Journal of spinal disorders & techniques

Publisher: Lippincott, Williams & Wilkins

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  • Impact factor
    1.21
  • 5-year impact
    1.69
  • Cited half-life
    7.80
  • Immediacy index
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  • Other titles
    Journal of spinal disorders & techniques (Online), Journal of spinal disorders & techniques, Journal of spinal disorders and techniques, Journalofspinaldisorders & techniques.com
  • ISSN
    1539-2465
  • OCLC
    49377308
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

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Lippincott, Williams & Wilkins

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    • Publisher last reviewed on 10/04/2014
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Retrospective study of 52 patients who underwent anterior cervical fusion with the new implant. To investigate the clinical outcomes and complications of the new implant for anterior cervical discectomy and fusion, and evaluate the radiographic features in the treatment of cervical degenerative diseases. Although high fusion rates can be achieved with the anterior cervical plate, plate-related morbidity affects the patient's satisfaction with the surgical outcomes. A retrospective study was performed in 52 consecutive patients who used the new implant at 106 levels. The clinical outcomes were evaluated preoperatively and postoperatively using the visual analog scale score for neck and arm pain and the Japanese Orthopedic Association and ASIA motor score for myelopathy preoperatively and postoperatively. The cervical curvature, the segment height and fusion status were assessed on radiographs during a mean 12-month follow-up period. There was statistically significant difference in perioperative neck and arm visual analog scale pain score. The preoperative Japanese Orthopedic Association and ASIA motor score were significantly lower than those before surgery (P<0.05), and this difference was maintained at the last follow-up. The occurrence of dysphagia was 11.5%, which was significantly lower than that reported in the previous literature. There was significant difference in lordosis before and after surgery (10.9±12.2 vs. 23.7±11.3, P<0.01) in trisegmental group. The anterior disc height and interbody height of targeting segments increased from preoperative 5.1±1.56 and 31.9±3.43 to postoperative 9.1±1.02 and 36.7±2.44 respectively. Firm fusion was observed in all patients. Our investigations suggest that this new implant facilitates anterior cervical surgery with satisfactory clinical outcomes and a low rate of dysphagia. Our study has demonstrated that this new implant is able to restore and maintain physiological lordosis and segment height of the cervical spine postoperatively.
    Journal of spinal disorders & techniques 04/2014;
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    ABSTRACT: A retrospective study was performed in 148 spinal tuberculosis (T)B patients (M:F, 92:56; mean age 39.7±12.3, range 16-74▒y) treated with anterior debridement and bone graft fusion with nail and screw internal fixation (Nails+screws group); posterior pedicle screw fixation (Pedicle screw group); vertebral arch pedicle internal fixation via a posterior route (Posterior arch fixation group); or posterior debridement, bone graft fusion, and vertebral arch pedicle internal fixation (Arch fixation group). We investigated four variant surgical approaches for internal fixation of spinal TB. The effectiveness of single-stage surgical fixation for different degrees of spinal TB is a matter of debate. Operation time and bleeding volume were recorded. Complications, American Spinal Injury Association (ASIA) score, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were examined preoperatively and 6 months after surgery. Overall, 78, 48, 16, and 6 patients underwent nails+screws, pedicle screws, arch fixation, and posterior arch fixation approaches, respectively. The mean operation times were 175.8±48.8, 308.5±76.7, 143.8±43.0, and 398.3±90.8, respectively (P<0.01). Mean blood transfusion volumes were 1227.1±988.2, 1771.7±794.7, 467.7±123.3, and 2833.3±1083.8▒mL, respectively (P<0.01). Primary wound healing was achieved in 127 patients. No patients experienced spinal TB recurrence or failure of bone graft or fixation. All groups achieved significantly improved CRP and ESR, but significantly improved ASIA scores were only observed in the nails+screws and pedicle screw groups (P<0.01). Surgical approach limitations and advantages should be considered based on the position and severity of spinal TB infection to maximize functional outcomes and minimize surgical risks.
    Journal of spinal disorders & techniques 04/2014;
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    ABSTRACT: Retrospective analysis of the clinical outcomes of 15 patients with the old thoracolumbar junction fracture treated by minimally invasive surgery (MIS) transforaminal interbody fusion surgery. To investigate the efficacy and safety of MIS for the old fracture of the thoracolumbar junction in a pilot study. MIS have demonstrated efficacy in the treatment of lumbar degenerative diseases. There is some controversy regarding the ideal management of thoracolumbar fractures, especially those without an associated neurologic deficit. Reports concerning MIS for old thoracolumbar junction fracture with chronic pain are quite rare. A total of 15 MIS fusion, performed between October 2006 and May 2011, were examined in a retrospective study. The clinical and radiological data were collected and analyzed. Fusion levels were T10–T11 (2 patients), T11–T12 (5 patients), T12–L1 (6 patients), L1–L2 (2 patients). Clinical outcome was assessed using the visual analogue scale and the Oswestry disability index. Radiographic evaluation of the lumbar spine was performed at the second day and 12 months postoperatively. The average follow-up period was 26.3 months, with a minimum of 17 months. The mean operating time, intraoperative blood loss, and x-ray exposure time were 125±31 minutes, 226±45 mL, and 47±12 seconds, respectively. At last followup,the visual analogue scale for back pain and the Oswestry disability index decreased significantly postoperatively from 7.4±2.3 to 1.8±0.6 (P<0.01) and from 38.9±7.1 to 13.5±4.5 (P<0.01), respectively. The average Cobb angle was improved from 19.1–15.1 degrees in this series. No significant correction of local kyphosis was found postoperatively (P>0.05). Radiographic evaluation showed satisfactory bony union at the fixed level in all cases except for 2 patients. There were no other major complications at last follow-up. MIS transforaminal interbody fusion is a safe and effective procedure for old thoracolumbar junction fracture with chronic pain. Improvement of kyphosis is limited and occurrence of nonunion is relatively high.
    Journal of spinal disorders & techniques 04/2014; 27(2):E55-60.
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    ABSTRACT: Retrospective analysis of prospectively collected data. To determine which, if any, radiographic parameters are predictive of clinical outcome following cervical disc replacement (CDR) surgery. It is unclear whether radiographic parameters are predictive of outcome following CDR. An analysis of the radiographic parameters and clinical outcomes of the CDR cohort of the Discover artificial cervical disc IDE trial was performed. Clinical outcome measures included NDI, VAS (neck, arm, and shoulder), and SF-36 PCS scores, collected preoperatively and at regularly scheduled postoperative time periods. Patients with at-least 1-year follow-up were included. The change in outcomes from baseline was determined at each follow-up interval. The following minimal clinically important difference (MCID) thresholds were applied: -7.5 for NDI, -25 for VAS, and +4.1 for PCS. Fifty-six radiographic variables were analyzed to identify factors that may be associated with a poor clinical outcome, defined as failure to achieve the MCID in NDI. A total of 243 patients underwent CDR at 304 levels (182 one-level, 61 two-level). 171 patients (89 female, 82 male; mean age 44.2 years, range 28 to 67) had at least 1-year follow-up. A preoperative disc height of <3.5▒mm was associated with a 3.4 times greater risk of not achieving a MCID in NDI (P=0.018). Increasing the functional spinal unit (FSU) angle by> 3 degrees was associated with a 3.5 times greater risk of not achieving a MCID in NDI (P=0.016). There were 21/171 patients (25 levels) who did not achieve the NDI MCID threshold. All of these patients had at least one, and 16/21 of these patients had more than one abnormal radiographic finding. Seventy percent of treatment levels had severe or bridging heterotopic ossification at three-years follow-up, the incidence of which increased linearly with time. Conclusions: Several radiographic variables are predictive of clinical outcomes, including decreased preoperative disc space height and excessive postoperative segmental lordosis.
    Journal of spinal disorders & techniques 04/2014;
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    ABSTRACT: Analysis of the adjacent-segment fractures in 171 balloon kyphoplasty (BK)-performed patients. The purpose of this study was to investigate the risk factors for new symptomatic vertebral compression fractures (VCF) after BK. Although there are many studies about the incidence and possible risk factors for occurrence of adjacent-level fractures, there is no consensus on the increased risk of adjacent-level fractures after BK. We performed a retrospective analysis of 171 patients treated with percutaneous kyphoplasty. The follow-up period was 41.04±21.78 months. The occurrence of new symptomatic VCF was recorded after the procedure. We evaluated the variables of patient age and sex, the amount of injected cement, the initial kyphotic angle (KA) of VCF, the change of the KA after BK, the severity of osteoporosis, and the percentage of height restoration of the vertebral body. Furthermore, possible risk factors were reported for new symptomatic VCFs. The only 2 factors identified as being significantly associated with adjacent-level fractures were the sex (P=0.001) of the patient and the preoperative KA (P=0.013). The patients with new symptomatic compression fracture had higher initial KA than those without fractures. The female group had higher risk than the male group in occurrence of the new vertebra fractures. The severity of the osteoporosis (low bone mineral density) was not a determinant in occurrence of the new VCF after BK. If the patients experience severe or mild back pain with higher preoperative KA, especially in the first 2 months, then they deserve detailed radiologic examination. To avoid subsequent fracture in the same or adjacent level, vertebral body should be filled adequately and sagittal balance should be obtained with KA correction. BK alone did not influence the incidence of subsequent VCF.
    Journal of spinal disorders & techniques 04/2014; 27(2):98-104.
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    ABSTRACT: This is a retrospective analysis of lumbar segmental motion using Kinetic magnetic resonance imaging(KMRI). The aim of the study was to investigate lumbar segmental motion in functional (ie, standing weight-bearing flexion and extension) positions and examine the effects of lumbar disk degeneration on lumbar segmental motion. Various biomechanical studies using cadaveric specimens have demonstrated the effects of disk degeneration on lumbar motion. However, the studies did not determine the effect of disk degeneration on segmental motion in the functional, living spine. Segmental range of motion (ROM) was calculated and disk degeneration was graded in patients who had undergone KMRI in weight-bearing neutral, 60 degrees of flexion, and 20 degrees of extension. Patients (n=262) were categorized as having normal disks (n=94), single-level degeneration at L4–L5 (n=28) or L5–S1 (N=71), or double-level degeneration at L4–L5–S1 (N=69). Angular ROM, contribution (%)of each segment to total lumbar motion, and contribution of motion from upper (L1–L3) and lower (L4–S1) lumbar levels were compared. Mean ROMo f the lumbar spine in the normal group was 41.3±13.3 degrees. The L4–L5 degeneration group (36.1±12.4 degrees) and the L4–L5–S1 degeneration group (37.1±12.5 degrees) showed significantly decreased total lumbar ROM compared with the normal group. The ROM in upper lumbar segments was significantly larger than that in the lower segments in the normal group and similar in the degeneration groups. The contribution of L5–S1 to total lumbar motion was the smallest of all segments, and no significant difference was found between all groups. In functional positions assessed utilizing weight bearing KMRI, segmental motion at levels with degenerated disks was decreased. The contribution of upper lumbar segments to the total lumbar motion was not smaller than that of the lower segments. The L5–S1 level showed the smallest ROM in lumbar motion.
    Journal of spinal disorders & techniques 04/2014; 27(2):111-6.
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    ABSTRACT: A retrospective study. To determine the incidence of pedicle screws close to vital structures and to identify patient or curve characteristics that increase the risk of screw misplacement. Most pedicle screw misplacements are asymptomatic, thus they are frequently undetected. This study identifies the rate of screw placement in proximity to vital structures using postoperative computed tomography scans. A total of 2132 screws in 101 patients, who underwent posterior spinal fusion for spinal deformity, were reviewed. Screws adjacent to great vessels and viscera were identified and evaluated. Patients with screws at risk (group B) were compared with patients without screws at risk (group A). Patient and curve characteristics were analyzed to determine whether a correlation with screw misplacement exists. A total of 40 at risk screws (∼2%) were identified in 25 patients (∼25%). These 40 screws were in proximity to the aorta (31), left subclavian artery (1), esophagus (3), trachea (3), pleura (1), and diaphragm (1). Of the 31 screws close to the aorta, 10 screws in 6 patients were impinging or distorting the aortic wall. One hundred percent of misplaced screws were in the thoracic spine, 50% were misplaced laterally, 50% were 35 mm long, 57.5% were in pedicles with normal morphology, and 75% were in curves between 40 and 70 degrees. Median screw misplacement rate was 10% in group A and 13% in group B. Adjusted for age and preoperative Cobb angle, patients with a higher misplacement rate were more likely to have screws adjacent to vital organs [adjusted odds ratio: 1.06 (95% confidence interval, 1.01-1.13), P=0.033]. Although only a small number of screws were at risk, they occurred in a large percentage of patients (25%). A single at-risk screw causes a significant complication for the patient. Postoperative imaging beyond routine x-rays may be needed to detect at-risk screws in asymptomatic patients.
    Journal of spinal disorders & techniques 04/2014; 27(2):64-9.
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    ABSTRACT: Retrospective 1-year cost-utility analysis. To determine the cost effectiveness of anterior cervical discectomy and fusion with plating (ACDFP) in comparison to posterior cervical foraminotomy (PCF) for patients with single-level cervical radiculopathy. Cervical radiculopathy due to cervical spondylosis is commonly treated by either PCF or ACDFP for patients who are refractory to nonsurgical treatment. While some have suggested superior outcomes with ACDFP as compared to PCF, the former is also associated with greater costs. The present study analyzes the cost effectiveness of ACDFP versus PCF for patients with single-level cervical radiculopathy. 45 patients who underwent ACDFP and 25 patients who underwent PCF for single-level cervical radiculopathy were analyzed. 1-year postoperative health outcomes were assessed based on Visual Analogue Scale (VAS), Pain Disability Questionnaire (PDQ), Patient Health Questionnaire (PHQ-9), and EuroQol-5 Dimensions (EQ-5D) questionnaires to analyze the comparative effectiveness of each procedure. Direct medical costs were estimated using Medicare national payment amounts and indirect costs were based on patient missed work days and patient income. Postoperative 1-year cost/utility ratios and the incremental cost effectiveness ratio (ICER) were calculated to assess for cost effectiveness using a threshold of $100,000/QALY gained. The 1-year cost-utility ratio for the PCF cohort was significantly lower ($79,856/QALY gained) than that for the ACDFP cohort ($131,951/QALY gained) (P<0.01). In calculating the 1-year ICER, since the ACDFP cohort showed lower QALY gained than the PCF cohort, the ICER was negative and is not reported, meaning that ACDFP was dominated by PCF. Statistically significant and clinically relevant improvements (via minimum clinically important differences) were seen in both cohorts. While both cohorts showed improved health outcomes, ACDFP was not cost effective relative to the threshold of $100,000/QALY gained at 1 year postoperatively while PCF was. The durability of these results must be analyzed with longer term cost-utility analysis studies.
    Journal of spinal disorders & techniques 03/2014;
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    ABSTRACT: Retrospective study. To test a new surgical approach "pedicle exposure technique" for atlantoaxial instability patients with C1 posterior arches measuring less than 4 mm, its feasibility and clinical outcomes. C1 posterior arch screw placement is one of the most effective methods for atlantoaxial instability; however, several studies showed that this method to be restricted when the posterior arch measures less than 4 mm. Hence, modification of this technique is necessary to expand its indications. The average height of the C1 posterior arch in 79 atlantoaxial instability cases was 3.3 (range 2.5-3.9) mm. All patients were treated by the C1 "pedicle exposure technique" and C2 pedicle screw fixation. The feasibility and clinical outcome of this technique were analyzed by postoperative X-rays, computed tomography, and VAS and JOA scores. 158 screws were successfully placed into the atlas in all 79 patients. There were no VA or spinal cord injuries. Venous plexus bleeding was encountered in 3 patients; there were no cases of new onset occipital neuralgia. 3 screws penetrated into the external wall of the C1 lateral mass and 4 screws into the internal wall. 79 patients were followed for 6-80 months. Bony fusion was confirmed in all cases within 3-6 months by computed tomography; there were no instrument failures. Significant differences in pre- and postoperative VAS and JOA scores were found. 36 and 15 of 62 patients with preoperative neck pain had alleviation or resolution of symptoms, respectively; 33 of 36 patients with myelopathy demonstrated significant improvement. The "pedicle exposure technique" is an effective alternative in patients with the C1 posterior arch measuring less than 4 mm. In consideration of a high screw entry point on the C1 posterior arch, similar to the C1 posterior arch screw technique, we propose that this new technique can reduce venous plexus and C2 nerve root injury while providing effective biomechanical stability.
    Journal of spinal disorders & techniques 03/2014;
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    ABSTRACT: A retrospective clinical study was conducted and related literatures were reviewed. This study aimed to evaluate outcome of multilevel anterior cervical discectomy and fusion with plate fixation for juvenile unilateral muscular atrophy of the distal upper extremity accompanied by cervical kyphosis. Juvenile unilateral muscular atrophy of the distal upper extremity is a rare disease. Traditional treatment uses a neck collar to immobilize neck motion. However, if the disease is accompanied by cervical kyphosis, conservative treatment is difficult to correct cervical kyphosis and the prognosis is worsened. Therefore, it is important to initially apply surgical treatment for juvenile unilateral muscular atrophy accompanied with cervical kyphosis. From March 2008 to May 2010, four patients were transferred to our spine medical center because of a history of slowly progressive distal weakness and atrophy of their hands and forearms. Four patients were diagnosed with Hirayama disease accompanied with cervical kyphosis based on their clinical representations and radiological findings. After conservative treatment failed, these patients underwent multilevel anterior cervical discectomy and fusion with plate fixation after unsatisfactory conservative treatment. The clinical outcomes were retrospectively evaluated with follow-up ranging from 1.5 to 3 years. The clinical and radiological follow-up indicated satisfactory clinical relief from symptoms, cervical sagittal alignment and cervical spinal canal volume for all the patients. Within six months after surgery, the JOA score improved from a preoperative average of 14 to a postoperative average of 16.3; JOA recovery rates of all patients were more than good level. The muscle strengths of intrinsic muscles, wrist flexors and extensors, and biceps and triceps muscle improved on average by one grade. No complications occurred. Hirayama disease is a rare disease, a proper diagnosis of which can be made relying on significant clinical symptoms and neurological imaging (dynamic MRI). The primary results from this study showed the tendency that multilevel anterior cervical discectomy and fusion with plate fixation is a preferred treatment for patients showing anterior effacement and apparent cervical kyphosis.
    Journal of spinal disorders & techniques 03/2014;
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    ABSTRACT: Prospective single surgeon non-randomized clinical study. To evaluate radiographic and clinical outcomes, by fixation type, in extreme lateral interbody fusion (XLIF) patients and provide an algorithm for determining patients suitable for standalone XLIF. XLIF may be supplemented with pedicle screw fixation, however, since stabilizing structures remain intact, it is suggested that standalone XLIF can be used for certain indications. This eliminates the associated morbidity, though subsidence rates may be elevated, potentially minimizing the clinical benefits. A fixation algorithm was developed after evaluation of patient outcomes from the surgeon's first 30 cases. This algorithm was used prospectively for 40 subsequent patients to determine requirement for supplemental fixation. Preoperative, postoperative and 12 month follow-up computed tomography (CT) scans were measured for segmental and global lumbar lordosis and posterior disc height. Clinical outcome measures included back and leg pain (visual analogue scale), Oswestry Disability Index (ODI), and SF-36 physical and mental component scores (PCS and MCS). Preoperatively to 12 month follow-up there were increases in segmental lordosis (7.9° to 9.4, P=0.0497), lumbar lordosis (48.8° to 55.2°, P=0.0328) and disc height (3.7 mm to 5.5 mm, P=0.0018); there were also improvements in back (58.6%) and leg pain (60.0%), ODI (44.4%), PCS (56.7%) and MCS (16.1%) for standalone XLIF. For instrumented XLIF, segmental lordosis (7.6° to 10.5°, P=0.0120) and disc height (3.5 mm to 5.6 mm, P<0.001) increased, whilst lumbar lordosis decreased (51.1° to 45.8°, P=0.2560). Back (49.8%) and leg pain (30.8%), ODI (32.3%), PCS (37.4%) and MCS (2.0%) were all improved. Subsidence occurred in 3 (7.5%) standalone patients. The XLIF treatment fixation algorithm provided a clinical pathway to select suitable patients for standalone XLIF. These patients achieved positive clinical outcomes, satisfactory fusion rates, with sustained correction of lordosis and restoration of disc height.
    Journal of spinal disorders & techniques 03/2014;
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    ABSTRACT: A retrospective study. To review the treatment of deep wound infection after posterior instrumented lumbar fusion, and thereby to optimize the decision-making process of implant removal or retention based on MRI assessment. Biofilm formed on the surface of spinal implant prevents infiltration of antibiotics, and makes the infection treatment more complicated. Decision of implant removal, if necessary, should be made appropriately, but the problem is a lack of consensus for implant removal or retention. 1445 consecutive patients who underwent posterior instrumented lumbar fusions were reviewed retrospectively. There were 23 deep wound infections (1.6%) requiring surgical treatment. MR images were used to evaluate the presence or absence of osteomyelitis of instrumented vertebra and intervertebral abscess. Six patients in the negative MRI group (n=7) were successfully treated by a single salvage surgery without implant removal; fusion occurred in 86%. However, in the positive MRI group (n=13), 4 required implant removal at the initial surgery and 5 eventually warranted implant removal after an average of 2.4 additional operations. Notably, 3 of the 4 patients who kept the implants ended up with a loss of fixation stability attributed to screw loosening with progressive destruction of the instrumented vertebra. The fusion rate was, therefore only 23% for the MR positive patients. Furthermore, making the wrong decision regarding implant removal increased the number of salvage surgeries, and frequently resulted in progressive bone destruction and pseudarthrosis. Once vertebral osteomyelitis and/or intervertebral abscess were evident in MR images, all the hard ware should be removed. Failure to adhere this recommendation resulted in multiple additional failed operations, and ultimate pseudarthrosis with further bony destruction.
    Journal of spinal disorders & techniques 03/2014;
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    ABSTRACT: Retrospective chart and radiographic review. To determine if LIV-tilt and disc wedging measured intra-operatively are correlated to their respective values on standing radiographs at intermediate follow-up. No guidelines exist regarding an acceptable intraoperative LIV-tilt. After IRB approval, a consecutive series of patients with AIS and structural lumbar curves treated with PSF at a single institution between 2007 and 2010 was identified. 163 patients with AIS underwent PSF during this time period. 17 had fusion of structural lumbar curves with adequate imaging and minimum two year follow-up. The LIV-tilt and disc angle below the LIV was measured on the pre-operative standing, intra-operative supine fluoroscopy, and postoperative standing radiographs, and coronal balance was measured on the preoperative and postoperative standing radiographs using a standardized method separately by two authors. The curve distribution was as follows: Lenke 3 (29%), Lenke 5 (47%) and Lenke 6 (24%). There was agreement on radiographic measurements between the two authors with a correlation coefficient of 0.98 for coronal balance, 0.91 for LIV-tilt and 0.65 for disc angle. LIV-tilt improved from 19.4° preoperatively to 3.6° intra-operatively. At minimum two year follow-up LIV had on average progressed to 8.6°. The disc angle improved from 5.4° preoperatively to 2.5° intra-operatively. This improvement was maintained at two years (2.8°). Coronal balance also improved during the post-operative period from 17.9 mm immediately following surgery to 11.1 mm at the last follow-up. Compared to prone intra-operative fluoroscopic images, disc wedging below LIV remains stable at two years post-surgery on standing radiographs in patients with AIS undergoing PSF including structural lumbar curves, while LIV-tilt improvement is not maintained. Intraoperative fluoroscopy provides a reliable prediction of disc wedging below LIV two years after surgery on standing radiographs.
    Journal of spinal disorders & techniques 03/2014;
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    ABSTRACT: Cost effectiveness analysis using a Markov model with inputs from published literature. To learn which graft or hardware option used in a single-level anterior cervical discectomy and fusion (ACDF) is most beneficial in terms of cost, quality of life and overall cost effectiveness. Options studied were autograft (auto), allograft (allo) and polyetheretherketone cages (PEEK) for cervical fusion. ACDF is commonly used to treat cervical myelopathy and/or radiculopathy. No study has compared the cost effectiveness of auto, allo and PEEK in one-level ACDF. A literature review provided inputs into a Markov decision model to determine the most effective graft or hardware option for one-level ACDF. Data regarding rate of complications, quality adjusted life years gained (QALYs) and cost for each procedure type was collected. The Markov model was first run in a base case, using all currently available data. The model was then tested using 1-way and 2-way sensitivity analyses to determine the validity of the model's conclusions if specific aspects of model were changed. This model was run for 10 years postoperatively. The cost per QALY for each option in the base case analysis was $3328/QALY for PEEK, $2492/QALY for auto, and $2492/QALY for allo. All graft/hardware options are cost effective ways to improve outcomes for patients living with chronic neck pain. For graft/hardware options the most cost-effective option was allo. The incremental cost-effectiveness ratio (ICER) for PEEK compared to auto or allo was greater than $100,000/QALY. Allo is the most cost-effective graft/hardware option for ACDF. Compared to living with cervical myelopathy and/or radiculopathy, ACDF using any graft or hardware option is a cost-effective method of improving the quality of life of patients. PEEK is not a cost-effective option compared to allo or auto for use in ACDF.
    Journal of spinal disorders & techniques 03/2014;
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    ABSTRACT: Retrospective cohort. To determine whether a genetic test is associated with successful Providence bracing for adolescent idiopathic scoliosis. Genetic factors have been defined that predict risk of progression of adolescent idiopathic scoliosis in a polygenic fashion. From these data, a commercially available genetic test, ScoliScore, was developed. It is now used in clinical practice for counseling and to guide clinical management. Bracing is a mainstay of treatment for adolescent idiopathic scoliosis. Large efforts have been made recently to reduce potential confounding across studies of different braces; however, none of these have considered genetics as a potential confounder. In particular, ScoliScore has not been evaluated in a population undergoing bracing. We conducted a retrospective cohort study in which we identified a population of adolescent idiopathic scoliosis patients who were initiated with Providence bracing and followed over time. While these patients did not necessarily fit the commercial indications for ScoliScore, we contacted the patients and obtained a saliva sample from each for genetic analysis. We then tested whether ScoliScore correlated with the outcome of their bracing therapy. We were able to contact and invite 25 eligible subjects, of whom 16 (64.0%) returned samples for laboratory analysis. Patients were followed for an average of 2.3 years (range 1.1 to 4) after initiation of the Providence brace. 8 patients (50.0%) progressed to more than 45 degrees, while 8 patients (50.0%) did not. The mean ScoliScore among those who progressed to more than 45 degrees was higher than that among those who did not (176 vs. 112, P=0.030). We demonstrate that a genetic test correlates with bracing outcome. It may be appropriate for future bracing studies to include analysis of genetic predisposition to limit potential confounding.
    Journal of spinal disorders & techniques 03/2014;
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    ABSTRACT: A retrospective, multi-center, medical record review and independent analysis of CT scans was performed in 46 patients to determine radiographic arthrodesis rates after one-, two- or three-segment instrumented posterolateral fusions using autograft, BMA, and a nanocrystalline hydroxyapatite bone void filler (nHA). To determine the radiographic arthrodesis rates after instrumented lumbar posterolateral fusions using local autograft, BMA and nHA. The use of iliac crest autograft in posterolateral spine fusion carries real and significant risks. Many forms of nanocrystalline hydroxyapatite have been studied in various preclinical models, but no human studies have reviewed its efficacy as a bone graft supplement in posterolateral fusions. Posterolateral arthrodesis progression was documented approximately 12 months postoperatively using a CT scan and evaluated by an independent radiologist for the presence of bridging bone. One year postoperative clinical outcomes were assessed using the PROLO score. Radiographically, 91% patients treated exhibited bilateral or unilateral posterolateral bridging bone. 94% segments treated exhibited bilateral or unilateral posterolateral bridging bone while 6% segments exhibited no posterolateral bridging bone on either side. 93% individual sites treated exhibited posterolateral bridging bone. In one-, two- and three- segment arthrodesis, 88%, 93% and 100% (respectively) of individual sites exhibited radiographic bridging bone. One year postoperative PROLO scores for 77% patients were excellent or good. There were no complications related to the posterolateral graft mass and no symptomatic non-unions. The arthrodesis rates after instrumented lumbar fusion using local autograft mixed with BMA and the nHA is equivalent to the rates reported for iliac crest autograft in these indications, including stringent indications, such as three-segment procedures. By approximately 12 months postoperatively, there was no significant difference in the rates of bridging bone between the one-, two- and three-segment procedures.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.
    Journal of spinal disorders & techniques 02/2014;
  • Journal of spinal disorders & techniques 02/2014;
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    ABSTRACT: Retrospective review of the prospective American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database with 30-day follow-up of 2164 patients undergoing elective anterior cervical discectomy and fusion (ACDF). To determine factors independently associated with increased length of stay (LOS) and complications following ACDF in order to facilitate preoperative planning and setting of realistic expectations for patients and providers. The effect of individual preoperative factors on LOS and complications has been evaluated in small-scale studies. Large database analysis with multivariate analysis of these variables has not been reported. The ACS NSQIP database from 2005-2010 was queried for patients undergoing ACDF procedures. Pre and perioperative variables were collected. Multivariate regression determined significant predictors (P<0.05) of extended LOS and complications. Average LOS was 2.0±4.0 days (mean±SD) with a range of 0 to 103 days. By multivariate analysis, age≥65, functional status, transfer from facility, preoperative anemia, and diabetes were the preoperative factors predictive of extended LOS. Major complications, minor complications, and extended surgery time were the perioperative factors associated with increased LOS. The elongating effect of these variables was determined, and ranged from 0.5-5.0 days. 71 (3.3%) had a total of 92 major complications, including return to OR (40), venous thrombotic events (13), respiratory (21), cardiac (6), mortality (5), sepsis (4), and organ space infection (3). Multivariate analysis determined ASA score≥3, preoperative anemia, age≥65, extended surgery time and male gender to be predictive of major complications (odds ratios ranging between 1.756-2.609) No association found between levels fused and LOS or complications. Extended LOS following ACDF is associated with factors including age, anemia, and diabetes, as well as the development of postoperative complications. One in 33 patients develops a major complication post-operatively, which are associated with an increased LOS of 5 days.
    Journal of spinal disorders & techniques 02/2014;
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    ABSTRACT: A retrospective radiographical study OBJECTIVE:: To evaluate the correlation between pelvic tilt (PT) and the sacro-femoral-pubic angle (SFP angle) in AIS patients and to clarify whether the predictability of PT is affected by different curve patterns. Pelvic retroversion is one of the compensatory mechanisms to maintain upright position and is also tied to health-related quality of life in patients with adolescent idiopathic scoliosis (AIS). However, measurement of spino-pelvic parameters including PT may be not accurate due to difficulty in visualizing femoral heads on lateral radiographs in some patients. In this study, 101 female AIS patients were recruited. The subjects were divided into two groups: thoracic scoliosis (TS) and lumbar scoliosis (LS) group. Long-cassette standing upright radiographs were taken; PT and SFP angles were measured through digital analysis software (Surgimap Spine Software, New York, USA). The relations between PT and SFP angle were determined via Pearson's correlation coefficient (r). Linear regressions between PT and SFP angle were also performed. The SFP angle was strongly correlated with PT in both groups, and PT could be estimated by the formulas: PT=74.052-0.991×SFP angle in TS group and PT=65.345-0.881×SFP angle in LS group. In TS group, SFP angle correlated with PT strongly with a Pearson's coefficient of 0.65. While in LS group, the coefficient was weaker than that in TS group (0.48 vs. 0.65) but still showed that PT was significantly associated with SFP. Given the high correlation between PT and SFP angle, SFP angle should be considered as a reliable alternative option to PT, which has routinely excellent visibility in coronal films in AIS patients. The predictability was more accurate for AIS patients with thoracic curves than with lumbar curves.
    Journal of spinal disorders & techniques 02/2014;