bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of cemented rescue screws for anterior cervical plate fixation
Authors: Pitzen Tobias Rainer , Drumm Jörg , Bruchmann Bernhard , Barbier Dragos Doru , Steudel Wolf-Ingo 
Published: January 2008

ObjectAmong the various ways to optimize the fixation of bone implants is to use bone cement, for example, in a total hip prosthesis. No data exist, however, concerning the effectiveness of cemented rescue screws for anterior cervical plate fixation. The aim of this study was to investigate whether cemented rescue screws increase fixation strength in comparison with uncemented standard screws.MethodsSix cervical spine segments (C4–7) were explanted during routine autopsy studies from fresh human cadavers. Bone mineral density (BMD) was measured for each vertebral body (VB) using quantitative computerized tomography scanning, and 24 VBs were dissected from the segments. Two initial pilot holes were drilled into each VB parallel to the sagittal plane. Based on their BMD, the specimens were assigned to one of two groups in which torque and pullout force were tested. The test was begun with standard screws and was repeated with cannulated slotted rescue screws into which bone cement was injected. The mean values of peak torque and pullout forces resulting from the left and right measurements were used for statistical analysis. A t-test was performed to determine the effect of screw type on peak torque and pullout force. Moment correlation coefficients were calculated to determine the effect of BMD on peak torque and pullout force for each type of screw.The mean insertional peak torque was 67.1 N/cm for the standard screw and 102.6 N/cm for the cemented screw (p < 0.05). The mean pullout force was 526.9 N for standard osteoporosis screws and 531.5 N for cemented screws (p > 0.05). The effect of increased holding strength as measured by peak torque and pullout force was more pronounced in the presence of low bone density.ConclusionsCemented rescue screws that have been inserted into a fatigued pilot hole in the cervical VB strengthen the screw–bone interface compared with the strength initially conferred by a standard screw.
Epidural meningioma of the sacral canal
Authors: Rutherford Scott A. , Linton Kim M. , Durnian Jonathan M. , Cowie Richard A. 
Published: January 2008

✓ Spinal meningiomas are reported infrequently as pure epidural tumors, and they are rarely located at the caudal end of the spine. The unique combination of a wholly epidural tumor confined entirely to the sacral canal has not been previously described.
The authors describe the case of a 29-year-old man who presented with coccygeal and left-sided S2–4 dermatomal pain. Examination confirmed sensory loss in the same distribution. A magnetic resonance image revealed an enhancing mass lesion in the sacral canal scalloping the bone at S-2 and S-3.
An apparent complete resection was performed. Intraoperatively the authors observed an entirely epidural tumor with a small dural attachment at the most caudal end of the thecal sac. Histological examination confirmed that the tumor was an atypical meningioma. A local recurrence developed within 1 year of surgery, and the patient underwent a hemisacrectomy for tumor removal. An additional recurrence in the lumbosacral spine and multiple pulmonary metastases developed thereafter.
In addition to the unique nature of this case, the authors also observed a tumor behaving in a far more aggressive fashion than its histological findings would suggest. This adds to the differential diagnosis of tumors occurring in the sacral canal.
Complications with cervical arthroplasty
Authors: Pickett Gwynedd E. , Sekhon Lali H. S. , Sears William R. , Duggal Neil 
Published: January 2008

Object
Spinal arthroplasty is becoming more widely performed in the treatment of degenerative cervical disc disease. Although this new technology may offer benefits over arthrodesis, it also requires that the surgeon acquire new operative techniques, and new potential complications are introduced. To determine the incidence and distribution of perioperative complications, the authors analyzed their early data obtained in a series of patients treated with the Bryan Cervical Disc prosthesis.

Methods
The authors prospectively recorded operative data, complications, and clinical and radiographic outcome data in all patients treated with Bryan prosthesis–based arthroplasty at two tertiary care centers since 2001. Patients underwent standard anterior cervical discectomy followed by one- to three-level arthroplasty.
Ninety-six discs were implanted in 74 patients. The perioperative complication rate was 6.2% per treated level. In one patient a retropharyngeal hematoma developed, requiring evacuation. Neurological worsening occurred in three patients. Intraoperative migration of the prosthesis was observed in one two-level case, whereas delayed migration occurred in one patient with postoperative segmental kyphosis. In another patient with severe postoperative segmental kyphosis, revision was required with a customized lordotic prosthesis. Heterotopic ossification and spontaneous fusion occurred in two cases; motion was preserved in the remaining 94 prostheses. Partial dislocation of the prosthesis in extension occurred in one patient with preoperative segmental hypermobility, the first reported failure of a Bryan prosthesis. Twenty-five percent of patients reported neck and shoulder pain during the late follow-up period. There was a trend toward increased kyphosis of the C2–7 curvature postoperatively.

Conclusions
The Bryan prosthesis was effective in maintaining spinal motion. Major perioperative and device-related complications were infrequent.
Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period
Authors: Taneichi Hiroshi , Suda Kota , Kajino Tomomichi , Matsumura Akira , Moridaira Hiroshi , Kaneda Kiyoshi 
Published: January 2008

ObjectThere are no published reports of unilateral transforaminal lumbar interbody fusion (TLIF) in which two Brantigan I/F cages were placed per level through a single portal to achieve bilateral anterior-column support. The authors describe such a surgical technique and evaluate the clinical outcomes of this procedure.MethodsData obtained in 86 (93.5%) of the first 92 consecutive patients who underwent the procedure were retrospectively reviewed; the minimum follow-up duration was 2 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Disc height, disc angle, cage positioning in the axial plane, and fusion status were radiographically evaluated.The mean follow-up period was 33.8 months. The mean improvement in the JOA score was 77.2%. Fusion was successful in 93% of the cases. According to the Farfan method, the mean anterior and posterior disc heights increased from 20.2 and 16.9% preoperatively to 35.9 and 22.7% at follow up, respectively (p < 0.01). The mean disc angle increased from 4.8° preoperatively to 7.5° at last follow-up examination (p < 0.01). Two cages were correctly placed to achieve bilateral anterior-column support in greater than 85% of the cases. The following complications occurred: hardware migration in two patients and deep infection cured by intravenous antibiotic therapy in one patient.ConclusionsUnilateral TLIF involving the placement of two Brantigan cages per level led to good clinical results. Two Brantigan cages were adequately placed via a single portal, and reliable bilateral anterior-column support was achieved. Although the less invasive unilateral approach was used, the outcomes were as good as those in many reported series of posterior lumbar interbody fusion in which the Brantigan cages were placed via the bilateral approach.
Anatomical feasibility of using the ninth, 10th, and 11th intercostal nerves for the treatment of neurological deficits after damage to the spinal cord
Authors: Vialle Raphaël , Lepeintre Jean-François , Court Charles , Loureiro Maria-Carolina , Lacroix Catherine , Tadié Marc 
Published: January 2008

Object
The topographic anatomy of the lower intercostal nerves is less well known than that of the upper ones, except for the 12th intercostal nerve. It is possible to use the lower intercostal nerves to perform a neurotization of the lumbar roots. The authors studied the anatomy of the ninth, 10th, and 11th intercostal nerves to obtain descriptive and topographic anatomical data to aid in establishing optimal conditions for harvesting.

Methods
The ninth, 10th, and 11th intercostal nerves of 50 cadavers were dissected. The proximal part of the nerve in the posterior intercostal space (ISC) was exposed through a posterior approach. The lateral ICS was exposed through a lateral approach, under the latissimus dorsi, which made it possible to harvest the intercostal nerves using a stripping technique. A histological study was conducted on 10 pigs to evaluate the risk of nerve lesions during the stripping procedure.

Conclusions
The proximal course of the nerve in the posterior ICS was the same in all cases. The mean total length of the intercostal nerves harvested was 17.96 cm for the ninth, 17.14 cm for the 10th, and 15.94 cm for the 11th intercostal nerve. The harvested nerve length was sufficient in 297 of the 300 cases to perform lumbar root neurotization. The histological study showed no difference between the “open” and the “stripping” techniques regarding the risk of histological lesions in harvested nerves.
Spinal cord injury–induced expression of the immune-regulatory chemokine interleukin-16 caused by activated microglia/macrophages and CD8+ cells
Authors: Mueller Christian A. , Schluesener Hermann J. , Conrad Sabine , Pietsch Torsten , Schwab Jan M. 
Published: January 2008

ObjectSpinal cord injury (SCI) elicits a strong inflammatory response that readily participates in lipid oxygenation, edema formation, apoptotic cell death, and tissue remodeling. Because cytokines determine the postinjury inflammatory milieu, the authors analyzed the expression of the immunomodulatory chemokine interleukin-16 (IL-16) after SCI.MethodsThe authors detected a highly significant, persistent, lesional accumulation of parenchymal IL-16+microglia/macrophages, which reached a maximal level 3 days postinjury compared with control rats. The majority of cells that demonstrated positive labeling for IL-16 also had positive labeling for ED1 (> 70%) and OX-8/CD8; these cells exhibited the morphological hallmarks of activated microglia/macrophages and pronounced MHC Class II expression. In contrast to IL-16+ED1+cells, IL-16+microglia/macrophages that coexpressed OX-8 were exclusively seen in the pannecrotic lesion core. In addition, clustering of IL-16+cells was observed in perivascular Virchow–Robin-like spaces in areas of the primary injury (lesion core) and in immediately adjacent areas of secondary injury. Furthermore, on Day 3 postinjury, IL-16+microglia/macrophages were frequently observed in a perineuronal position.ConclusionsThe early lesional accumulation of IL-16+microglia/macrophages suggests a role for IL-16 in the early postinjury immune response such as recruitment and activation of immune cells, leading to microvessel clustering and secondary damage progression.
Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury
Authors: Kilburg Craig , Sullivan Humbert G. , Mathiason Michelle A. 
Published: January 2008

Object
This retrospective study was designed to determine whether side of approach during instrumented, one- or two-level primary anterior cervical discectomy and fusion (ACDF) affects the incidence of recurrent laryngeal nerve (RLN) injury diagnosed by observation of the vocal cords (OVC).

Methods
Records of all patients who underwent one- or two-level instrumented primary ACDF (418 patients) between January 1995 and February 2004 were reviewed. Data collected from these charts included surgeon, patient demographics, preoperative diagnosis, side of exposure, number of vertebral levels fused, and presence of RLN injury diagnosed by OVC after referral for persistent dysphonia. Time from surgery to OVC for patients with right-sided exposures was not statistically different from that for patients with left-sided exposures. Of 418 patients, 278 (66.5%) had right-sided exposures and 140 (33.5%) had left-sided exposures. Eight RLN injuries (1.9%) were noted—five in patients with right-sided exposures (1.8%) and three in patients with left-sided exposures (2.1%). The difference between right- and left-sided injury rates was shown to be nonsignificant using Fisher exact tests.

Conclusions
Results indicate that, given the study’s sample size, side of approach during instrumented, one- or two-level primary ACDF has no significant effect on RLN injury incidence in patients with persistent dysphonia referred for OVC. The definitive answer regarding the true incidence of RLN injury relative to approach side awaits a prospective study with preoperative, immediate postoperative, and periodic OVC in a large, homogeneous population with sufficient numbers of patients with right- and left-sided approaches.
Expandable cylindrical cages in the cervical spine: a review of 22 cases
Authors: Auguste Kurtis I. , Chin Cynthia , Acosta Frank L. , Ames Christopher P. 
Published: January 2008

ObjectExpandable cylindrical cages (ECCs) have been utilized successfully to reconstruct the thoracic and lumbar spine. Their advantages include ease of insertion, reduced endplate trauma, direct application/maintenance of interbody distraction force, and one-step kyphosis correction. The authors present their experience with ECCs in the reconstruction of the cervical spine in patients with various pathological conditions.MethodsData obtained in 22 patients were reviewed retrospectively. A standard anterior cervical corpectomy was performed in all cases. Local vertebral body bone was harvested for use as graft material. Patients underwent pre- and postoperative assessment involving the visual analog scale (VAS), Nurick grading system for determining myelopathy disability, and radiographic studies to determine cervical kyphosis/lordosis and cage subsidence. Fusion was defined as the absence of motion on flexion–extension x-ray films.Sixteen patients presented with spondylotic myelopathy, two with osteomyelitis, two with fracture, one with tumor metastasis, and one with severe stenosis. Fourteen patients underwent supplemental posterior spinal fusion, seven underwent single-level corpectomy, and 15 patients underwent multilevel corpectomy. No perioperative complications occurred. The mean follow-up period was 22 months. In 11 patients with preexisting kyphosis (mean deformity +19°), the mean correction was 22°. There was no statistically significant difference in subsidence between single- and multilevel corpectomy or between 360º fusion and anterior fusion alone. The VAS scores improved by 35%, and the Nurick grade improved by 31%. The fusion rate was 100%.ConclusionsThe preliminary results support the use of ECCs in the cervical spine in the treatment of patients with various disease processes. No significant subsidence was noted, and pain and functional scores improved in all cases. Expandable cylindrical cages appear to be well suited for cervical reconstruction and for correcting sagittal malalignment.
Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients
Authors: Okuda Shinya , Miyauchi Akira , Oda Takenori , Haku Takamitsu , Yamamoto Tomio , Iwasaki Motoki 
Published: January 2008

ObjectPrevious studies of surgical complications associated with posterior lumbar interbody fusion (PLIF) are of limited value due to intrastudy variation in instrumentation and fusion techniques. The purpose of the present study was to examine rates of intraoperative and postoperative complications of PLIF using a large number of cases with uniform instrumentation and a uniform fusion technique.MethodsThe authors reviewed the hospital records of 251 patients who underwent PLIF for degenerative lumbar disorders between 1996 and 2002 and who could be followed for at least 2 years. Intraoperative, early postoperative, and late postoperative complications were investigated.Intraoperative complications occurred in 26 patients: dural tearing in 19 patients and pedicle screw malposition in seven patients. Intraoperative complications did not affect the postoperative clinical results. Early postoperative complications occurred in 19 patients: brain infarction occurred in one, infection in one, and neurological complications in 17. Of the 17 patients with neurological complications, nine showed severe motor loss such as foot drop; the remaining eight patients showed slight motor loss or radicular pain alone, and their symptoms improved within 6 weeks. Late postoperative complications occurred in 17 patients: hardware failure in three, nonunion in three, and adjacent-segment degeneration in 11. Postoperative progression of symptomatic adjacentsegment degeneration was defined as a condition that required additional surgery to treat neurological deterioration.ConclusionsThe most serious complications of PLIF were postoperative severe neurological deficits and adjacent-segment degeneration. Prevention and management of such complications are necessary to attain good long-term clinical results.
Unilateral atlantal lateral mass hypertrophy
Authors: Goel Atul , Bonde Vivek , Menon Ram 
Published: January 2008

✓ The authors report the cases of four patients in whom they diagnosed an extremely rare and hitherto unreported clinical condition—unilateral hypertrophy of the C-1 lateral mass causing symptomatic cord compression. All patients presented with long-standing torticollis and progressive myelopathy. Three patients underwent posterior decompressive surgery and one underwent resection of the part of the lateral mass invading into the spinal canal and subsequent atlantoaxial plate and screw fixation. Clinical improvement of varying degrees occurred in all cases following surgery. The clinical recovery, however, was most remarkable in the patient who underwent resection of the bone portion indenting the cord. The follow-up periods ranged from 2 to 14 years.
The remarkable similarity in the presenting clinical and radiological/neuroimaging features in all four patients suggests that unilateral hypertrophy of the lateral mass of atlas may be a defined clinical entity. The treatment strategy needs to be evaluated; however, resection of the compression-causing portion of the hypertrophic bone appears to be the best treatment option.
Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review
Authors: Thomas Kenneth C. , Bailey Christopher S. , Dvorak Marcel F. , Kwon Brian , Fisher Charles 
Published: January 2008

ObjectDespite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit.MethodsIn their search of the literature, the authors identified all possible relevant studies concerning thoracolumbar burst fracture without neurological deficit. Two independent observers performed study selection, methodological quality assessment, and data extraction in a blinded and objective manner for all papers identified during the search. In a synthesis of the literature, the authors obtained evidence for both operative and nonoperative treatments.ConclusionsThere is a lack of evidence demonstrating the superiority of one approach over the other as measured using generic and disease-specific health-related quality of life scales. There is no scientific evidence linking posttraumatic kyphosis to clinical outcomes. The authors found that there is a strong need for improved clinical research methodology to be applied to this patient population.
Chimney sublaminar decompression for degenerative lumbar spinal stenosis
Authors: Lin Swei-Ming , Tseng Sheng-Hong , Yang Jiao-Chiao , Tu Chi-Cheng 
Published: January 2008

Object
The authors evaluated the efficacy and safety of so-called chimney sublaminar decompression, a new technique to decompress the degenerative stenotic lumbar spinal canal without stripping of the paravertebral muscles.

Methods
Eighteen patients (nine men and nine women whose mean age was 67 years) with symptoms of claudication were selected to undergo chimney sublaminar decompression. The duration of symptoms was greater than 6 months in 17 patients. Two lumbar segments were involved in seven patients, three in eight, and four in the remaining three patients. Central canal stenosis was present in 13 patients, and lateral recess stenosis in five patients. Mild spondylolisthesis was noted in seven patients. All the patients underwent chimney sublaminar decompression.
After surgery, mild wound pain developed in 14 patients, moderate wound pain in two, and severe wound pain in two. The postoperative hospital stay was 4 days or fewer in 14 patients. At follow-up examination, excellent, good, and fair outcomes were achieved in 11, five, and two patients, respectively. No patient required a body brace, and no worsening of preexisting spondylolisthesis was detected. The spinal canal was increased to two- to 6.8-fold (mean 4.2-fold) the preoperative size.

Conclusions
Compared with laminectomy or endoscopic surgery, the aforementioned chimney sublaminar decompression technique was an equally effective and less invasive technique in the treatment of degenerative lumbar canal stenosis.
Subsidence of the Wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study
Authors: Schmieder Kirsten , Wolzik-Grossmann Markus , Pechlivanis Ioannis , Engelhardt Martin , Scholz Martin , Harders Albrecht 
Published: January 2008

Object
Cage subsidence occurs after anterior cervical discectomy and fusion (ACDF). The aim of this prospective study was to evaluate subsidence and total segmental height after implantation of a newly designed Wing titanium cage. Furthermore, alignment of the entire cervical spine was analyzed 2 years after surgery.

Methods
Fifty-four patients (26 women and 28 men) whose mean age was 48.3 years underwent ACDF. Follow-up examinations were performed at discharge and 6, 12, and 24 months postoperatively by an independent investigator. The clinical course was evaluated using the visual analog pain scale and the Prolo scales. Measurements of subsidence and total segmental height were conducted, and the alignment of the entire cervical spine was classified using two methods.
In 54 patients 64 levels were fused. The patients noted a significant reduction of pain, and scores on both Prolo scales were significantly improved. At the 2-year follow-up examination, subsidence was present in 30 of the 67 fused segments. There was a statistically significant correlation between subsidence and the presence of posterior spondylosis at the initial surgery. Furthermore, there was a significant correlation between reduction of total segmental height and the presence of subsidence; however, subsidence did not prevent the development of a solid bone arthrodesis (fusion rate 98%) or have an adverse effect on the alignment of the cervical spine.

Conclusions
Titanium Wing cage–augmented ACDF was associated with comparatively good long-term results. Subsidence was present but did not cause clinical complications. Furthermore, radiological studies demonstrated that the physiological alignment of the cervical spine was preserved and a solid bone arthrodesis was present at 2 years after surgery.