bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with pressure ulcers in patients with complete or sensory-only preserved spinal cord injury: is there any difference between traumatic and nontraumatic causes?
Authors: Taghipoor Keyvan Davatgaran , Arejan Roya Habibi , Rasouli Mohammad Reza , Saadat Soheil , Moghadam Mojgan , Vaccaro Alexander R. , Rahimi-Movaghar Vafa 
Published: February 2011

Object
Pressure ulcers (PUs) are common complications in patients with complete spinal cord injury (SCI) or incomplete SCI in which sensory function is spared. Most studies analyzing associated factors of PU and SCI have been performed in cases of traumatic SCI and in just a few cases of nontraumatic SCI. This study was designed to look specifically at the differences in causative factors of PU in cases of traumatic and nontraumatic SCIs.

Methods
The authors performed a retrospective, cross-sectional study evaluating patients with complete and incomplete SCIs (American Spinal Injury Association Grades A and B) under the coverage of the financial, medicosocial, and rehabilitative support provided by the State Welfare Organization of Iran (SWOI). There were 3791 cases of traumatic SCI (63.2%) and 2110 cases of nontraumatic SCI (35.2%). For 94 patients (1.6%), sufficient data were not available.

Results
A PU was detected in 39.2% of all patients with an SCI (71.8% of those with traumatic SCI vs 28.2% of those with nontraumatic SCI). A univariate analysis showed a significant association between occupation, education, and the presence of PU in patients with a traumatic SCI (p < 0.05). This contrasted with nontraumatic SCI in which an association between PU and age was noted (p < 0.05).
Using logistic regression, traumatic cause, older age, an interval less than 1 year since the onset of SCI, male sex, and single status were found to significantly increase the risk of PU in all patients with an SCI. However, a higher education level had a preventive effect on PU.

Conclusions
This study revealed some risk factors for PU in the authors' setting. The authors' findings suggest a possible difference between the risk factors for PU in patients with both types of SCI. Further study on the pathoetiology of these differences is paramount in the future.
Intraoperative indocyanine green angiography for obliteration of a spinal dural arteriovenous fistula
Authors: Colby Geoffrey P. , Coon Alexander L. , Sciubba Daniel M. , Bydon Ali , Gailloud Philippe , Tamargo Rafael J. 
Published: February 2011

Spinal dural arteriovenous fistulas (DAVFs) are the most common type of spinal arteriovenous malformation and are an important, underdiagnosed cause of progressive myelopathy and morbidity in patients with spine disorders. Successful microsurgical management of these lesions is dependent on the surgeon's ability to identify vessels of the fistula and to confirm its successful obliteration postintervention. Indocyanine green (ICG) fluorescent angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has significant potential utility in the treatment of vascular disease in the spine.
The authors present the case of a 76-year-old man with progressive and debilitating bilateral lower-extremity weakness and numbness on exertion, in whom a left T-8 spinal DAVF was diagnosed based on results of conventional spinal angiography. Unfavorable anatomy based on angiographic findings precluded endovascular embolization of the fistula, and the patient subsequently underwent T7–9 bilateral laminectomies for microsurgical clip occlusion. Intraoperative ICG fluorescent angiography was used before clip placement to identify the arterialized veins of the fistula, and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow.
Intraoperative ICG angiography serves an important role in the microsurgical treatment of DAVF. It can be used to map the anatomy of the fistula in real time during surgery and to verify fistula obliteration rapidly after clip placement. This report adds to the growing body of literature demonstrating the importance of ICG angiography in vascular neurosurgery of the spine.
The rationale of postoperative radiographs after cervical anterior discectomy with stand-alone cage for radicular pain
Authors: Bartels Ronald H. M. A. , Beems Tjemme , Schutte Pieter J. , Verbeek André L. M. 
Published: February 2011

Object
Cervical anterior discectomy with stand-alone cage (CADC) placement is a known treatment for cervical radiculopathy due to a herniated intervertebral disc or an osteophyte. Routine radiographs are obtained at regular postoperative intervals, but the consequences of routinely obtained radiographs are not known. In this study, the authors evaluated whether postoperative plain radiographs influenced the medical or surgical treatment of patients who underwent CADC placement.

Methods
The charts and radiographs of all patients who underwent CADC placement in 2007 were retrieved and reviewed retrospectively. In addition, the charts and radiographs of 50 consecutive patients who were seen after a CADC was placed during a period in 2008 were studied prospectively. Special emphasis was given to any abnormalities seen on the radiographs and especially their influence on further treatment.

Results
The charts and radiographs of 82 patients were retrospectively examined. A total of 138 levels were addressed, and in the prospective series 75 levels were surgically treated. The subsidence rate in the retrospective series was 14.5%. In 1 patient a slight anteroposition of the cage was seen. None of the radiographic abnormalities were related to the outcome of the patient or contributed to a change in the patient's treatment.

Conclusions
Routine radiographs after CADC placement are not warranted. Intraoperative verification of the position of the cage is recommended. Obtaining radiographs are only mandatory when signs or symptoms suggesting a postoperative complication are present. The authors propose a new algorithm for the follow-up of patients after CADC placement.
Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization
Authors: Bozkuş Hakan , Şenoğlu Mehmet , Baek Seungwon , Sawa Anna G. U. , Özer Ali Fahir , Sonntag Volker K. H. , Crawford Neil R. 
Published: February 2011

Object
It is unclear how the biomechanics of dynamic posterior lumbar stabilization systems and traditional rigid pedicle screw-rod systems differ. This study examined the biomechanical response of a hinged-dynamic pedicle screw compared with a standard rigid screw used in a 1-level pedicle screw-rod construct.

Methods
Unembalmed human cadaveric L3–S1 segments were tested intact, after L4–5 discectomy, after rigid pedicle screw-rod fixation, and after dynamic pedicle screw-rod fixation. Specimens were loaded using pure moments to induce flexion, extension, lateral bending, and axial rotation while recording motion optoelectronically. Specimens were then loaded in physiological flexion-extension while applying 400 N of compression. Moment and force across instrumentation were recorded from pairs of strain gauges mounted on the interconnecting rods.

Results
The hinged-dynamic screws allowed an average of 160% greater range of motion during flexion, extension, lateral bending, and axial rotation than standard rigid screws (p < 0.03) but 30% less motion than normal. When using standard screws, bending moments and axial loads on the rods were greater than the bending moments and axial loads on the rods when using dynamic screws during most loading modes (p < 0.05). The axis of rotation shifted significantly posteriorly more than 10 mm from its normal position with both devices.

Conclusions
In a 1-level pedicle screw-rod construct, hinged-dynamic screws allowed a quantity of motion that was substantially closer to normal motion than that allowed by rigid pedicle screws. Both systems altered kinematics similarly. Less load was borne by the hinged screw construct, indicating that the hinged-dynamic screws allow less stress shielding than standard rigid screws.
Lumbar microdiscectomy in pediatric patients: a large single-institution series
Authors: Cahill Kevin S. , Dunn Ian , Gunnarsson Thorsteinn , Proctor Mark R. 
Published: February 2011

Object
Lumbar disc herniation is a rare but significant cause of pain and disability in the pediatric population. Lumbar microdiscectomy, although routinely performed in adults, has not been described in the pediatric population. The objective of this study was to determine the surgical results of lumbar microdiscectomy in the pediatric population by analyzing the experiences at Children's Hospital Boston over the past decade.

Methods
A series of 87 consecutive cases of lumbar microdiscectomy performed by the senior author (M.R.P.) from 1999 to 2008 were reviewed. Presenting symptoms, physical examination findings, and preoperative MR imaging findings were obtained from medical records. Immediate operative results were assessed including operative duration, blood loss, length of stay, and complications, along with long-term outcome and need for repeat surgery.

Results
This series represents the first surgical series of pediatric microdiscectomies. The mean patient age was 16.6 years (range 12–18 years) and 60% were female. The preoperative physical examination results were notable for motor deficits in 26% of patients, sensory changes in 41%, loss of deep tendon reflex in 22%, and a positive straight leg raise in 95%. Conservative management was the first line of treatment in all patients and the mean duration of symptoms until surgical treatment was 12.2 months. The mean operative time was 110 minutes and the mean postoperative length of stay was 1.3 days. Complications were rare: postoperative infection occurred in 1%, postoperative CSF leak in 1%, and new postoperative neurological deficits in 1%. Only 6% of patients needed repeat lumbar surgery and 1 patient ultimately required lumbar fusion.

Conclusions
The treatment of pediatric lumbar disc herniation with microdiscectomy is a safe procedure with low operative complications. Nuances of the presentation, treatment options, and surgery in the pediatric population are discussed.
Efficacy and cost-effectiveness analysis of external beam and stereotactic body radiation therapy in the treatment of spine metastases: a matched-pair analysis
Authors: Haley Marsha L. , Gerszten Peter C. , Heron Dwight E. , Chang Yue-Fang , Atteberry Dave S. , Burton Steven A. 
Published: February 2011

Object
The objective of this study was to compare the palliative efficacy and cost effectiveness of external beam radiation therapy (EBRT) to stereotactic body radiation therapy (SBRT) as primary treatment for bone metastatic disease of the spinal column.

Methods
Forty-four patients were matched based on age, primary tumor site, year of treatment, and location of metastasis. Outcomes of interest were pain relief, cost-effectiveness, toxicities, and need for further intervention. Pain relief was rated as excellent, good, fair, or poor, using a radiosurgical pain scale to combine visual analog scale and verbal descriptor ordinal scale scores. Medicare fee schedules were used to compute the charges for both the technical and professional components of care. Patients in the EBRT group were treated using a linear accelerator while patients in the SBRT group were treated with the CyberKnife robotic radiosurgery system. Patients received regular follow-up evaluations by a radiation oncologist and neurosurgeon.

Results
Forty-four patients (22 pairs) were analyzed. At a follow-up of 1 month, there was no statistically significant difference in pain between the 2 groups (p = 0.11). Patients who underwent SBRT had the highest total gross charge; depending on technique, EBRT treatments ranged from 29% to 71% of the SBRT charge. Patients treated using EBRT had more acute toxicities, and more of these patients underwent further intervention at the treated spinal level. There were no late complications attributed to either treatment modality.

Conclusions
External beam radiation therapy remains an efficacious and cost-effective method of palliation of spine metastases. In this study, patients treated with EBRT had more acute toxicities and were more likely to require additional interventions at the treated sites. Stereotactic body radiation therapy, although more costly, resulted in comparable rates of pain relief and late treatment-related toxicity, and continues to show promise as an emerging modality for selected patients with spine metastases.
The biomechanical contribution of varying posterior constructs following anterior thoracolumbar corpectomy and reconstruction
Authors: Bishop Frank S. , Samuelson Mical M. , Finn Michael A. , Bachus Kent N. , Brodke Darrel S. , Schmidt Meic H. 
Published: February 2011

ObjectThoracolumbar corpectomy is a procedure commonly required for the treatment of various pathologies involving the vertebral body. Although the biomechanical stability of anterior reconstruction with plating has been studied, the biomechanical contribution of posterior instrumentation to anterior constructs remains unknown. The purpose of this study was to evaluate biomechanical stability after anterior thoracolumbar corpectomy and reconstruction with varying posterior constructs by measuring bending stiffness for the axes of flexion/extension, lateral bending, and axial rotation.MethodsSeven fresh human cadaveric thoracolumbar spine specimens were tested intact and after L-1 corpectomy and strut grafting with 4 different fixation techniques: anterior plating with bilateral, ipsilateral, contralateral, or no posterior pedicle screw fixation. Bending stiffness was measured under pure moments of ± 5 Nm in flexion/extension, lateral bending, and axial rotation, while maintaining an axial preload of 100 N with a follower load. Results for each configuration were normalized to the intact condition and were compared using ANOVA.ResultsSpinal constructs with anterior-posterior spinal reconstruction and bilateral posterior pedicle screws were significantly stiffer in flexion/extension than intact spines or spines with anterior plating alone. Anterior plating without pedicle screw fixation was no different from the intact spine in flexion/extension and lateral bending. All constructs had reduced stiffness in axial rotation compared with intact spines.ConclusionsThe addition of bilateral posterior instrumentation provided significantly greater stability at the thoracolumbar junction after total corpectomy than anterior plating and should be considered in cases in which anterior column reconstruction alone may be insufficient. In cases precluding bilateral posterior fixation, unilateral posterior instrumentation may provide some additional stability.
Lesion growth and degeneration patterns measured using diffusion tensor 9.4-T magnetic resonance imaging in rat spinal cord injury
Authors: Ellingson Benjamin M. , Schmit Brian D. , Kurpad Shekar N. 
Published: February 2011

Object
Using diffusion tensor MR imaging, the authors conducted a study to explore lesion growth and degeneration patterns, from the acute through chronic stages of spinal cord injury (SCI), in an experimental animal model.

Methods
In vivo and ex vivo diffusion tensor imaging was performed using a 9.4-T MR imaging system in rats allowed to recover from traumatic contusion SCI from 2 weeks through 25 weeks postinjury, mimicking progression of human SCI from the acute through chronic stages.

Results
Results showed significant growth of the traumatic lesion up to 15 weeks postinjury, where both the size and mean diffusivity (MD) reached a maximum that was maintained through the remainder of recovery. Mean diffusivity was sensitive to overall spinal cord integrity, whereas fractional anisotropy showed specificity to sites of cavity formation. The use of an MD contour map for in vivo data and a 3D surface map for ex vivo data, showing MD as a function of rostral-caudal distance and recovery time, allowed documentation of rostral and caudal spreading of the lesion.

Conclusions
Results from this study demonstrate changes in both lesion morphology and diffusivity beyond previously reported time points and provide a unique perspective on the process of cavity formation and degeneration following traumatic SCI. Additionally, results suggest that MD more accurately defines regions of histological damage than do regions of T2 signal hyperintensity. This could have significant clinical implications in the detection and potential treatment of posttraumatic syringes in SCI.
Clinical application of a novel assessment for lumbosacral stability
Authors: Ohmori Kazuo 
Published: February 2011

Object
To evaluate the grade of lumbosacral stability, shape analysis was conducted on plain radiographs of the lumbar spine.

Methods
One hundred twenty-six patients were classified into 2 groups: those with a single-segment disc space narrowing at L5–S1 or at L4–5. Stability was evaluated using the discriminant function (z score) derived from the analysis of radiographic parameters—that is, relative thickness of transverse process of L-5 and the sacral table angle.

Results
In patients with a space narrowing at L5–S1, the author observed a significantly slender L-5 transverse process and acute obliquity of the sacral endplate; accordingly, the z score was negative. In patients with a broad transverse process and a positive z score, the segment associated with disc height loss was L4–5. Thus, a close correlation was found between the site of the disc height loss and the bony characteristics of L-5 and S-1. Furthermore, it could be expected with a high degree reliability that when young adult patients had a z score less than −2 or −3, their L-5 vertebra would develop degenerative spondylolisthesis after middle age and the L5–S1 segment could be saved from age-related alterations as long as the z score was greater than 2.5.
The constitutional characteristics of the lumbosacral junction may exert a major influence on the site of disc degeneration.

Conclusions
Stability at the lumbosacral junction was thought to be quantitatively represented by the z score, with z being designated the lumbosacral stability score.
Gamma Knife surgery for parasellar meningiomas: long-term results including complications, predictive factors, and progression-free survival
Authors: Williams Brian J. , Yen Chun Po , Starke Robert M. , Basina Bhuvaneswara , Nguyen James , Rainey Jessica , Sherman Jonathan H. , Schlesinger David , Sheehan Jason P. 
Published: February 2011

Object
Stereotactic radiosurgery serves as an important primary and adjuvant treatment option for patients with many types of intracranial meningiomas. This is particularly true for patients with parasellar meningiomas. In this study, the authors evaluated the outcomes of Gamma Knife surgery (GKS) used to treat parasellar meningiomas.

Methods
The study is a retrospective review of the outcomes in 138 patients with meningiomas treated at the University of Virginia from 1989 to 2006; all patients had a minimum follow-up of 24 months. There were 31 men and 107 women whose mean age was 54 years (range 19–85 years). Eighty-four patients had previously undergone resection. The mean pre-GKS tumor volume was 7.5 ml (range 0.2–54.8 ml). Clinical and radiographic evaluations were performed, and factors related to favorable outcomes in each case were assessed.

Results
The mean follow-up duration was 84 months (median 75.5 months, range 24–216 months). In 118 patients (86%), the tumor volume was unchanged or had decreased at last follow-up. Kaplan-Meier analysis demonstrated radiographic progression-free survival at 5 and 10 years to be 95.4% and 69%, respectively. Fourteen patients (10%) developed new cranial nerve palsies following GKS. Factors associated with tumor control included younger age, a higher isodose, and smaller tumor volume. A longer follow-up duration was associated with either a decrease or increase in tumor volume. Fourteen patients (10%) experienced new or worsening cranial nerve deficits after treatment. Factors associated with this occurrence were larger pretreatment tumor volume, lower peripheral radiation dose, lower maximum dose, tumor progression, and longer follow-up.

Conclusions
Gamma Knife surgery offers an acceptable rate of tumor control for parasellar meningiomas and accomplishes this with a low incidence of neurological deficits. Radiological control after radiosurgery is more likely in those patients with a smaller tumor volume and a higher prescription dose.
Inhibition of proliferation of human cerebral meningioma cells by suramin: effects on cell growth, cell cycle phases, extracellular growth factors, and PDGF-BB autocrine growth loop
Authors: Schrell Uwe M. H. , Gauer Stefan , Kiesewetter Franklin , Bickel Andreas , Hren Jürgen , Adams Eric F. , Fahlbusch Rudolf 
Published: February 2011

✓ The growth of human cerebral meningiomas depends on various growth factors, including epidermal growth factor (EGF), transforming growth factor (TGF)-α and TGF-β, platelet-derived growth factor (PDGF)-BB, insulin-like growth factor (IGF)-I and IGF-II, and acidic and basic fibroblast growth factors. The latter three have been shown to form autocrine loops that are thought to be a major component of uncontrolled growth in meningioma tissue. Suramin is known to prevent binding of a variety of growth factors to their receptors in mammalian tissue, thus abolishing para- and/or autocrine-mediated cell growth. The authors therefore tested the effect of suramin on the proliferation of cultured human meningioma cells.
Suramin (10−5 to 10−4 M) significantly inhibited the growth of meningioma cells in culture. The maximum effect observed was with the higher dose (10−4 M), which resulted in a 40% to 70% reduction in cellular proliferation. This effect was observed in all 15 tumor samples studied and was confirmed by [3H]thymidine uptake. In studies using DNA flow cytometry, suramin inhibited meningioma cell proliferation in five tumor samples by arresting cells in the S and G2/M phases of the cell cycle. Growth factor (EGF, IGF-I, and PDGF-BB)—induced cell proliferation was completely abolished in five tumor samples when 10−4 M suramin was applied to meningioma cells. Western blot analysis of three tumor samples showed that the intracellular PDGF-BB content of meningioma cells was significantly reduced after treating the cells with 10−4 M suramin. Binding of iodinated growth factors (that is, [125I]EGF, [125I]IGF-I, and [125I]PDGF-BB) to their receptor sites was prevented by suramin in a dose-dependent manner in 10 meningioma membrane fractions. Lowering of the intracellular PDGF content and prevention of extracellular growth factor receptor binding demonstrates that suramin disrupts autocrine loops and paracrine growth stimulation in meningioma tissue.
These data provide evidence that growth of cerebral meningiomas in culture is strongly inhibited by suramin at a concentration of 10−4 M. Suramin acts as a scavenger neutralizing exogenous growth factors; thus it can interrupt autocrine loops and paracrine stimulation of human meningioma cell growth. The evidence favors suramin as a therapeutic option for controlling meningioma proliferation in patients with inoperable and recurrent high-grade meningiomas.