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
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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
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Lippincott, Williams & Wilkins

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Publications in this journal

  • [show abstract] [hide abstract]
    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 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: 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: 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: 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: 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: 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: 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: 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: 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: 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;
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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: Retrospective case control study. To assess patient quality of life with different fusion levels in posterior pedicle screw correction of idiopathic scoliosis. No previous study has been demonstrated differences of health-related quality of life (HRQoL) between patients fused to L3 versus L4. A retrospective study was conducted on 30 scoliotic patients fused to L3 using a complete pedicle screw instruments. 30 age- and gender-matched scoliotic patients fused to L4 as the control group. Radiologic parameters were assessed before surgery and at latest follow-up between the two groups. These two groups were compared for the SRS-22, ODI, VAS and SF-36 questionnaires which were administered preoperatively and at final follow-up. There were no significant differences in gender, age, follow-up duration, the distribution of curve patterns, the postoperative residual Cobb angle of the main curve, complications, or surgical method between the L3 group and the L4 group (P>0.05). Preoperative scores were statistically similar in the L3 and L4 groups for all domains of all questionnaires. There was no difference between L3 and L4 group for ODI (P=0.527) and VAS (P=0.518). There were no significant differences in the scores on function/activity, self-image/appearance, pain, mental health or satisfaction with treatment domains between the two groups. No significant differences between two groups were found at final follow-up in the SF-36 subscales/domain scores. This study attempted to elucidate the correlation between the length of fusion and functional outcome; however, could not identify any difference between different fusion levels. On the basis of short-term results, there were no significant differences in the Questionnaire scores between the two groups.
    Journal of spinal disorders & techniques 02/2014;
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    ABSTRACT: Prospective cohort study OBJECTIVE:: This study aims to evaluate the learning curve of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Very few studies have evaluated the learning curve of this technically demanding surgery. We intend to evaluate the learning curve of MIS TLIF with a larger sample size and assess surgical competence based not only on operative time, but with peri-operative variables, clinical and radiological outcomes, incidence of complications, and patient satisfaction. From 2005 to 2009, the first 90 single-level MIS TLIF, which utilized a consistent technique and spinal instrumentation, performed by a single surgeon at our tertiary institution were studied. Variables studied included operative time, peri-operative variables, clinical (Visual Analogue Scores for back and leg pain, Oswestry Disability Index, North American Spine Society Scores for neurogenic symptoms) and radiological outcomes, incidence of complications and patient rating of expectation met and the overall result of surgery. The asymptote of the surgeon's learning curve for MIS TLIF was achieved at the 44 case. Comparing the early group of 44 patients to the latter 46, the demographics were similar. For operative parameters, only 3 variables showed differences between the 2 groups: mean operative duration, fluoroscopy duration and usage of patient controlled analgesia. At the final follow-up, for clinical outcome parameters, the 2 groups were different in 3 parameters: VAS scores for back, leg pain and neurogenic symptom scores. For radiological outcome, both groups showed similar good fusion rates. For complications, none of the MIS TLIF cases were converted to Open TLIF intraoperatively. In the early group, there were 3 complications: 1 incidental durotomy and 2 asymptomatic cage migrations; and in the latter group, there was 1 asymptomatic cage migration. Our study showed technical proficiency in MIS TLIF was achieved after 44 surgeries, & the latter patients benefited from shorter operative duration & radiation, less pain, and more relief in their back, leg and neurogenic symptoms.
    Journal of spinal disorders & techniques 02/2014;
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    ABSTRACT: Case Report. Present a novel case of lumbosacral dislocation and its surgical management. Complete lumbosacral dislocations are rare injuries that ensue as a result of high-energy trauma. Anatomic stabilization of these injuries can be challenging and often involves open fixation and arthrodesis. We present the case of a 22 year old male who was involved in a high velocity motorcycle accident with neurological deficit in the lower extremities. Radiographic analysis demonstrated a complete lateral dislocation of L5 vertebral body over the sacrum. The patient was surgically managed with a combined anterior and posterior arthrodesis, posterior decompression and instrumentation. Successful arthrodesis and spinal alignment was achieved. The patient regained partial neurological function in the lower extremities with an improved VAS score of 1 and was able to ambulate semi-independently at latest follow up. A combined anterior and posterior arthrodesis with decompression and instrumentation is an effective method for the treatment of this type of lumbosacral dislocation.
    Journal of spinal disorders & techniques 02/2014;
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    ABSTRACT: An experimental and computational finite element analysis of human lumbar spine discography and its resulting effects on disc biomechanics. To characterize the changes in stress and displacement of the human lumbar spine discs after puncture due to discography. Discography of the intervertebral disc (IVD) may be used to diagnose pathology of the disc and determine if it may be a source for chronic back pain. It has recently been suggested that discography may lead to IVD degeneration, and has been a cause of controversy among spine care physicians. Both in-vivo experiment using cadaveric specimens and a finite element model of the same L3-L5 lumbar spine was developed using computed tomography scans. Discography was simulated in the model as an area in the disc affected by needle puncture. The material properties in the nucleus pulposus were adjusted to match experimental data both before and after puncture. Puncture of the IVD leads to increased deformation as well as increased stresses in the annulus fibrosis region of the disc. Pressure in the nucleus pulposus was found to decrease after puncture. Experimental and computational results correlated well. Puncturing the IVD changes disc biomechanics and hence may lead to progressive spine degenerations in particular in the punctured discs.
    Journal of spinal disorders & techniques 02/2014;
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    ABSTRACT: Retrospective. To investigate the risk factors for radiographic L5-S1 disk height reduction after lumbar posterolateral floating fusion surgery. We investigated data from 86 patients (45 men) who underwent posterolateral floating fusion surgery from 2007 to 2010. The follow-up was from 2 to 6 years. The mean age of the patients was 65.4 years. L5-S1 disk height was calculated and >2▒mm reduction was defined as significant. Age, sex, height, weight, body mass index, number of fused levels, grade of disk degeneration, disk height and diameter, sacrolumbar alignment, alignment of fused level, achievement of union, and proximal adjacent segment disorder at final follow-up were compared. Uni- and multivariate logistic regressions were performed. L5-S1 disk height reduction occurred in 14 patients (30.2%). The number of fused levels was significantly greater (1.8±0.8 vs. 1.4±0.6) in patients without disk height reduction. Radiology showed a significant change of L1-S1 sacrolumbar alignment after surgery in patients without disk height reduction (0.3±6.6° vs. -4.5±7.6°). The height of the disk posterior to the L5-S1 intervertebral disk before surgery was significantly greater (7.3±2.1▒mm vs. 6.1±2.1▒mm) in patients without disk height reduction. In multivariate logistic regression analysis, fusion of more than 3 levels was a significant risk factor for L5-S1 disk height reduction. In posterolateral floating fusion surgery, there was a higher risk of L5-S1 disk height reduction and consequent foraminal stenosis in patients with multiple level fusion. Surgical methods and fusion levels should be chosen after considering their association with L5-S1 disk height reduction.
    Journal of spinal disorders & techniques 02/2014;
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    ABSTRACT: A mechanical and chemical model of intervertebral disc (IVD) degeneration was developed by examining the enzymatic degradation of the nucleus pulposus (NP), and a gelatin-based restoration study was performed. It was hypothesized that forced enzymatic degradation of the NP will mimic natural degeneration through the loss of disc height, and that an injection of a gelatin solution will restore mechanical function. Collagen and proteoglycans are essential for normal NP function. Their chemical destruction, combined with light mechanical loading, will mimic degeneration. Previous studies have determined that collagenase and matrix metalloproteinase-3 (MMP3) are directly implicated in IVD degradation; therefore these enzymes were used in this model. Based upon preliminary testing, 0.5% collagenase, 1% collagenase, and 0.0025% MMP3 in PBS were injected directly into the NP of various motion segments from a young bovine lumbar spine and subjected to light cyclic loading. To restore disc height and mechanical function, 20% gelatin in PBS at 70°C was injected into a degraded disc and subjected to the same loading conditions after an allotted hardening time. Mechanical testing showed statistically significant changes in disc height between control segments, 1% collagenase, and 0.5% collagenase. 0.5% collagenase had the most accurate appearance and loading pattern of degeneration upon disc transection post-loading. A trend in restoration of disc function, given by the lessened loss of disc height upon loading, was seen with injection of gelatin after degradation with 0.5% collagenase. This study demonstrated the potential to create a degenerative model using enzymatic degradation of the NP, and the possibility to restore function with an injectable therapy. Although gelatin is not a clinically viable option, it provides preliminary data for other injectable IVD therapies.
    Journal of spinal disorders & techniques 02/2014;

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