bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of Impaction Grafting for Single-Level Transforaminal Lumbar Interbody Fusion-Technical Pearls and MicroCT Analysis
Authors: Tortolani Paul Justin , Lucas Sarah L. , Pivazyan Gnel , Wang Wenhai , Cunningham Bryan W. 
Published: February 2023

Study Design.
Cadaveric study.

Background Context.
Transforaminal lumbar interbody fusion (TLIF) represents a well-documented operative surgical technique utilized in the management of lumbar pathology requiring interbody arthrodesis. The microstructural properties of impaction grafting (IG) after TLIF has yet to be reported.

Purpose.
The current study was designed first, to quantify the degree, to which IG augmentation would increase intrabody final bone volume and bone graft surface contact area with the endplates; secondly to quantify the volumes of locally harvested bone and bone needed for maximal impaction.

Materials and Methods.
Three cadaveric lumbosacral spine specimens were dissected into L1-L2, L3-L4, and L5-S1 motion segments for a total of 9 functional spinal units. Each interbody unit underwent a TLIF procedure with the implantation of an interbody spacer containing autogenous morselized bone. Microcomputed tomography scans were then performed to evaluate the final bone volume and bone surface contact area (BSCA). Subsequently, IG augmented TLIF procedure was carried and microcomputed tomography scans were repeated.

Results.
IG augmentation of TLIF exhibited a 346% increase in final bone volume (TLIF: 0.30 ± 0.07 cm3; IG-TLIF: 1.34 ± 0.42 cm3; P < 0.05) and a 152% increase in BSCA (TLIF: 45.06 ± 15.47%; IG-TLIF: 68.28 ± 6.85%; P < 0.05) when compared with the nonimpacted TLIF treatment. In addition, the average amount of autogenous bone collected was 8.21±2.08 cm3, which sufficiently fulfilled the requirements for bone grafting (TLIF: 1.23 ± 0.40 cm3; IG-TLIF 6.42 ± 1.20 cm3).

Conclusions.
IG augmentation of TLIF significantly improved final bone volume in the disc space and BSCA with vertebral endplates in vitro.

Clinical Significance.
Greater BSCA and final volume of bone graft reflect promisingly on their potential to increase fusion rates. Clinical studies will be needed to corroborate these findings.
Optimizing the Definition of Proximal Junctional Kyphosis: A Sensitivity Analysis
Authors: Lovecchio Francis , Lafage Renaud , Line Breton , Bess Shay , Shaffrey Christopher , Kim Han Jo , Ames Christopher , Burton Douglas , Gupta Munish , Smith Justin S. , Eastlack Robert , Klineberg Eric , Mundis Gregory , Schwab Frank , Lafage Virginie ,   on behalf of the International Spine Study Group ISSG
Published: February 2023

Study Design.
Diagnostic binary threshold analysis.

Objective.
(1) Perform a sensitivity analysis demonstrating the test performance metrics for any combination of proximal junctional angle (PJA) magnitude and change; (2) Propose a new proximal junctional kyphosis (PJK) criteria.

Summary of Background Data.
Previous definitions of PJK have been arbitrarily selected and then tested through retrospective case series, often showing little correlation with clinical outcomes.

Materials and Methods.
Surgically treated adult spinal deformity patients (≥4 levels fused) enrolled into a prospective, multicenter database were evaluated at a minimum 2-year follow-up for proximal junctional failure (PJF). Using PJF as the outcome of interest, test performance metrics including sensitivity, positive predictive value, and F1 metrics (harmonic mean of precision and recall) were calculated for all combinations of PJA magnitude and change using different combinations of perijunctional vertebrae. The combination with the highest F1 score was selected as the new PJK criteria. Performance metrics of previous PJK definitions and the new PJK definition were compared.

Results.
Of the total, 669 patients were reviewed. PJF rate was 10%. Overall, the highest F1 scores were achieved when the upper instrumented vertebrae −1 (UIV−1)/UIV+2 angle was measured. For lower thoracic cases, out of all the PJA and magnitude/change combinations tested, a UIV−1/UIV+2 magnitude of −28° and a change of −20° was associated with the highest F1 score. For upper thoracic cases, a UIV−1/UIV+2 magnitude of −30° and a change of −24° were associated with the highest F1 score. Using PJF as the outcome, patients meeting this new criterion (11.5%) at 6 weeks had the lowest survival rate (74.7%) at 2 years postoperative, compared with Glattes (84.4%) and Bridwell (77.4%).

Conclusions.
Out of all possible PJA magnitude and change combinations, without stratifying by upper thoracic versus lower thoracic fusions, a magnitude of ≤−28° and a change of ≤−22° provide the best test performance metrics for predicting PJF.
Minimal Clinically Important Difference of the 6-Minute Walk Distance in Patients Undergoing Lumbar Spinal Canal Stenosis Surgery: 12 Months Follow-Up
Authors: Takenaka Hiroto , Kamiya Mitsuhiro , Sugiura Hideshi , Nishihama Kasuri , Suzuki Junya , Hanamura Shuntaro 
Published: February 2023

Study Design.
Retrospective review of prospectively collected data.

Objective.
We evaluated the responsiveness of the 6-minute walk distance (6MWD) and determined the threshold of the minimal clinically important difference (MCID) in patients who underwent lumbar spinal stenosis (LSS) surgery.

Summary of Background Data.
Little evidence exists on the MCID of 6MWD after LSS surgery. The 6MWD is an objective gait assessment that can be measured quickly.

Materials and Methods.
In total, 126 patients (74 men; average age, 72.2 ± 6.5 yr) were included and assessed preoperatively and at 12 months postoperatively. We used the Oswestry Disability Index (ODI), as an anchor to calculate the MCID for the 6MWD and measured internal and external responsiveness of the 6MWD. The external responsiveness was assessed in 2 ways: (1) One based on the anchoring questionnaire and (2) another based on the scale distribution. The anchor-based approach was evaluated using the Spearman rank correlation coefficient and receiver-operating characteristic curve. The distribution-based approach was evaluated using the minimal detectable change.

Results.
The ODI scores and 6MWD for each anchor significantly improved postoperatively. The change in the 6MWD was significantly correlated with change in the ODI (6 mo, r = −0.45; 12 mo, r = −0.49). The receiver-operating characteristic analysis demonstrated good discriminative properties for the 6MWD using the ODI anchor (6 mo, 0.72; 12 mo, 0.78). The cutoff values for 6MWD were 102.3 and 57.5 at 6 and 12 months, respectively. In the distribution-based approach, the minimal detectable change for the 6MWD was 95.7 m.

Conclusions.
We validated both the internal and external responsiveness of the 6MWD using the ODI and estimated the MCID in the 6MWD for patients undergoing LSS surgery. However, there was lower validity for the MCID among those participants with the high walking ability and low disability at baseline.
Cranially Directed Upper Instrumented Vertebrae Screw Angles Are Associated With Proximal Junctional Kyphosis in Adult Spinal Deformity Surgery
Authors: Chen Jeffrey W. , Longo Michael , Chanbour Hani , LaBarge Matthew E. , Abtahi Amir M. , Stephens Byron F. , Zuckerman Scott L. 
Published: February 2023

Study Design.
A retrospective cohort study.

Objective.
To evaluate the impact of the upper instrumented vertebral (UIV) screw angle in adult spinal deformity (ASD) surgery on: (1) proximal junctional kyphosis/failure (PJK/F), (2) mechanical complications and radiographic measurements, and (3) patient-reported outcome measures (PROMs).

Summary of Background Data.
The effect of UIV screw angle in ASD surgery on patient outcomes remains understudied.

Materials and Methods.
A single-institution, retrospective study was undertaken from 2011 to 2017. UIV screw angle was trichotomized into positive: cranially directed screws relative to the superior endplate (2°≤θ), neutral: parallel to the superior endplate (−2°<θ<2°), and negative: caudally directed screws relative to the superior endplate (−2°≥θ). The primary outcome was PJK/F. Secondary outcomes included remaining mechanical complications, reoperation, and PROMs: Oswestry Disability Index, Numeric Rating Scale (NRS) back/leg, and EuroQol. Regression controlled for age, body mass index, postoperative sagittal vertical axis (SVA), and pelvic incidence lumbar-lordosis mismatch.

Results.
Among 145 patients undergoing ASD surgery, UIV screw angles were 35 (24.1%) cranially directed, 24 (16.6%) neutral, and 86 (59.3%) caudally directed. PJK occurred in 47(32.4%) patients. Positive screws were independently associated with increased PJK [odds ratio (OR)=4.88; 95% CI, 1.85–13.5, P=0.002] and PJF (OR=3.06; 95% CI, 1.32–12.30, P=0.015). Among 108 (74.5%) patients with lower thoracic UIV, PJK occurred in 38 (35.1%). Cranially directed screws were independently associated with an increased odds of PJK (OR=5.56; 95% CI, 1.86–17.90, P=0.003) with a threshold of 0.2° (area under the curve =0.65; 95% CI, 0.54–0.76, P<0.001), above which the risk of PJK significantly increased. No association was found between positive screw angle and PJF (OR=3.13; 95% CI, 0.91–11.40, P=0.073). Because of the low number of patients with an upper thoracic UIV (N=37, 25.5%), no meaningful conclusions could be drawn from this subgroup. There was no association between UIV screw angle and remaining mechanical complications, reoperations, postoperative SVA and T1-pelvic angle, or PROMs.

Conclusions.
Cranially directed UIV screw angles increased the odds of PJK in patients with lower thoracic UIV. Meticulous attention should be paid to the lower thoracic UIV screw angle to mitigate the risk of PJK in ASD.
Is There Utility to Requiring Spine MRI Pre-authorizations? Pre-authorizations
Authors: Kebaish Kareem J. , Galivanche Anoop R. , Mercier Michael R. , Varthi Arya G. , Rubin Lee E. , Grauer Jonathan N. 
Published: February 2023

Study Design:
A retrospective cohort study of a patient undergoing treatment at a single institution’s Spine Center.

Objective:
The current study assessed the rates and eventual disposition of pre-authorizations required before spine MRIs are ordered from an academic spine center.

Summary of Background Data:
Spine magnetic resonance imaging (MRI) often requires preauthorization by insurance carriers. While there are potential advantages to ensuring consistent indicators for imaging modalities, previous studies have found that such processes can add administrative burdens and barriers to care.

Methods:
Patients from a single academic institution’s spine center who were covered by commercial insurance and had a spine MRI ordered between January 2013 and December 2019 were identified. The requirement for preauthorization and eventual disposition of each of these studies was tracked. Multivariate logistic regression was used to determine if commercial insurance carriers or anatomic region MRIs were associated with requiring a preauthorization. The eventual disposition of studies associated with this process was tracked.

Results:
In total, 2480 MRI requests were identified, of which preauthorization was needed for 2122 (85.56%). Relative to cervical spine scans, preauthorization had greater odds of being required for thoracic (OR=2.71, P=0.003) and lumbar (OR=2.46, P<0.001) scans. Relative to a reference insurer, 4 of the 5 commercial carriers had statistically significant increased odds of requiring preauthorization (OR=1.54–10.17 P<0.050 for each).
Of the imaging studies requiring preauthorization, peer to peer review was required for 204 (9.61%), and 1,747 (82.33% of all requiring preauthorization) were approved. Of 375 (17.67%) initially cancelled or denied by the preauthorization process, 290 (77.33% of those initially cancelled or denied) were completed within 3 months. In total, only 85 were not eventually approved and completed.

Conclusion:
Of 2480 distinct MRI orders, commercial insurers required preauthorization for 85.56%. Nonetheless, 96.57% of all scans went on to be completed within 3 months, raising questions about the costs, benefits, and overall value of this administrative process.
Intraoperative and Postoperative Management of Incidental Durotomies During Open Degenerative Lumbar Spine Surgery
Authors: Ahmady Arya A. , Butt Bilal B. , Muscateli Stefano , Aleem Ilyas S. 
Published: February 2023

Summary of Background Data:
Incidental durotomy is a common intraoperative complication of lumbar spine surgery. Intra and postoperative protocols in the management of this common complication vary considerably, with no consensus in the literature.

Objective:
To systematically review (1) lumbar dural repair techniques for open degenerative procedures; (2) review described postoperative protocols after lumbar dural repairs.

Study Design:
Systematic review.

Materials and Methods:
A systematic review of the literature was performed for all articles published from inception until September 2022 using Pubmed, EMBASE, Medline, and Cochrane databases to identify articles assessing the management of durotomy in open surgery for degenerative diseases of the lumbar spine. Two independent reviewers assessed the articles for inclusion criteria, and disagreements were resolved by consensus. Outcomes included persistent leaks, return to the operating room, recurrent symptoms, medical complications, or patient satisfaction.

Results:
A total of 10,227 articles were initially screened. After inclusion criteria were applied, 9 studies were included (n=1270 patients) for final review. Repair techniques included; no primary repair, suture repair in running or interrupted manner with or without adjunctive sealants, sealants alone, or patch repair with muscle, fat, epidural blood patch, or synthetic graft. Postoperative protocols included the placement of a subfascial drain with varying durations of bed rest. Notable findings included no benefit of prolonged bedrest compared with early ambulation (P=0.4), reduced cerebrospinal fluid leakage with fat graft compared with muscle grafts (P <0.001), and decreased rates of revision surgery in studies that used subfascial drains (1.7%–2.2% vs 4.34%–6.66%).

Conclusions:
Significant variability in intraoperative durotomy repair techniques and postoperative protocols exists. Primary repair with fat graft augmentation seems to have the highest success rate. Postoperatively, the use of a subfascial drain with early ambulation reduces the risk of pseudomenignocele formation, medical complications, and return to the operating room. Further research should focus on prospective studies with the goal to standardize repair techniques and postoperative protocols.
Safety and Efficacy of Local Steroid Application on Dysphagia Following Anterior Cervical Discectomy and Fusion
Authors: Wang Jun-wu , Shi Peng-zhi , Li Kai , Zhu Lei , Feng Xin-min , Zhang Wen-jie , Zhang Liang 
Published: February 2023

Study Design:
A systematic review and meta-analysis.

Objective:
To evaluate the safety and efficacy of local steroid application (LSA) on dysphagia after anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:
Dysphagia is one of the most common adverse events in the early postoperative period of ACDF. LSA is reported as an effective method to reduce the swelling of soft tissues, thereby decreasing the incidence of dysphagia. However, the safety and efficacy of LSA on dysphagia after ACDF need to be systematically reviewed and analyzed.

Methods:
A comprehensive literature search was carried out in the database PubMed, Web of Science, EMBASE, Clinical key, Cochrane library, and Wiley Online Library to screen papers that report LSA in ACDF surgery. The Cochrane Collaboration tool and a methodological index for nonrandomized studies were used for the assessment of study quality. Data were analyzed with the Review Manager 5.3 software.

Results:
A total of 10 studies were included. The results revealed no significant differences between the steroid group and the control group in ACDF regarding postoperative drainage, estimated blood loss, and neck disability index score (P > 0.05). LSA significantly alleviates visual analog scale score for neck pain (or odynophagia) (P < 0.05), reduces the length of hospital stay (weighted mean difference, −1.00 (−1.05 to −0.95); P < 0.001), and mitigates dysphagia rate and prevertebral soft-tissue swelling in the early postoperative period (P < 0.05). There seemed to be no significant increase in the complication rate and steroid-related adverse events in the steroid group compared with the control group (P < 0.05).

Conclusions:
LSA shows advantages in reducing the length of hospital stay, decreasing dysphagia rate, and mitigating prevertebral soft-tissue swelling in the early postoperative period of ACDF. Further large-scale studies are urgently required for the development of a standard protocol for LSA and further analysis of potential delay complications.
Cross Screw Fixation for First Metatarsophalangeal Joint Arthrodesis: A Technical Guide
Authors: Sikora Rebecca Rose , Leffler Luke Emerson , Blazek Cody Douglas 
Published: February 2023

Background:
First metatarsophalangeal joint (MPJ) arthritis, treatments, and fixation methods have been well described in the literature. Indications for the fusion of the first MPJ include hallux rigidus, severe hallux valgus, failed bunionectomy, failed joint arthroplasty, rheumatoid arthritis, and neuromuscular disorders. Crossing screw fixation has been found to be a stable construct that provides reliable outcomes with high patient satisfaction, specifically for those patients with hallux rigidus and minimal hallux valgus deformity. Crossing screw fixation has also been found to be reliable and more cost-effective than other fixation techniques. However, this method may pose some challenges to novice surgeons and those at academic training institutions.

Objective:
The objective of this technical guide is to propose a reproducible technique to first MPJ fusion with 2 crossing, cannulated screws. This technique is designed to increase the reliability and speed of the crossing screw technique.

Conclusion:
Overall, using this technique with cross screw fixation, we have found decreased operative times, better reproducibility of results, efficiency with use in training with resident learners, and reduced hardware costs.

Levels of Evidence:
Level V, expert opinion
Circular RNA circ_0000212 accelerates cervical cancer progression by acting as a miR-625-5p sponge to upregulate PTP4A1
Authors: Li Hu , Zheng Shaolie , Wan Ting , Yang Xiang , Ouyang Yuan , Xia Hong , Wang Xiaoyu 
Published: February 2023

Background
Cervical cancer is one of the most common malignant tumors in women. Circular RNA (circRNA) has been shown to play a crucial role in cervical cancer. Here, the aim of this study was to explore the functions and a novel miRNA/mRNA network underlying circ_0000212 in cervical cancer regulation.

Methods
The expression of circ_000212, miR-625-5p and Protein Tyrosine Phosphatase 4A1 (PTP4A1) mRNA was measured by quantitative real-time PCR (qRT-PCR). 5-ethynyl-2’-deoxyuridine assay was conducted to detect the proliferation of cervical cancer cells. Wound healing and transwell assays were employed to assess cell migration and invasion. The angiogenesis abilities of cervical cancer cells were evaluated by tube formation assay. Flow cytometry was performed for analyzing cell apoptosis. The expression of PTP4A1 protein and apoptosis-relative protein were detected via western blot. The dual-luciferase reporter and RNA immunoprecipitation (RIP) assays were employed to clarify the interaction between circ_0000212 or PTP4A1 and miR-625-5p. The impact of circ_0000212 on cervical cancer growth in vivo was detected by xenograft assay.

Results
Circ_0000212 and PTP4A1 were highly expressed and miR-625-5p expression level was decreased in cervical cancer. Circ_0000212 silencing suppressed cervical cancer cell proliferation, migration, invasion and angiogenesis while promoting apoptosis. MiR-625-5p was targeted by circ_0000212, and miR-625-5p inhibition reversed the effects of circ_0000212 knockdown. MiR-625-5p directly targeted PTP4A1, and the inhibitory effect of miR-625-5p on the malignant progression of cervical cancer was reversed after PTP4A1 overexpression. In-vivo assays validated that circ_0000212 promoted cervical cancer tumor growth in vivo.

Conclusion.
circ_0000212 acted as an oncogene in cervical cancer progression, and knockdown of circ_0000212 repressed cervical cancer development by increasing miR-625-5p and decreasing PTP4A1.
LncRNA ARAP1-AS1 targets miR-516b-5p/PDE5A axis to facilitate the progression of thyroid cancer
Authors: Du Qiuli , Huang Lin , Guo Wei 
Published: February 2023

Aim
Thyroid cancer (TC) remains a prevalent public health concern. To further study the molecular mechanism of TC development, we explored the regulatory mechanism and function of lncRNA ARAP1-AS1 in TC progression.

Methods
The verification of ARAP1-AS1, PDE5A and miR-516b-5p expression levels among the TC cell lines and tissues was fulfilled via RT-qPCR and western blot analyses. Cell Counting Kit-8 and colony formation experiments were executed to assess ARAP1-AS1’s biological function in vitro. Western blotting was conducted to assess apoptosis through the expressions of apoptotic markers. A tumor xenograft experiment was conducted to evaluate whether ARAP1-AS1 affected TC tumor development in vivo. The interactions of miR-516b-5p with ARAP1-AS1 and PDE5A were explored through a dual-luciferase reporter and RNA Binding Protein Immunoprecipitation assays, as well as through Pearson’s correlation analysis.

Results
ARAP1-AS1 and PDE5A were evidently upregulated in the TC cell lines and tissues whereas miR-516b-5p was poorly expressed. ARAP1-AS1 silencing in TC cells hampered cell proliferation, reduced their viability and boosted apoptosis. Moreover, it inhibited tumor growth in vivo. ARAP1-AS1 had been revealed to be correlated negatively to miR-516b-5p. Finally, we demonstrated that the miR-516b-5p inhibitor was capable of reversing ARAP1-AS1-knockdown’s repressive effects on TC cell development by means of regulating PDE5A expression.

Conclusion
ARAP1-AS1 partially facilitated TC cell development and survival through the modulation of miR-516b-5p/PDE5A axis. This contributes a novel biomarker and new perspectives for TC treatment.