bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative patient selection with magnetic resonance imaging, computed tomography, and electroencephalography: does the test predict outcome after cervical surgery?
Authors: Mummaneni Praveen V. , Kaiser Michael G. , Matz Paul G. , Anderson Paul A. , Groff Michael , Heary Robert , Holly Langston , Ryken Timothy , Choudhri Tanvir , Vresilovic Edward , Resnick Daniel 
Published: February 2011

Object
The objective of this systematic review was to use evidence-based medicine to assess whether preoperative imaging or electromyography (EMG) predicts surgical outcomes in patients undergoing cervical surgery.

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the preoperative imaging and EMG. Abstracts were reviewed after which 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
Preoperative MR imaging and CT myelography are successful in confirming clinical radiculopathy (Class II). Multilevel T2 hyperintensity, T1 focal hypointensity combined with T2 focal hyperintensity, and spinal cord atrophy each convey a poor prognosis (Class III). There is conflicting data concerning whether focal T2 hyperintensity or cervical stenosis are associated with a worse outcome. Electromyography has mixed utility in predicting outcome (Class III).

Conclusions
Magnetic resonance imaging or CT myelography are important for preoperative assessment. Magnetic resonance imaging may be helpful in assessing prognosis, whereas EMG has mixed utility in assessing outcome.
Anterior cervical surgery for the treatment of cervical degenerative myelopathy
Authors: Matz Paul G. , Holly Langston T. , Mummaneni Praveen V. , Anderson Paul A. , Groff Michael W. , Heary Robert F. , Kaiser Michael G. , 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 examine the efficacy of anterior cervical surgery for the treatment of cervical spondylotic myelopathy (CSM).

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to anterior cervical surgery and CSM. 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
Mild CSM (modified Japanese Orthopaedic Association [mJOA] scale scores > 12) responds in the short term (3 years) to either surgical decompression or nonoperative therapy (prolonged immobilization in a stiff cervical collar, “low-risk” activity modification or bed rest, and antiinflammatory medications) (Class II). More severe CSM responds to surgical decompression with benefits being maintained a minimum of 5 years and as long as 15 years postoperatively (Class III).

Conclusions
Treatment of mild CSM may involve surgical decompression or nonoperative therapy for the first 3 years after diagnosis. More severe CSM (mJOA scale score ≤ 12) should be considered for surgery depending upon the individual case. The shortcomings of this systematic review are that the group was not able to determine whether an mJOA scale score of 12 was indicative of a more severe CSM disease course, and whether patients who received nonsurgical treatment for 3 years had a significant probability for clinical deterioration after that time point.
Cervical surgical techniques for the treatment of cervical spondylotic myelopathy
Authors: Mummaneni Praveen V. , Kaiser Michael G. , 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 compare the efficacy of different surgical techniques for the treatment of cervical spondylotic myelopathy (CSM).

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to anterior and posterior cervical spine surgery and CSM. 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
A variety of techniques have improved functional outcome after surgical treatment for CSM, including anterior cervical discectomy with fusion (ACDF), anterior cervical corpectomy with fusion (ACCF), laminoplasty, laminectomy, and laminectomy with fusion (Class III). Anterior cervical discectomy with fusion and ACCF appear to yield similar results in multilevel spine decompression for lesions at the disc level. The use of anterior plating allows for equivalent fusion rates between these techniques (Class III). If anterior fixation is not used, ACCF may provide a higher fusion rate than multilevel ACDF but also a higher graft failure rate than multilevel ACDF (Class III). Anterior cervical discectomy with fusion, ACCF, laminectomy, laminoplasty, and laminectomy with arthrodesis all provide near-term functional improvement for CSM. However, laminectomy is associated with late deterioration compared with the other types of anterior and posterior surgeries (Class III).

Conclusions
Multiple approaches exist with similar near-term improvements; however, laminectomy appears to have a late deterioration rate that may need to be considered when appropriate.
Clinical results of cervical myelopathy in patients older than 80 years of age: evaluation of spinal function with motor evoked potentials
Authors: Tanaka Nobuhiro , Nakanishi Kazuyoshi , Fujimoto Yoshinori , Sasaki Hirofumi , Kamei Naosuke , Hamasaki Takahiko , Yamada Kiyotaka , Yamamoto Risako , Nakamae Toshio , Ochi Mitsuo 
Published: February 2011

Object
In this prospective analysis the authors describe the clinical results of surgical treatment in patients > 80 years of age in whom spinal function was evaluated with motor evoked potential (MEPs) monitoring.

Methods
The authors included 57 patients > 80 years of age who were suspected of having cervical myelopathy. The mean age of the patients was 83.0 years (range 80–90 years). The central motor conduction time (CMCT) was calculated from the latencies of the MEPs following transcranial magnetic stimulation and from M and F waves following peripheral nerve stimulation.

Results
Preoperative electrophysiological evaluation demonstrated significant elongation of CMCT or abnormalities in MEP waveforms in 37 patients (65%), and 35 patients of these underwent laminoplasty. In 30 patients cervical spondylotic myelopathy was diagnosed and 5 patients ossification of the posterior longitudinal ligament was diagnosed. The preoperative mean Japanese Orthopaedic Association Scale score was 8.6 (range 3–12.5) and the mean postoperative score was 12.6 (range 6–14.5) with an average recovery rate of 45% (range −21 to 100%). There were no major complications in any of the patients during the operative period and there were no cases of death resulting from operative intervention.

Conclusions
Sufficient clinical results are expected even in patients with myelopathy who are older than 80 years of age, provided the patients are correctly selected by electrophysiological evaluation with MEPs and CMCT.
The quality of quality of life publications in the spinal literature: are we getting any better?
Authors: Street John , Lenehan Brian , Fisher Charles 
Published: February 2011

Object
Criteria for methodological quality have been widely accepted in many fields of surgical practice. These criteria include those of Velanovich and Gill and Feinstein. No such analysis of the spine surgery literature has ever been reported. This study is a systematic review of the quality of life (QOL) publications to determine if the recent interest in QOL measurements following spinal surgery has been accompanied by an improvement in the quality of the papers published.

Methods
The archives of the journals Journal of Neurosurgery: Spine, Spine, Journal of Spinal Disorders & Techniques, European Spine Journal, and The Spine Journal, for the years 2000–2004 inclusive, were examined, and all publications reporting QOL outcomes were analyzed. Each paper was scored according to the criteria of Velanovich and Gill and Feinstein, and the methodological quality of these manuscripts—and any time-dependent changes—were determined.

Results
During the study period, the total number of articles published increased by 36%, while the number of QOL articles increased by 102%. According to the criteria of Velanovich, there was a statistically significant improvement in the quality of the publications over the study period (p = 0.0394). In 2000, only 27% of outcome measures were disease specific, 77% were valid, and 77% were appropriate for the study design. In 2004, 43% were disease specific, 88% were valid, and 89% were appropriate. In 2000, 53% of studies used appropriate statistical analysis compared with 100 and 96% for 2003 and 2004, respectively. There was no demonstrable improvement in the fulfillment of the more rigorous Gill and Feinstein criteria for any of the 5 journals over the period of the study.

Conclusions
The authors' study illustrates a moderate improvement in the quality of these publications over the study period but much methodological improvement is required.
Image classification of idiopathic spinal cord herniation based on symptom severity and surgical outcome: a multicenter study
Authors: Imagama Shiro , Matsuyama Yukihiro , Sakai Yoshihito , Nakamura Hiroshi , Katayama Yoshito , Ito Zenya , Wakao Norimitsu , Sato Koji , Kamiya Mitsuhiro , Kato Fumihiko , Yukawa Yasutsugu , Miura Yasushi , Yoshihara Hisatake , Suzuki Kazuhiro , Ando Kei , Hirano Kenichi , Tauchi Ryoji , Muramoto Akio , Ishiguro Naoki 
Published: February 2011

Object
The purpose of this study was to provide the first evidence for image classification of idiopathic spinal cord herniation (ISCH) in a multicenter study.

Methods
Twelve patients who underwent surgery for ISCH were identified, and preoperative symptoms, severity of paralysis and myelopathy, disease duration, plain radiographs, MR imaging and CT myelography findings, surgical procedure, intraoperative findings, data from spinal cord monitoring, and postoperative recovery were investigated in these patients. Findings on sagittal MR imaging and CT myelography were classified into 3 types: a kink type (Type K), a discontinuous type (Type D), and a protrusion type (Type P). Using axial images, the location of the hiatus was classified as either central (Type C) or lateral (Type L), and the laterality of the herniated spinal cord was classified based on correspondence (same; Type S) or noncorrespondence (opposite; Type O) with the hiatus location. A bone defect at the ISCH site and the laterality of the defect were also noted.

Results
Patients with Type P herniation had a good postoperative recovery, and those with a Type C location had significant severe preoperative lower-extremity paralysis and a significantly poor postoperative recovery. Patients with a bone defect had a significantly severe preoperative myelopathy, but showed no difference in postoperative recovery.

Conclusions
The authors' results showed that a Type C classification and a bone defect have strong relationships with severity of symptoms and surgical outcome and are important imaging and clinical features for ISCH. These findings may allow surgeons to determine the severity of preoperative symptoms and the probable surgical outcome from imaging.
Quality of life assessment after central corpectomy for cervical spondylotic myelopathy: comparative evaluation of the 36-Item Short Form Health Survey and the World Health Organization Quality of Life–Bref
Authors: Thakar Sumit , Christopher Solomon , Rajshekhar Vedantam 
Published: February 2011

Object
In this study, the authors assessed the construct validity and the reliability of the World Health Organization Quality of Life–Bref (WHOQOL-Bref) questionnaire in patients with cervical spondylotic myelopathy (CSM) and compared the performance of the WHOQOL-Bref and the 36-Item Short Form Health Survey (SF-36) in assessing quality of life (QOL) in patients with CSM.

Methods
In this prospective study, 70 patients with CSM were assessed preoperatively and again 1 year after central corpectomy using the Nurick scale, the SF-36, and the WHOQOL-Bref. Construct validity and reliability of the WHOQOL-Bref, its responsiveness compared with that of the SF-36, and the correlations between the 2 scales were studied.

Results
The WHOQOL-Bref was found to be valid (p < 0.001, Cuzick test for trend between the physical domain of the WHOQOL-Bref and Nurick grade) and reliable (Cronbach α > 0.7). It had smaller floor and ceiling effects (ranges 1.4–7.1% and 0–7.1%, respectively) than the SF-36 (ranges 2.9–71.4% and 0–14.1%, respectively). There was significant postoperative improvement in patient scores on all the SF-36 scales (p < 0.001) and the physical, psychological, and environment domains of the WHOQOL-Bref (p < 0.001). The SF-36 scales were more responsive to change (relative efficiency range 0.24–1) than the WHOQOL-Bref domains (relative efficiency range 0.002–0.73). Among scales measuring similar concepts, only the physical functioning and bodily pain scales of the SF-36 had a moderate correlation (r = 0.57 and 0.53, respectively; p < 0.001) with the physical domain of WHOQOL-Bref. Many of the scales of these 2 QOL instruments unexpectedly had a fair correlation with one another (r range = 0.2–0.4).

Conclusions
The WHOQOL-Bref, like the SF-36, is valid and reliable in assessing outcome in patients with CSM. It measures impairment in CSM in a more uniform manner than the SF-36, but its domains are less responsive to postoperative changes. Because the WHOQOL-Bref measures different constructs and has additive value, it should be used along with the SF-36 for QOL assessment in patients with CSM.
Importance of the vasculature in cyst formation after spinal cord injury
Authors: Rooney Gemma E. , Endo Toshiki , Ameenuddin Syed , Chen Bingkun , Vaishya Sandeep , Gross LouAnn , Schiefer Terry K. , Currier Bradford L. , Spinner Robert J. , Yaszemski Michael J. , Windebank Anthony J. 
Published: February 2011

Object
Glial scar and cystic formation greatly contribute to the inhibition of axonal regeneration after spinal cord injury (SCI). Attempts to promote axonal regeneration are extremely challenging in this type of hostile environment. The objective of this study was to examine the surgical methods that may be used to assess the factors that influence the level of scar and cystic formation in SCI.

Methods
In the first part of this study, a complete transection was performed at vertebral level T9–10 in adult female Sprague-Dawley rats. The dura mater was either left open (control group) or was closed using sutures or hyaluronic acid. In the second part of the study, complete or subpial transection was performed, with the same dural closure technique applied to both groups. Histological analysis of longitudinal sections of the spinal cord was performed, and the percentage of scar and cyst formation was determined.

Results
Dural closure using sutures resulted in significantly less glial scar formation (p = 0.0248), while incorporation of the subpial transection surgical technique was then shown to significantly decrease cyst formation (p < 0.0001).

Conclusions
In this study, the authors demonstrated the importance of the vasculature in cyst formation after spinal cord trauma and confirmed the importance of dural closure in reducing glial scar formation.
Surgical treatment of spontaneous spinal epidural hematoma: a 5-year experience
Authors: Liao Cheng-Chih , Hsieh Po-Chuan , Lin Tzu-Kang , Lin Chih-Lung , Lo Yang-Lan , Lee Sai-Cheung 
Published: February 2011

Object
Spontaneous spinal epidural hematoma (SSEH) is a rare disease. The goal of this study was to clarify the treatment results and management options in SSEH.

Methods
Patients with SSEH who were surgically treated in the authors' center between June 2003 and June 2008 were included in this study. Patients were treated as early as possible if their neurological deficits were incomplete or had been complete for 12 hours or less. The patients were assigned to 1 of 2 groups based on completeness of preoperative cord dysfunction (complete vs incomplete deficit). Surgical outcomes of the 2 groups were compared by functional performance, coded as Nurick grades at 1, 3, and 6 months after the operation. Also compared were duration of hospital stay and the number of days needed to regain the ability to function independently (defined as Nurick Grades 1 and 2) after the operation.

Results
There were 17 patients (7 female and 10 male) with pathologically confirmed SSEH. Coagulopathy, greater size (length) of SSEH, and preoperative complete spinal dysfunction were found to contribute to poor postoperative functional recovery (p < 0.05). Patients with incomplete preoperative deficits (ASIA Impairment Scale Grades B, C, and D) were able to achieve functional independent recovery within a month after surgery and had significantly better outcomes (lower Nurick grades) at 1, 3, and 6 months postoperatively than those with complete deficits (p < 0.001, p = 0.027, and p = 0.027, respectively). Median time to independent functional recovery and median length of hospital stay were significantly shorter in patients with incomplete preoperative deficits than in those with complete deficits (6 vs 110 and 9 vs 58 days, respectively; both p < 0.001).

Conclusions
Impaired preoperative hemostasis contributes to larger size of SSEH, high probability of postoperative recurrence of spinal epidural hematoma, and poor functional recovery following surgical evacuation. Incomplete spinal cord dysfunction before surgery predicts good outcome and warrants emergent evacuation of SSEH especially in the cervical and thoracic regions, where the clots are located in proximity to the spinal cord.
Utility of modified transarticular screw in the middle and lower cervical spine as intermediate fixation in posterior long fusion surgery
Authors: Miyamoto Hiroshi , Sumi Masatoshi , Uno Koki 
Published: February 2011

Object
The use of a pedicle screw (PS) in the cervical spine ensures strong fixation. However, 6.7–29% of such screws appear to be malpositioned using manual insertion techniques, especially at C-3 to C-6 where the pedicle diameter is smaller, potentially causing catastrophic complications such as vertebral artery (VA) and spinal cord or nerve root injuries. To optimize safety, the authors use a new technique: cephalad and/or caudad ends at C-2 and C-7/T-1, respectively, are fixed with PSs, and intermediate points around C3–6 are fixed using a modified transarticular screw technique that captures 3 dorsal cortices and preserves the ventral cortex of the facet in posterior long fusion surgery involving occipitospinal fixation. The purpose of the present study was to demonstrate this technique and evaluate the clinical and radiological outcomes.

Methods
Thirty-nine patients, 8 men and 31 women, with a mean age of 61.7 ± 11.0 years at surgery, were included in the study. Twenty-eight occipitospinal fusions and 11 posterior long fusions were performed. Patients were divided into 2 groups: a rheumatoid arthritis (RA) group consisting of 26 patients and a non-RA group of 13 patients including 7 with athetoid cerebral palsy. Clinical outcomes were evaluated according to the Japanese Orthopaedic Association (JOA) score. For radiological evaluation, the Cobb angle on lateral radiographs was measured preoperatively, postoperatively, and at the final follow-up, and the degree of realignment from pre- to postoperation and the loss of correction from postoperation to the follow-up were compared between the 2 patient groups.

Results
The recovery rate of the JOA score was 50.6 ± 20.7% in the RA group and 37.3 ± 24.3% in the non-RA group. Neither VA injury nor spinal cord or nerve root injury occurred among this series. The degree of realignment was greater in the non-RA group (9.2 ± 13.9°) than the RA group (1.4 ± 12.7°) as the Cobb angle was more kyphotic preoperatively in the non-RA group (2.9 ± 18.6°) than in the RA group (17.4 ± 15.7°). However, 38.5% of patients in the non-RA group had a correction loss > 10% compared with 7.7% in the RA group; this difference was statistically significant.

Conclusions
The featured transarticular screw technique, which preserves the ventral cortex of the facet, as intermediate fixation in long fusion is a safe and easy procedure with few complications. It ensures acceptable clinical and radiological outcomes, especially in patients with RA.
Surgical site infection rates after minimally invasive spinal surgery
Authors: O'Toole John E. , Eichholz Kurt M. , Fessler Richard G. 
Published: February 2011

Object
Postoperative surgical site infections (SSIs) have been reported after 2–6% of spinal surgeries in most large series. The incidence of SSI can be < 1% after decompressive procedures and > 10% after instrumented fusions. Anecdotal evidence has suggested that there is a lower rate of SSI when minimally invasive techniques are used.

Methods
A retrospective review of prospectively collected databases of consecutive patients who underwent minimally invasive spinal surgery was performed. Minimally invasive spinal surgery was defined as any spinal procedure performed through a tubular retractor system. All surgeries were performed under standard sterile conditions with preoperative antibiotic prophylaxis. The databases were reviewed for any infectious complications. Cases of SSI were identified and reviewed for clinically relevant details. The incidence of postoperative SSIs was then calculated for the entire cohort as well as for subgroups based on the type of procedure performed, and then compared with an analogous series selected from an extensive literature review.

Results
The authors performed 1338 minimally invasive spinal surgeries in 1274 patients of average age 55.5 years. The primary diagnosis was degenerative in nature in 93% of cases. A single minimally invasive spinal surgery procedure was undertaken in 1213 patients, 2 procedures in 58, and 3 procedures in 3 patients. The region of surgery was lumbar in 85%, cervical in 12%, and thoracic in 3%. Simple decompressive procedures comprised 78%, instrumented arthrodeses 20%, and minimally invasive intradural procedures 2% of the collected cases. Three postoperative SSIs were detected, 2 were superficial and 1 deep. The procedural rate of SSI for simple decompression was 0.10%, and for minimally invasive fusion/fixation was 0.74%. The total SSI rate for the entire group was only 0.22%.

Conclusions
Minimally invasive spinal surgery techniques may reduce postoperative wound infections as much as 10-fold compared with other large, modern series of open spinal surgery published in the literature.