intervention, this study was undertaken to determine how often patients who were transferred required intervention and if there were factors that could predict that need.

Methods
The authors performed a retrospective review of cases involving patients who were transferred to the University of New Mexico Level 1 trauma center for evaluation of mTBI between January 2005 and December 2009. Information including demographic data, lesion type, need for neurosurgical intervention, and short-term outcome was recorded.

Results
During the 4-year study period, 292 patients (age range newborn to 92 years) were transferred for evaluation of mTBI. Of these 292 patients, 182 (62.3%) had an acute traumatic finding of some kind; 110 (60.4%) of these had a follow-up CT to evaluate progression, whereas 60 (33.0%) did not require a follow-up CT. In 15 cases (5.1% overall), the patients were taken immediately to the operating room (either before or after the first CT). Only 4 patients (1.5% overall) had either clinical or radiographic deterioration requiring delayed surgical intervention after the second CT scan. Epidural hematoma (EDH) and subdural hematoma (SDH) were both found to be significantly associated with the need for surgery (OR 29.5 for EDH, 95% CI 6.6–131.8; OR 9.7 for SDH, 95% CI 2.4–39.1). There were no in-hospital deaths in the series, and 97% of patients were discharged with a Glasgow Coma Scale score of 15.

Conclusions
Most patients who are transferred with mTBI who need neurosurgical intervention have a surgical lesion initially. Only a very small percentage will have a delayed deterioration requiring surgery, with EDH and SDH being more concerning lesions. In most cases of mTBI, triage can be performed by a neurosurgeon and the patient can be observed without interhospital transfer.
Role of the S100B serum biomarker in the treatment of children suffering from mild traumatic brain injury
Authors: Filippidis Aristotelis S. , Papadopoulos Dimitrios C. , Kapsalaki Eftychia Z. , Fountas Kostas N. 
Published: November 2010

Object
The aim of this study was to provide a systematic update of the current literature regarding the clinical role of the S100B serum biomarker in the initial evaluation of children who have sustained a mild traumatic brain injury (TBI).

Methods
Searches in MEDLINE were defined with the keywords “mild TBI children S100,” “mild TBI pediatric S100,” and “children S100 brain injury.” From the pool of obtained studies, those that had the inclusion criteria of mild TBI only or mixed types of TBI but including detailed information about groups of children with mild TBI were used.

Results
Few studies were identified and fewer included more than 100 cases. The prospective studies showed that the S100B biomarker levels could be influenced by patient age and the time frame between head injury and blood sampling. Moreover, extracranial sources of S100B or additional injuries could influence the measured levels of this biomarker. A normal value of S100B in children with mild TBI could rule out injury-associated abnormalities on CT scans in the majority of reported cases.

Conclusions
The vulnerability of S100B serum levels to the influences of patient age, blood sampling time, and extracranial S100B release limits the biomarker's role in the initial evaluation of children with mild TBI. The application of S100B in pediatric mild TBI cases has an elusive role, although it could help in selected cases to avoid unnecessary head CT scans.
Treatment of anterior skull base defects by a transnasal endoscopic approach in children
Authors: Di Rocco Federico , Couloigner Vincent , Dastoli Patricia , Sainte-Rose Christian , Zerah Michel , Roger Gilles 
Published: November 2010

Object
The object of this study was to assess the efficacy and complications of endoscopic management of anterior skull base defects.

Method
The authors reviewed the medical records of 28 children (20 boys and 8 girls) undergoing endoscopic repair of anterior skull base defects in their tertiary referral center between 2001 and 2008; 18 cases were congenital and 10 cases posttraumatic. During the endoscopic procedure, rigid telescopes—2.7 or 4 mm in diameter, with 0° or 30° lenses—were used. In 23 patients the anterior skull base defect was sealed with fragments of middle turbinate (bone and mucosa). In the remaining 5 patients it was sealed with cartilage harvested from the nasal septum (3 cases) or from the auricle (2 cases), fibrin glue, and oxidized cellulose. A combined external and endoscopic approach was required in 3 cases because of the size and extensions of the encephalocele. Outcome was primarily assessed by means of clinical examination, nasal fibroscopy, and imaging.

Results
The mean duration of follow-up was 26.7 months (range 9–57 months). One patient treated by a combined approach died of meningitis 2 years after surgery. In the remaining 27 patients, there was no recurrence of CSF leak, meningitis, or encephalocele. An iatrogenic frontal or ethmoidal mucocele was observed in 4 cases.

Conclusions
The endoscopic approach is a minimally invasive, safe, and efficient technique for removing nasal encephaloceles in children.