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1
Morishita, Yuichiro, Zorica Buser, Anthony D'Oro, Keiichiro Shiba, and Jeffrey C. Wang. "Clinical Relationship of Degenerative Changes between the Cervical and Lumbar Spine." Asian Spine Journal 12, no. 2 (2018): 343–48. http://dx.doi.org/10.4184/asj.2018.12.2.343.
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<sec><title>Study Design</title><p>Retrospective, observational, case series.</p></sec><sec><title>Purpose</title><p>To elucidate the prevalence of degenerative changes in the cervical and lumbar spine and estimate the degenerative changes in the cervical spine based on the degeneration of lumbar disc through a retrospective review of magnetic resonance (MR) images.</p></sec><sec><title>Overview of Literature</title><p>Over 50% of middle-aged adults show evidence of spinal degeneration. However, the relationship between degenerative changes in the cervical and lumbar spine has yet to be elucidated.</p></sec><sec><title>Methods</title><p>A retrospective review of positional MR images of 152 patients with symptoms related to cervical and lumbar spondylosis with or without a neurogenic component was conducted. The degree of intervertebral disc degeneration (IDD) was assessed on a grade of 1–5 for each segment of the cervical and lumbar spine using MR T2-weighted sagittal images. The grades across all segments were summed to produce the degenerative disc score (DDS) for the cervical and lumbar spine. The patients were divided into two groups based on the IDD grade for each lumbar segment: normal (grades 1 and 2) and degenerative (grades 3–5).</p></sec><sec><title>Results</title><p>DDSs for the cervical and lumbar spine were positively correlated. Significant differences in cervical DDSs between the groups were observed in all lumbar segments. Although there were no significant differences in cervical DDSs among the degenerative lumbar segment, cervical DDSs at the L1–2 and L2–3 segments tended to be higher than those at the L3–4, L4–5, and L5–S degenerative segments.</p></sec><sec><title>Conclusions</title><p>Our study shows that participants with degenerative changes in the upper lumbar segments are more likely to have a certain amount of cervical spondylosis. This information could be used to lower the incidence of a missed diagnosis of cervical spine disorders in patients presenting with lumbar spine symptomology.</p></sec>
2
Rao, Akhilesh, Atul Mishra, Yayati Pimpalwar, Ravinder Sahdev, and Neha Yadu. "Incorporation of Whole Spine Screening in Magnetic Resonance Imaging Protocols for Low Back Pain: A Valuable Addition." Asian Spine Journal 11, no. 5 (2017): 700–705. http://dx.doi.org/10.4184/asj.2017.11.5.700.
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<sec><title>Study Design</title><p>A retrospective review of lumbar magnetic resonance imaging (MRI) studies conducted at the Department of Radiodiagnosis &amp; Imaging of a Tertiary Care Armed Forces Hospital between May 2014 and May 2016.</p></sec><sec><title>Purpose</title><p>To assess the advantages of incorporating sagittal screening of the whole spine in protocols for conventional lumbar spine MRI for patients presenting with low back pain.</p></sec><sec><title>Overview of Literature</title><p>Advances in MRI have resulted in faster examinations, particularly for patients with low back pain. The additional detection of incidental abnormalities on MRI helps to improve patient outcomes by providing a swifter definitive diagnosis. Because low back pain is extremely common, any change to the diagnostic and treatment approach has a significant impact on health care resources.</p></sec><sec><title>Methods</title><p>We documented all additional incidental findings detected on sagittal screenings of the spine that were of clinical significance and would otherwise have been undiagnosed.</p></sec><sec><title>Results</title><p>A total of 1,837 patients who met our inclusion criteria underwent MRI of the lumbar spine. The mean age of the study population was 45.7 years; 66.8% were men and 33.2% women. Approximately 26.7% of the patients were diagnosed with incidental findings. These included determining the level of indeterminate vertebrae, incidental findings of space-occupying lesions of the cervicothoracic spine, myelomalacic changes, and compression fractures at cervicothoracic levels.</p></sec><sec><title>Conclusions</title><p>We propose that T2-weighted sagittal screening of the whole spine be included as a routine sequence when imaging the lumbosacral spine for suspected degenerative pathology of the intervertebral discs.</p></sec>
3
Yamamoto, Norio, Hirofumi Kosaka, Kosaku Higashino, et al. "Vertebral Lateral Notch as Optimal Entry Point for Lateral Mass Screwing Using Modified Roy-Camille Technique." Asian Spine Journal 12, no. 2 (2018): 272–76. http://dx.doi.org/10.4184/asj.2018.12.2.272.
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<sec><title>Study Design</title><p>Retrospective study of 37 consecutive female patients with cervical spondylotic myelopathy who underwent reconstructed computed tomography (CT) scanning of the cervical spine.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to investigate whether the vertebral lateral notch of the cervical spine is an effective landmark to determine the entry point for lateral mass screwing. A modified Roy-Camille technique was used to determine the entry point associated with the lateral notch of the cervical spine.</p></sec><sec><title>Overview of Literature</title><p>The Roy-Camille technique has been a popular technique for the posterior fixation of the cervical spine. A problem with this technique is determining the entry point on the lateral mass via visual inspection, such as in cases with degenerative or destructive cervical facet joints.</p></sec><sec><title>Methods</title><p>Thirty-three female patients with cervical spondylotic myelopathy underwent reconstructed CT scanning of the cervical spine. Overall, 132 vertebrae from C3 to C6 were reviewed using reconstructed CT. The probable trajectory using a modified Roy-Camille technique was determined using reconstructed CT scans, and the optimal entry point was identified. Horizontal and vertical distances from the vertebral lateral notch were measured.</p></sec><sec><title>Results</title><p>The entry point determined using the modified Roy-Camille technique was significantly superior and medial compared with that determined using the conventional Roy-Camille technique. At C3 and C4 levels, the entry point using the modified technique was 1.4 mm below and 4.4 mm medial to the lateral notch, and at C5 and C6 levels, it was 2.3 mm below and 4.9 mm medial to the lateral notch.</p></sec><sec><title>Conclusions</title><p>The vertebral lateral notch of the cervical spine was an effective landmark to determine the entry point for lateral mass screwing. The modified Roy-Camille technique proposed here may prevent surgical complications and poor outcomes.</p></sec>
4
Srivastava, Sudhir Kumar, Rishi Anil Aggarwal, Sunil Krishna Bhosale, Kunal Roy, and Pradip Sharad Nemade. "The Versatile Approach: A Novel Single Incision Combined with Anterior and Posterior Approaches for Decompression and Instrumented Fusion to Treat Tuberculosis of the Thoracic Spine." Asian Spine Journal 11, no. 2 (2017): 294–304. http://dx.doi.org/10.4184/asj.2017.11.2.294.
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<sec><title>Study Design</title><p>Retrospective case series.</p></sec><sec><title>Purpose</title><p>To describe a novel single incision that combines anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine and study the neurological and radiological outcomes.</p></sec><sec><title>Overview of Literature</title><p>Tuberculosis of the spine remains a major health issue in many developing countries. The options for treating tuberculosis of the thoracic spine include the anterior, posterior, and combined approaches, each with its advantages and disadvantages.</p></sec><sec><title>Methods</title><p>Totally, 143 patients with tuberculosis of the thoracic spine were surgically treated using the “Versatile approach”. Posterior fixation was performed using sublaminar wires and a Hartshill rectangle in all patients. Anterior reconstruction was accomplished using bone graft harvested from autologous rib, iliac crest, or fibula.</p></sec><sec><title>Results</title><p>The study included 45 males and 98 females, with a mean age of 33.18±18.65 years (range, 3–82 years) and a mean follow-up of 60.23±24.56 months (range, 18–156 months). Kyphosis improved from a mean value of 24.02 preoperatively to 10.25 postoperatively. A preoperative neurological deficit was observed in 131 patients, with 130 patients regaining ambulatory power. No patient had deterioration of neurological status following surgery. Fusion was achieved in all cases. The visual analogscale score improved from an average score of 7.02 preoperatively to 1.51 at final follow-up. Eight patients had superficial macerations, which healed spontaneously. One patient had buckling of the anterior graft, and one patient had implant breakage following road traffic accident.</p></sec><sec><title>Conclusions</title><p>The “Versatile approach” is an effective, single-stage, single-incision method that combines anterior and posterior approaches for the surgically treating tuberculosis of the thoracic spine. It offers the advantage of direct visualization for decompression and reconstruction of the anterior and posterior vertebral columns, thus providing an excellent, long-lasting clinical outcome.</p></sec>
5
Garcia, Janaina Moreno, Pola Maria Poli de Araújo, Maria Stella Peccin, Ricardo Edésio Amorim Santos Diniz, Roger Amorim Santos Diniz, and Império Lombardi Júnior. "Spine school for patients with low back pain: interdisciplinary approach." Coluna/Columna 14, no. 2 (2015): 113–15. http://dx.doi.org/10.1590/s1808-185120151402147020.
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<sec><title>OBJECTIVE:</title><p> To analyze and evaluate an interdisciplinary educational treatment - Spine School.</p></sec><sec><title>METHODS:</title><p> This study is a non-controlled clinical trial. Twenty one individuals (19 women) aged 27-74 years diagnosed with chronic low back pain were enrolled and followed-up by a rheumatologist and an orthopedist. The evaluations used were SF36, Roland Morris, canadian occupational performance measure (COPM) and visual analogue scale (VAS) of pain that were performed before and after seven weeks of treatment.</p></sec><sec><title>RESULTS:</title><p> We found statistically significant improvements in vitality (mean 48.10 vs. 81.25) p=0.009 and limitations caused by physical aspects (mean 48.81 vs. 81.25) p=0.038 and perception of pain (mean 6.88 vs. 5.38) p=0.005. Although the results were suggestive of improvement, there were no statistical significant differences in the domains social aspects (average 70.82 vs. 92.86) p=0.078, emotional aspects (average 52.38 vs. 88.95) p=0.078, and the performance satisfaction (mean 4.94 vs. 8.24) p=0.074.</p></sec><sec><title>CONCLUSION:</title><p> The Interdisciplinary Spine School was useful for improvement in some domains of quality of life of people with low back pain.</p></sec>
6
Bundoc, Rafael Cruz, Giorgio De Guzman Delgado, and Samuel Arsenio Munoz Grozman. "A Novel Patient-Specific Drill Guide Template for Pedicle Screw Insertion into the Subaxial Cervical Spine Utilizing Stereolithographic Modelling: An <italic>In Vitro</italic> Study." Asian Spine Journal 11, no. 1 (2017): 4–14. http://dx.doi.org/10.4184/asj.2017.11.1.4.
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<sec><title>Study Design</title><p>Cadaveric study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to assess the accuracy and feasibility of cervical pedicle screw (CPS) insertion into the subaxial cervical spine placed using a patient-specific drill guide template constructed from a stereolithographic model.</p></sec><sec><title>Overview of Literature</title><p>CPS fixation is an invaluable tool for posterior cervical fixation because of its biomechanical advantages. The major drawback is its narrow corridor that allows very little clearance for neural and vascular injuries.</p></sec><sec><title>Methods</title><p>Fifty subaxial pedicles of the cervical vertebrae from five cadavers were scanned into thin slices using computed tomography (CT). Digital imaging and communications in medicine images of the cadaver spine were digitally processed and printed to scale as a three-dimensional (3D) model. Drill guide templates were manually moulded over the 3D-printed models incorporating pins inserted in the pedicles. The drill guide templates were used for precise placement of the drill holes in the pedicles of cadaveric specimens for pedicle screw fixation.</p></sec><sec><title>Results</title><p>The instrumented cadaveric spines were subjected to CT to assess the accuracy of our pedicle placement by an external observer. Our patient-specific drill guide template had an accuracy of 94%.</p></sec><sec><title>Conclusions</title><p>The use of a patient-specific drill guide constructed using stereolithography improved the accuracy of CPS placement in a cadaveric model.</p></sec>
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Sasaki, Ken, Michio Hongo, Naohisa Miyakoshi, et al. "Evaluation of Sagittal Spine-Pelvis-Lower Limb Alignment in Elderly Women with Pelvic Retroversion while Standing and Walking Using a Three-Dimensional Musculoskeletal Model." Asian Spine Journal 11, no. 4 (2017): 562–69. http://dx.doi.org/10.4184/asj.2017.11.4.562.
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<sec><title>Study Design</title><p>In vivo biomechanical study using a three-dimensional (3D) musculoskeletal model for elderly individuals with or without pelvic retroversion.</p></sec><sec><title>Purpose</title><p>To evaluate the effect of pelvic retroversion on the sagittal alignment of the spine, pelvis, and lower limb in elderly females while standing and walking.</p></sec><sec><title>Overview of Literature</title><p>Patients with hip–spine syndrome have concurrent hip-joint and spine diseases. However, the dynamic sagittal alignment between the hip joint and spine has rarely been investigated. We used a 3D musculoskeletal model to evaluate global spinopelvic parameters, including spinal inclination and pelvic tilt (PT).</p></sec><sec><title>Methods</title><p>A total of 32 ambulant females (mean age=78 years) without assistance were enrolled in the study. On the basis of the radiographic measurement for PT, participants were divided into the pelvic retroversion group (R-group; PT≥20°) and the normal group (N-group; PT&lt;20°). A 3D musculoskeletal motion analysis system was used to analyze the calculated value for the alignment of spine, pelvis, and lower limb, including calculated (C)-PT, sagittal vertical axis (C-SVA), pelvic incidence, lumbar lordosis, T1 pelvic angle (C-TPA), as well as knee and hip flexion angles while standing and walking.</p></sec><sec><title>Results</title><p>While standing, C-PT and C-TPA in the R-group were significantly larger than those in the N-group. Hip angle was significantly smaller in the R-group than in the N-group, unlike knee angle, which did not show difference. While walking, C-SVA and C-TPA were significantly increased, whereas C-PT decreased compared with those while standing. The maximum hip-flexion angle was significantly smaller in the R-group than in the N-group. There was a significant correlation between the radiographic and calculated parameters.</p></sec><sec><title>Conclusions</title><p>The 3D musculoskeletal model was useful in evaluating the sagittal alignment of the spine, pelvis, and leg. Spinopelvic sagittal alignment showed deterioration while walking. C-PT was significantly decreased while walking in the R-group, indicating possible compensatory mechanisms attempting to increase coverage of the femoral head. The reduction in the hip flexion angle in the R-group was also considered as a compensatory mechanism.</p></sec>
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Srinivas, Gunti Ranga, Malhar N. Kumar, and Anindya Deb. "Adjacent Disc Stress Following Floating Lumbar Spine Fusion: A Finite Element Study." Asian Spine Journal 11, no. 4 (2017): 538–47. http://dx.doi.org/10.4184/asj.2017.11.4.538.
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<sec><title>Study Design</title><p>Experimental study.</p></sec><sec><title>Purpose</title><p>The study aimed to develop a finite element (FE) model to determine the stress on the discs adjacent to the fused segment following different types of floating lumbar spinal fusions.</p></sec><sec><title>Overview of Literature</title><p>The quantification of the adjacent disc stress following different types of floating lumbar fusions has not been reported. The magnitude of the stress on the discs above and below the floating fusion remains unknown.</p></sec><sec><title>Methods</title><p>A computer-aided engineering-based approach using implicit FE analysis was employed to assess the stress on the lumbar discs above and below the floating fusion segment (L4–L5) following anterior and posterior lumbar spine fusions at one, two, and three levels (with and without instrumentation).</p></sec><sec><title>Results</title><p>Both discs suprajacent and infrajacent to the floating fusion experienced increased stress, but the suprajacent disc experienced relatively high stress level. Instrumentation increased the stress on the discs suprajacent and infrajacent to the floating fusion, but the magnitude of stress on the suprajacent disc remained relatively high.</p></sec><sec><title>Conclusions</title><p>The FE model was employed under similar loading and boundary conditions to provide quantitative data, which will be useful for clinicians to understand the probable long-term effects of floating fusions.</p></sec>
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Silva, Juliano Almeida e., Murilo Tavares Daher, Adriano Passáglia Esperidião, André Luiz Passos Cardoso, Wilson Eloy Pimenta Júnior, and Sérgio Daher. "Results and complications of vertebrectomy with posterior approach after 2-year follow-up." Coluna/Columna 14, no. 2 (2015): 121–24. http://dx.doi.org/10.1590/s1808-185120151402132533.
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<sec><title>OBJECTIVE:</title><p> To describe the surgical technique for vertebrectomy by posterior single approach in the thoracic and thoracolumbar spine with circumferential reconstruction and arthrodesis, and evaluate retrospectively the results and complications after 2 years of follow-up in patients undergoing this technique.</p></sec><sec><title>METHODS:</title><p> Retrospective analysis of medical records and imaging studies of 12 patients with vertebrectomy indication for various pathologies, undergoing this surgical technique.</p></sec><sec><title>RESULTS:</title><p> Eight (66.67%) patients were male and four patients (33.33%) were females aged 13-66 years (mean 40 years). There were nine patients with involvement of the thoracic spine and three of the lumbar, and one patient with two consecutive vertebrae affected. All patients had improved or remained with the neurological condition. Surgical complications were two cases of hemothorax, two cases of loosening of the screws, one of them requiring surgical revision, and a case of material failure and pseudarthrosis.</p></sec><sec><title>CONCLUSION:</title><p> Vertebrectomy by posterior approach in thoracolumbar spine with circumferential reconstruction and fusion can be performed safely for a variety of indications.</p></sec>
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Kumar, Shashwat, Jagannath Manickam Palaniappan, and Anantha Kishan. "Preemptive Caudal Ropivacaine: An Effective Analgesic during Degenerative Lumbar Spine Surgery." Asian Spine Journal 11, no. 1 (2017): 113–19. http://dx.doi.org/10.4184/asj.2017.11.1.113.
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<sec><title>Study Design</title><p>This was a prospective, randomized, controlled trial comprising 60 patients undergoing lumbosacral spine (noninstrumentation/nonfusion) surgery.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate the efficacy of 0.2% ropivacaine (20 mL) administered alone as a single, preoperative, caudal epidural block injection versus that of intravenous analgesics in providing effective postoperative analgesia to patients undergoing lumbosacral spine surgery.</p></sec><sec><title>Overview of Literature</title><p>Various studies have shown the effectiveness of a caudal epidural injection (bupivacaine or ropivacaine) in providing postoperative analgesia in combination with steroids or other analgesics. This study uniquely analyzed the efficacy of a single injection of caudal epidural ropivacaine in providing postoperative pain relief.</p></sec><sec><title>Methods</title><p>Sixty patients who were scheduled to undergo surgery for degenerative lumbar spine disease (noninstrumentation/nonfusion) were consecutively divided into two groups, group R (Study) and group I (Control). 30 group R patients received a caudal epidural block with 20 mL of 0.2% ropivacaine after the administration of general anesthesia. 30 group I patients received no preoperative analgesia. Intravenous analgesics were administered during the postoperative period after a complaint of pain. Various parameters indicating analgesic effect were recorded.</p></sec><sec><title>Results</title><p>There was a significant delay in the average time to the first demand for rescue analgesia in the study group, suggesting significantly better postoperative pain relief than that in the control group. In comparison with the control group, the study group also showed earlier ambulation with minimal adverse effects. The requirement for intraoperative fentanyl was higher in the control group than that in the study group.</p></sec><sec><title>Conclusions</title><p>Preemptive analgesia with a single epidural injection of ropivacaine is a safe, simple, and effective approach, providing better postoperative pain relief, facilitating early mobilization, and decreasing the intraoperative requirement for opioid administration.</p></sec>
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Risso Neto, Marcelo Italo, Guilherme Rebechi Zuiani, Roberto Rossanez, et al. "Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation." Coluna/Columna 14, no. 2 (2015): 108–12. http://dx.doi.org/10.1590/s1808-185120151402146365.
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<sec><title>OBJECTIVE:</title><p> To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.</p></sec><sec><title>METHODS:</title><p> One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analyzed looking for arthrodesis signals. The appearance of bone healing in each operated level was classified in five categories as proposed by Glassman to the posterolateral arthrodesis: 1) bilateral solid arthrodesis; 2) unilateral solid arthrodesis; 3) bilateral partial arthrodesis; 4) unilateral partial arthrodesis; 5) absence of arthrodesis. In a second step, the evaluation of each operated level was divided into two categories: fusion (including type 1, 2, 3, and 4) and non fusion (type 5). Statistical analysis was performed by calculating the Kappa coefficient considering the paired analysis between the two experienced observers and between the two observers in training.</p></sec><sec><title>RESULTS:</title><p> The interobserver reproducibility by the kappa coefficient for arthrodesis consolidation analysis for the classification proposed, divided into 5 types, was 0.729 for both experienced surgeons and training surgeons. Considering only two categories kappa coefficient was 0.745 between experienced surgeons and 0.795 between training surgeons. In all analyzes, we obtained high concordance power.</p></sec><sec><title>CONCLUSION:</title><p> Interobserver reproducibility was observed with high concordance in the classification proposed by Glassman for posterolateral arthrodesis of the lumbar and lumbosacral spine.</p></sec>
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Aoude, Ahmed, Saber Ghadakzadeh, Hamzah Alhamzah, et al. "Postoperative Assessment of Pedicle Screws and Management of Breaches: A Survey among Canadian Spine Surgeons and a New Scoring System." Asian Spine Journal 12, no. 1 (2018): 37–46. http://dx.doi.org/10.4184/asj.2018.12.1.37.
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<sec><title>Study Design</title><p>This study was designed as a survey amongst Canadian spine surgeon to determine a scoring system to standardize pedicle screw placement assessment.</p></sec><sec><title>Purpose</title><p>This study aimed to obtain and analyze the opinions of spine surgeons regarding the assessment of pedicle screw accuracy, with the goal of establishing clinical guidelines for interventions for malpositioned pedicle screws.</p></sec><sec><title>Overview of Literature</title><p>Accurate placement of pedicle screws is challenging, and misalignment can lead to various complications. To date, there is no recognized gold standard for assessing pedicle screw placement accuracy. The literature is lacking studies attempting to standardize pedicle screw placement accuracy assessment.</p></sec><sec><title>Methods</title><p>A survey of the clinical methods and imaging criteria that are used for assessing pedicle screw placement accuracy was designed and sent to orthopedic and neurosurgery spine surgeons from the Canadian Spine Society for their anonymous participation.</p></sec><sec><title>Results</title><p>Thirty-five surgeons completed the questionnaire. The most commonly used modalities for assessing pedicle screw position postoperatively were plain X-rays (97%) and computed tomography (CT, 97%). In both symptomatic and asymptomatic patients, the most and least worrisome breaches were medial and anterior breaches, respectively. The majority of surgeons tended not to re-operate on asymptomatic breaches. More than 60% of surgeons would re-operate on patients with new-onset pain and a ≤4-mm medial or inferior breach in both thoracic and lumbar regions. If a patient experienced sensory loss and a breach on CT, in either the thoracic or lumbar levels, 90% and 70% of the surgeons would re-operate for a medial breach and an inferior breach, respectively.</p></sec><sec><title>Conclusions</title><p>Postoperative clinical presentation and imaging findings are crucial for interpreting aberrant pedicle screw placement. This study presents a preliminary scoring system for standardizing the classification of pedicle screws.</p></sec>
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Figueiredo, Felipe José Vieira, Paulo Roberto Brum, and Rogério Frota Góes Monteiro. "Clinical evaluation of patients undergoing dynamic pedicle fixation in lumbar spine." Coluna/Columna 14, no. 2 (2015): 105–7. http://dx.doi.org/10.1590/s1808-185120151402147170.
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<sec><title>OBJECTIVE:</title><p> To evaluate the preliminary clinical results and complications in patients undergoing dynamic pedicle fixation of the spine in the treatment of a specific group of degenerative lumbar disease.</p></sec><sec><title>METHODS:</title><p> In this preliminary retrospective study, we selected 14 patients who underwent surgery from January 2006 to July 2010. We selected only patients with spondylolisthesis without spondylolysis (Grade 1 Meyerding). All patients underwent surgery at one level and the levels mostly addressed were: L3-L4, L4-L5 or L5-S1. The approach was the same in all patients (posterior median approach with preservation of the posterior elements). All patients underwent intense conservative treatment without clinical response and the same research algorithm preoperatively.</p></sec><sec><title>RESULTS:</title><p> Retrospective analysis of Oswestry questionnaire after selection and publication of results of 14 patients with Grade 1 spondylolisthesis who underwent dynamic pedicle stabilization in a total of 56 pedicle screws, being all in one level. There was no fracture of any screws, the mean hospital stay was a day and a half, no patient required blood transfusion and there were no cases of infection, with significant improvement in the Oswestry questionnaire.</p></sec><sec><title>CONCLUSION:</title><p> In this study, the dynamic pedicle stabilization method proved to be an excellent treatment option when surgical criteria are strictly adhered to. There was an improvement in Oswestry values, lower hospital stay and low rate of complications, consisting of an alternative in motion preservation surgery.</p></sec>
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Nagamoto, Yukitaka, Shota Takenaka, and Hiroyuki Aono. "Postoperative Spinal Subdural Lesions Following Lumbar Spine Surgery: Prevalence and Risk Factors." Asian Spine Journal 11, no. 5 (2017): 793–803. http://dx.doi.org/10.4184/asj.2017.11.5.793.
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<sec><title>Study Design</title><p>Retrospective case–control study</p></sec><sec><title>Purpose</title><p>To clarify the prevalence and risk factors for spinal subdural lesions (SSDLs) following lumbar spine surgery.</p></sec><sec><title>Overview of Literature</title><p>Because SSDLs, including arachnoid cyst and subdural hematoma, that develop following spinal surgery are seldom symptomatic and require reoperation, there are few reports on these pathologies. No study has addressed the prevalence and risk factors for SSDLs following lumbar spine surgery.</p></sec><sec><title>Methods</title><p>We conducted a retrospective analysis of the magnetic resonance (MR) images and medical records of 410 patients who underwent lumbar decompression surgery with or without instrumented fusion for degenerative disorders. SSDLs were classified into three grades: grade 0, no obvious lesion; grade 1, cystic lesion; and grade 2, lesions other than a cyst. Grading was based on the examination of preoperative and postoperative MR images. The prevalence of SSDLs per grade was calculated and risk factors were evaluated using multivariate logistic regression analysis.</p></sec><sec><title>Results</title><p>Postoperative SSDLs were identified in 123 patients (30.0%), with 50 (12.2%) and 73 (17.8%) patients being classified with grade 1 and 2 SSDLs, respectively. Among these, one patient was symptomatic, requiring hematoma evacuation because of the development of incomplete paraplegia. Bilateral partial laminectomy was a significantly independent risk factor for SSDLs (odds ratio, 1.52; 95% confidence interval, 1.20–1.92; <italic>p</italic>&lt;0.001). In contrast, a unilateral partial laminectomy was a protective factor (odds ratio, 0.11; 95% confidence interval, 0.03–0.46; <italic>p</italic>=0.002).</p></sec><sec><title>Conclusions</title><p>The prevalence rate of grade 1 SSDLs was 30%, with no associated clinical symptoms observed in all but one patient. Bilateral partial laminectomy increases the risk for SSDLs, whereas unilateral partial laminectomy is a protective factor.</p></sec>
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Bechara, Alexandre Henrique Silveira, André Frazão Rosa, Marcelo Ítalo Risso Neto, et al. "Correlation between actual survival and Tokuhashi and tomita scores in spine metastases." Coluna/Columna 14, no. 2 (2015): 138–43. http://dx.doi.org/10.1590/s1808-185120151402147872.
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<sec><title>OBJECTIVE:</title><p> To evaluate the accuracy of the scores of Tokuhashi and Tomita and the actual survival of patients with vertebral metastases.</p></sec><sec><title>METHODS:</title><p> A retrospective assessment of 45 patients with spinal metastases. Thirty-one patients underwent surgical treatment and adjuvant therapy and 14 received conservative treatment (chemotherapy/radiotherapy) or palliative/supportive, depending on the scores of Tokuhashi and Tomita.</p></sec><sec><title>RESULTS:</title><p> In the study, 80% of patients were female and the mean age was 57.8 years (SD=11.3 years). The most frequent primary tumors were breast and prostate (68.9%). The accuracy of Tokuhashi scale was 53.4% and the Tomita, 64.5%. The concentration of Tomita range of correct classification was in the category of survival > 12 months (57.8%), while the Tokuhashi scale presented some adjustment in the other categories, < 6 months (15.6%) and 6 to 12 months (2.2%). The histological type of the primary tumor was the only variable that statistically influenced the survival time of patients (p<0.001), and patients with lung or liver tumor (most aggressive) presented a risk of death 9.89 times higher than patients with primary tumors of breast or prostate (less aggressive) (95% CI: 3.10 to 31.57).</p></sec><sec><title>CONCLUSION:</title><p> The Tokuhashi and Tomita scores showed good accuracy with respect to the actual survival of patients with tumor metastasis in the spine.</p></sec>
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Soman, Shardul Madhav, Jimmy Chokshi, Naitik Chhatrala, Gulam Haider Tharadara, and Mukund Prabhakar. "Qualitative Grading as a Tool in the Management of Multilevel Lumbar Spine Stenosis." Asian Spine Journal 11, no. 2 (2017): 278–84. http://dx.doi.org/10.4184/asj.2017.11.2.278.
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<sec><title>Study Design</title><p>This is a prospective study that was undertaken at a single centre and involved 80 consecutive patients diagnosed with lumbar spinal stenosis (LSS).</p></sec><sec><title>Purpose</title><p>The aim of the study was to assess the efficacy of a qualitative grading system as seen on magnetic resonance imaging (MRI) as a tool in the management of multilevel LSS.</p></sec><sec><title>Overview of Literature</title><p>LSS diagnosis is clinical but is usually radiologically supplemented. However, there are often multilevel radiological findings with non-specific or atypical clinical features. We used a qualitative grading system to help in the decision-making process of the management of patients with multilevel LSS.</p></sec><sec><title>Methods</title><p>80 patients with LSS were treated with decompression and prospectively followed-up for a minimum of 12 months. All had failed conservative treatment. Qualitative grading of LSS severity was based on the dural sac in T2 weighted axial MRI images at all disc levels and was done from L1–2 to L5–S1 (n=400). Functional outcome was assessed using the Oswestry disability index (ODI).</p></sec><sec><title>Results</title><p>The mean patient age was 56.6 years, with a gender ratio of 0.6:1. Forty patients had degenerative LSS and 40 had degenerative spondylolysthesis. A total of 178 levels were decompressed, the majority of which were L4–L5 (43.82%), followed by L5–S1 (41.57%). According to our qualitative grading system, grade D stenosis (53.93%) was decompressed most frequently, followed by grade C stenosis (41.57%). The average preoperative ODI score was 58.55%, which later reduced to 19.15%. Seventy percent of patients achieved excellent results, whereas 30% achieved good results.</p></sec><sec><title>Conclusions</title><p>Morphological grading is a useful tool in decision making in surgery for multilevel LSS. Grade C and D stenosis should be decompressed, whereas A and B should not be, unless clinically justified.</p></sec>
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Jagannathan, Devimeenal, Venkatraman Indiran, Fouzal Hithaya, M. Alamelu, and S. Padmanaban. "Role of Anatomical Landmarks in Identifying Normal and Transitional Vertebra in Lumbar Spine Magnetic Resonance Imaging." Asian Spine Journal 11, no. 3 (2017): 365–79. http://dx.doi.org/10.4184/asj.2017.11.3.365.
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<sec><title>Study Design</title><p>Retrospective study.</p></sec><sec><title>Purpose</title><p>Identification of transitional vertebra is important in spine imaging, especially in presurgical planning. Pasted images of the whole spine obtained using high-field magnetic resonance imaging (MRI) are helpful in counting vertebrae and identifying transitional vertebrae. Counting vertebrae and identifying transitional vertebrae is challenging in isolated studies of lumbar spine and in studies conducted in low-field MRI. An incorrect evaluation may lead to wrong-level treatment. Here, we identify the location of different anatomical structures that can help in counting and identifying vertebrae.</p></sec><sec><title>Overview of Literature</title><p>Many studies have assessed the vertebral segments using various anatomical structures such as costal facets (CF), aortic bifurcation (AB), inferior vena cava confluence (IC), right renal artery (RRA), celiac trunk (CT), superior mesenteric artery root (SR), iliolumbar ligament (ILL) psoas muscle (PM) origin, and conus medullaris. However, none have yielded any consistent results.</p></sec><sec><title>Methods</title><p>We studied the locations of the anatomical structures CF, AB, IC, RRA, CT, SR, ILL, and PM in patients who underwent whole spine MRI at our department.</p></sec><sec><title>Results</title><p>In our study, 81.4% patients had normal spinal segmentation, 14.7% had sacralization, and 3.8% had lumbarization. Vascular landmarks had variable origin. There were caudal and cranial shifts with respect to lumbarization and sacralization. In 93.8% of cases in the normal group, ILL emerged from either L5 alone or the adjacent disc. In the sacralization group, ILL was commonly seen in L5. In the lumbarization group, ILL emerged from L5 and the adjacent disc (66.6%). CFs were identified at D12 in 96.9% and 91.7% of patients in the normal and lumbarization groups, respectively. The PM origin was observed from D12 or D12–L1 in most patients in the normal and sacralization groups.</p></sec><sec><title>Conclusions</title><p>CF, PM, and ILL were good identification markers for D12 and L5, but none were 100% accurate.</p></sec>
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Kawano, Osamu, Takeshi Maeda, Eiji Mori, Itaru Yugue, Takayoshi Ueta, and Keiichiro Shiba. "A Safe Surgical Procedure for Old Distractive Flexion Injuries of the Subaxial Cervical Spine." Asian Spine Journal 11, no. 6 (2017): 935–42. http://dx.doi.org/10.4184/asj.2017.11.6.935.
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<sec><title>Study Design</title><p>Retrospective review.</p></sec><sec><title>Purpose</title><p>To describe a safe and effective surgical procedure for old distractive flexion (DF) injuries of the subaxial cervical spine.</p></sec><sec><title>Overview of Literature</title><p>Surgical treatment is required in old cases when a progression of the kyphotic deformity and/or persistent neck pain and/or the appearance of new neurological symptoms are observed. Since surgical treatment is more complicated and dangerous in old cases than in acute distractive-flexion cases, the indications for surgery and the selection of the surgical procedure must be carefully conducted.</p></sec><sec><title>Methods</title><p>To identify a safe and effective surgical procedure, the procedure selected, reason(s) for its selection, and associated neurological complications were investigated in 13 patients with old cervical DF injuries.</p></sec><sec><title>Results</title><p>No neurological complications were observed in nine patients (DF stage 2 or 3) who underwent the anterior-posterior-anterior (A-P-A) method and two patients (DF stage 1) who underwent the posterior method. It was initially planned that two patients (DF stage 2) who underwent the P-A method would be treated using the Posterior method alone; however, anterior discectomy was added to the procedure after the development of a severe spinal cord disorder.</p></sec><sec><title>Conclusions</title><p>The A-P-A method (anterior discectomy, posterior release and/or partial facetectomy, reduction and instrumentation, anterior bone grafting) is considered to be a suitable surgical procedure for old cervical DF injuries.</p></sec>
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Lee, Choon Sung, Chang Ju Hwang, Nam Heun Kim, et al. "Preoperative Magnetic Resonance Imaging Evaluation in Patients with Adolescent Idiopathic Scoliosis." Asian Spine Journal 11, no. 1 (2017): 37–43. http://dx.doi.org/10.4184/asj.2017.11.1.37.
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<sec><title>Study Design</title><p>Retrospective case series.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to examine the incidence of neural axis abnormalities and the relevant risk factors in patients with adolescent idiopathic scoliosis (AIS).</p></sec><sec><title>Overview of Literature</title><p>The use of preoperative magnetic resonance imaging (MRI) to assess the whole spine in patients with idiopathic scoliosis is controversial, and indications for such MRI evaluations have not been definitively established. However, we routinely use whole-spine MRI in patients with scoliosis who are scheduled to undergo surgical correction.</p></sec><sec><title>Methods</title><p>A total of 378 consecutive patients with presumed AIS who were admitted for spinal surgery were examined for neural axis abnormalities using MRI. To differentiate patients with normal and abnormal MRI findings, the following clinical parameters were evaluated: age, sex, menarcheal status, rotation angle (using a scoliometer), coronal balance, shoulder height difference, and low back pain. We radiographically evaluated curve type, thoracic or thoracolumbar curve direction, curve magnitude and flexibility, apical vertebral rotation, curve length, coronal balance, sagittal balance, shoulder height difference, thoracic kyphosis, and the Risser sign.</p></sec><sec><title>Results</title><p>Neural axis abnormalities were detected in 24 patients (6.3%). Abnormal MRI findings were significantly more common in males than in females and were associated with increased thoracic kyphosis. However, there were no significant differences in terms of the other measured parameters.</p></sec><sec><title>Conclusions</title><p>Among the patients with presumed AIS who received preoperative whole-spine MRI, 6.3% had neural axis abnormalities. Males and patients with increased thoracic kyphosis were at a higher risk.</p></sec>
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Divi, Srikanth Naga, and Mark M. Mikhael. "Use of Allogenic Mesenchymal Cellular Bone Matrix in Anterior and Posterior Cervical Spinal Fusion: A Case Series of 21 Patients." Asian Spine Journal 11, no. 3 (2017): 454–62. http://dx.doi.org/10.4184/asj.2017.11.3.454.
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<sec><title>Study Design</title><p>Retrospective case series.</p></sec><sec><title>Purpose</title><p>To report our early experience using allogenic mesenchymal cellular bone matrix (CBM) products in cervical spine fusion.</p></sec><sec><title>Overview of Literature</title><p>Multi-level cervical fusions have historically yielded lower fusion rates than single level fusions, especially in patients with high risk medical comorbidities. At this time, significant literature in cervical fusion outcomes with this cellular allograft technology is lacking.</p></sec><sec><title>Methods</title><p>Twenty-one patients underwent either multilevel (3 or 4 level) anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, or posterior cervical fusion. ViviGen (DePuy Synthes Spine, Raynham, MA, USA), an allogenic bone matrix product, was used in addition to standard instrumentation. Radiographic evaluation was performed at 2 weeks, 12 weeks, 24 weeks and 1 year postoperative. Visual analog scale (VAS) and neck disability index (NDI) scores along with return to work and leisure activity were recorded.</p></sec><sec><title>Results</title><p>At 6 months postoperative, all patients had radiographic evidence of bone fusion regardless of age or medical comorbidities. All patients reported subjective improvement with a mean decrease in VAS from 8.3 to 1.5 and a mean decrease in NDI from 40.3% to 6.0% at 1 year. All patients also returned to work and/or regular leisure activity within 3 months.</p></sec><sec><title>Conclusions</title><p>Twenty-one patients undergoing high-risk anterior and posterior cervical spine fusion, with the use of a commercially available mesenchymal CBM product, went on to radiographic fusion and all had improvement in subjective outcomes. While further effort and research is needed to validate its widespread use, this study shows favorable use of CBM in cervical fusion for high-risk cases.</p></sec>
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Shaikh, Asra, Sohail Ahmed Khan, Munawar Hussain, et al. "Prevalence of Lumbosacral Transitional Vertebra in Individuals with Low Back Pain: Evaluation Using Plain Radiography and Magnetic Resonance Imaging." Asian Spine Journal 11, no. 6 (2017): 892–97. http://dx.doi.org/10.4184/asj.2017.11.6.892.
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<sec><title>Study Design</title><p>Descriptive cross-sectional study.</p></sec><sec><title>Purpose</title><p>To determine the frequency of lumbosacral transitional vertebrae (LSTV) in patients with low back pain (LBP) and the role of iliolumbar ligament (ILL) origin from L5 in LSTV cases.</p></sec><sec><title>Overview of Literature</title><p>Transitional vertebrae are developmental variants of the spine. LSTV is a common congenital abnormality, and failure to recognize this anomaly may result in serious consequences during surgery.</p></sec><sec><title>Methods</title><p>All patients aged 11–90 years of either gender with LBP for any duration, who presented for X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine, were included. X-rays of the lumbosacral spine in anteroposterior and lateral views were acquired. In addition, T1- and T2-weighted sagittal and axial MRI was performed. Images were evaluated on a workstation.</p></sec><sec><title>Results</title><p>Of 504 patients, transitional vertebrae were observed in 75 patients (15%). Among them, 39 (52%) patients had Castellvi type III and 36 (48%) patients had Castellvi type II. However, on MRI, 42 (56%) patients had O'Driscoll type II, 18 (24%) patients had O'Driscoll type IV, and 15 patients (20%) had O'Driscoll type III. ILL origin from L5 was significantly higher (n=429, 100%) among patients with a normal lumbosacral junction than among patients with a transitional lumbosacral junction (n=22, 29.3%) (p&lt;0.001).</p></sec><sec><title>Conclusions</title><p>LSTV occurs at a high frequency in patients with LBP. Furthermore, in the presence of LSTV, the ILL is not a reliable marker for the identification of L5.</p></sec>
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Tisot, Rodrigo Arnold, Juliano da Silveira Vieira, Renato Tadeu dos Santos, et al. "Burst fracture of the thoracolumbar spine: correlation between kyphosis and clinical result of the treatment." Coluna/Columna 14, no. 2 (2015): 129–33. http://dx.doi.org/10.1590/s1808-185120151402146349.
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<sec><title>OBJECTIVE:</title><p> To evaluate the correlation between kyphosis due to burst fractures of thoracic and lumbar spine and clinical outcome in patients undergoing conservative or surgical treatment.</p></sec><sec><title>METHODS:</title><p> A retrospective, cross-sectional study was conducted with 29 patients with thoracolumbar burst fractures treated by the Spine Group in a trauma reference hospital between the years 2002 and 2011. Patients were followed-up as outpatients for a minimum of 24 months. All cases were clinically evaluated by Oswestry and SF-36 quality of life questionnaires and the visual analogue scale (VAS) of pain. They were also evaluated by X-ray examinations and CT scans of the lumbosacral spine at the time of hospitalization and subsequently as outpatients by Cobb method for measuring the degree of kyphosis.</p></sec><sec><title>RESULTS:</title><p> There was no statistically significant correlation between the degree of initial kyphosis and clinical outcome measured by VAS and by most of the SF-36 domains in both patients treated conservatively and the surgically treated. The Oswestry questionnaire showed benefits for patients who received conservative treatment (p=0.047) compared to those surgically treated (p=0.335). The analysis of difference between initial and final kyphosis and final kyphosis alone in relation to clinical outcome showed no statistical correlation in any of the scores used.</p></sec><sec><title>CONCLUSION:</title><p> The clinical outcome of treatment of the thoracic and lumbar burst fractures was not influenced by a greater or lesser degree of initial or residual kyphosis, regardless of the type of treatment.</p></sec>
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Choi, Jee-Hye, Paul J. Park, Vuthy Din, Nang Sam, Vycheth Iv, and Kee B. Park. "Epidemiology and Clinical Management of Traumatic Spine Injuries at a Major Government Hospital in Cambodia." Asian Spine Journal 11, no. 6 (2017): 908–16. http://dx.doi.org/10.4184/asj.2017.11.6.908.
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<sec><title>Study Design</title><p>Cross sectional study.</p></sec><sec><title>Purpose</title><p>To characterize the pattern of injury, describe the current clinical management, and determine the outcomes in traumatic spine injury (TSI) patients presenting to a major government hospital in Phnom Penh, Cambodia.</p></sec><sec><title>Overview of Literature</title><p>There is a paucity of literature on epidemiology or current clinical practices for TSIs in Cambodia. The findings from this study can thus serve as a valuable resource for future progress in treating TSIs in low-income countries.</p></sec><sec><title>Methods</title><p>This study was a cross-sectional study of TSI patients admitted to Preah Kossamak Hospital in Phnom Penh, Cambodia. Demographics, cause of spinal injury, spinal level of injury, surgical procedures and techniques, complications, and American Spinal Injury Association (ASIA) grades were recorded and analyzed.</p></sec><sec><title>Results</title><p>Eighty patients were admitted with TSI between October 2013 and June 2014. Falls from heights were the most common cause of TSI, followed by road traffic accidents. 78% of the admitted patients underwent at least one surgical procedure. Without intraoperative imaging, 4 patients (6%) had wrong level surgery, and 1 patient (2%) had misplacement of pedicle screws. Sacral decubitus ulcers were the most common non-surgically related complication. Antibiotics were administered to &gt;90% of patients. There were no in-hospital mortalities. Of the 60 spinal cord injury (SCI) patients, 32% (19/60) showed improvement in their ASIA grade at the time of discharge, and 52% (31/60) showed no change. At follow-up, 32% (19/60) of SCI patients reported improvement, and 8% (5/60) reported no change. However, 36 SCI patients (60%) were lost to follow-up.</p></sec><sec><title>Conclusions</title><p>Despite technological limitations, outcomes of TSI patients in Cambodia appear favorable with evidence of clinical improvement and low mortality.</p></sec>
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Acar, Nihat. "Behavior of Injured Lamina in Lumbar Burst Fractures during Reduction Maneuvers: A Biomechanical Study." Asian Spine Journal 11, no. 4 (2017): 507–12. http://dx.doi.org/10.4184/asj.2017.11.4.507.
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<sec><title>Study Design</title><p>An experimental biomechanical study.</p></sec><sec><title>Purpose</title><p>This study aims to investigate the behavior of a lamina injury in lumbar burst fractures during reduction maneuvers.</p></sec><sec><title>Overview of Literature</title><p>Lumbar burst fractures are frequently accompanied by a lamina fracture. Many researchers concluded that any reduction maneuver will close the fractured lamina edges and possibly crush the entrapped neural elements. This conclusion did not rely on solid biomechanical trials and was based primarily on clinical experience.</p></sec><sec><title>Methods</title><p>Eighteen fresh-frozen lamb spines were randomly divided into three groups. Using the preinjury and the dropped-mass technique, a burst fracture model was developed. A central laminectomy of 5 mm of the L3 lumbar spine was created to mimic a complete type of lamina fracture. To measure the movement of the fractured laminar edges, two holes were drilled on both sides of the upper and lower regions of the lamina to allow for optic marker placement. A single specific spine movement was applied to each group: traction, flexion, and extension. Gap changes were measured by camera extensometers.</p></sec><sec><title>Results</title><p>After traction, the average values of the upper and lower aspects of the lamina interval showed narrowing of 1.65±0.82 mm and 1.97±1.14 mm, respectively. No statistical significance was detected between the two aspects. The upper and lower regions of the lamina gap behaved differently during extension. At 10°, 20°, and 30°, the upper part of the lamina interval was widened by an average of 0.016±0.024, 0.29±0.32, and 1.73±1.45 mm, respectively, whereas the lower part was narrowed by an average of 0.023±0.012, 0.47±0.038, and 1.94±1.46 mm, respectively.</p></sec><sec><title>Conclusions</title><p>Neural element crushing may take place, particularly at the lower aspect of the fractured lamina gap during extension and throughout the whole lamina gap during traction. The lamina gap widens during flexion. Reduction maneuvers should be attempted after exploring the fractured lamina to prevent further neurological compromise.</p></sec>
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Ortega-Porcayo, Luis Alberto, Andres Leal-López, Miroslava Elizabeth Soriano-López, et al. "Assessment of Paraspinal Muscle Atrophy Percentage after Minimally Invasive Transforaminal Lumbar Interbody Fusion and Unilateral Instrumentation Using a Novel Contralateral Intact Muscle-Controlled Model." Asian Spine Journal 12, no. 2 (2018): 256–62. http://dx.doi.org/10.4184/asj.2018.12.2.256.
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<sec><title>Study Design</title><p>Retrospective comparative clinical study.</p></sec><sec><title>Purpose</title><p>This study aimed to assess paraspinal muscle atrophy in patients who underwent minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and unilateral pedicle screw fixation using a novel contralateral intact muscle-controlled model.</p></sec><sec><title>Overview of Literature</title><p>The increased incidence of paravertebral lumbar muscle injuries after open techniques has raised the importance of implementing minimally invasive spine surgical techniques using tubular retractors and minimally invasive screw placement. The functional cross-sectional area (FCSA) represents the lean muscle mass; furthermore, FCSA is a useful marker of the contractile ability of a muscle following a spine surgery. However, the benefits of unilateral fixation and MI-TLIF on paraspinal muscles have not been defined.</p></sec><sec><title>Methods</title><p>We performed a retrospective imagenological review on eleven patients who underwent unilateral MI-TLIF and unilateral transpedicular screw lumbar placement. FCSAs of the multifidus and erector spinae were measured 1 year after surgery at adjacent levels and were compared to the contralateral intact muscles. Measurement differences between the surgical and nonsurgical sites were compared. The interobserver reliability was calculated using an intraclass correlation coefficient.</p></sec><sec><title>Results</title><p>The mean FCSA at the surgical site was 20.97±5.07 cm<sup>2</sup> at the superior level and 8.89±2.87 cm<sup>2</sup> at the inferior level. The mean FCSA at the contralateral nonsurgical site was 20.15±5.95 cm<sup>2</sup> at the superior level and 9.20±2.66 cm<sup>2</sup> at the inferior level was. The superior and inferior FCSA measurements showed no significant difference between the surgical and nonsurgical sites (<italic>p</italic>=0.5, <italic>p</italic>=0.922, respectively).</p></sec><sec><title>Conclusions</title><p>Using a mini-open tubular approach through the sulcus between the longissimus and iliocostalis, MI-TLIF and unilateral pedicle screw instrumentation produced minimal paraspinal muscle damage at the superior and inferior adjacent levels.</p></sec>
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Padhye, Kedar Prashant, Yuvaraja Murugan, Raunak Milton, N. Arunai Nambi Raj, and Kenny Samuel David. "The “Skipped Segment Screw” Construct: An Alternative to Conventional Lateral Mass Fixation–Biomechanical Analysis in a Porcine Cervical Spine Model." Asian Spine Journal 11, no. 5 (2017): 733–38. http://dx.doi.org/10.4184/asj.2017.11.5.733.
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<sec><title>Study Design</title><p>Cadaveric biomechanical study.</p></sec><sec><title>Purpose</title><p>We compared the “skipped segment screw” (SSS) construct with the conventional “all segment screw” (ASS) construct for cervical spine fixation in six degrees of freedom in terms of the range of motion (ROM).</p></sec><sec><title>Overview of Literature</title><p>Currently, no clear guidelines are available in the literature for the configuration of lateral mass (LM) screwrod fixation for cervical spine stabilization. Most surgeons tend to insert screws bilaterally at all segments from C3 to C6 with the assumption that implants at every level will provide maximum stability.</p></sec><sec><title>Methods</title><p>Six porcine cervical spine specimens were harvested from fresh 6–9-month-old pigs. Each specimen was sequentially tested in the following order: intact uninstrumented (UIS), SSS (LM screws in C3, C5, and C7 bilaterally), and ASS (LM screws in C3–C7 bilaterally). Biomechanical testing was performed with a force of 2 Nm in six degrees of freedom and 3D motion tracking was performed.</p></sec><sec><title>Results</title><p>The two-tailed paired <italic>t</italic>-test was used for statistical analysis. There was a significant decrease in ROM in instrumented specimens compared with that in UIS specimens in all six degrees of motion (<italic>p</italic>&lt;0.05), whereas there was no significant difference in ROM between the different types of constructs (SSS and ASS).</p></sec><sec><title>Conclusions</title><p>Because both configurations provide comparable stability under physiological loading, we provide a biomechanical basis for the use of SSS configuration owing to its potential clinical advantages, such as relatively less bulk of implants within a small operative field, relative ease of manipulating the rod into position, shorter surgical time, less blood loss, lower risk of screw-related complications, less implant-related costs, and most importantly, no compromise in the required stability needed until fusion.</p></sec>
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Lee, Gun Woo, Myun-Whan Ahn, Ji-Hoon Shin, et al. "A Sternum-Disk Distance Method to Identify the Skin Level for Approaching a Surgical Segment without Fluoroscopy Guidance during Anterior Cervical Discectomy And Fusion." Asian Spine Journal 11, no. 1 (2017): 50–56. http://dx.doi.org/10.4184/asj.2017.11.1.50.
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<sec><title>Study Design</title><p>A retrospective review of prospectively collected data.</p></sec><sec><title>Purpose</title><p>To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability.</p></sec><sec><title>Overview of Literature</title><p>Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported.</p></sec><sec><title>Methods</title><p>In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons.</p></sec><sec><title>Results</title><p>The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6–C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability).</p></sec><sec><title>Conclusions</title><p>Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.</p></sec>
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Toyoda, Hiromitsu, Hidetomi Terai, Kentaro Yamada, et al. "Prevalence of Diffuse Idiopathic Skeletal Hyperostosis in Patients with Spinal Disorders." Asian Spine Journal 11, no. 1 (2017): 63–70. http://dx.doi.org/10.4184/asj.2017.11.1.63.
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<sec><title>Study Design</title><p>Retrospective cohort study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in patients with spinal diseases determined by roentgen images of the whole spine.</p></sec><sec><title>Overview of Literature</title><p>Although several studies have investigated the prevalence of DISH in healthy subjects, no detailed data have been reported on the prevalence of DISH in patients with degenerative spinal disorders.</p></sec><sec><title>Methods</title><p>Standing whole-spine roentgen images of 345 consecutive patients who underwent surgery in our hospital were obtained. Patients aged &lt;18 years or with congenital spinal disease, metastatic spinal tumors, or inflammatory spinal disease were excluded. In total, 281 patients were eligible for inclusion. The presence of DISH was assessed according to Resnick's criteria and Mata's scoring system. The prevalence, location, and numbers of fused vertebral bodies of DISH were recorded.</p></sec><sec><title>Results</title><p>DISH was present in 25.6% of patients (72/281). The prevalence of DISH in the 41–49, 50–59, 60–69, 70–79, and ≥80 year age groups was 8.3% (2/24), 9.8% (5/51), 16.0% (12/75), 49.5% (48/97), and 33.3% (4/12), respectively; the prevalence increased with age. The average number of fused vertebral bodies was 7.5. More than 80% of DISH was located from T7 to T11, and more than 95% of DISH was located at T9/10. Patients with DISH were significantly older (71.1 years vs. 60.9 years, <italic>p</italic>&lt;0.05), and men were more likely to have DISH than women (<italic>p</italic>&lt;0.05).</p></sec><sec><title>Conclusions</title><p>In patients with degenerative spinal diseases with DISH, fused vertebrae were found most frequently in the lower thoracic spine, and their prevalence increased with age. DISH may be an age-related skeletal disorder with a higher overall prevalence in patients with spinal disorders than that in healthy subjects.</p></sec>
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Patil, Nirmal D., Sudhir K. Srivastava, Sunil Bhosale, and Shaligram Purohit. "Computed Tomography- and Radiography-Based Morphometric Analysis of the Lateral Mass of the Subaxial Cervical Spine in the Indian Population." Asian Spine Journal 12, no. 1 (2018): 18–28. http://dx.doi.org/10.4184/asj.2018.12.1.18.
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<sec><title>Study Design</title><p>This was a double-blinded cross-sectional study, which obtained no financial support for the research.</p></sec><sec><title>Purpose</title><p>To obtain a detailed morphometry of the lateral mass of the subaxial cervical spine.</p></sec><sec><title>Overview of Literature</title><p>The literature offers little data on the dimensions of the lateral mass of the subaxial cervical spine.</p></sec><sec><title>Methods</title><p>We assessed axial, sagittal, and coronal computed tomography (CT) cuts and anteroposterior and lateral X-rays of the lateral mass of the subaxial cervical spine of 104 patients (2,080 lateral masses) who presented to a tertiary care public hospital (King Edward Memorial Hospital, Mumbai) in a metropolitan city in India.</p></sec><sec><title>Results</title><p>For a majority of the parameters, males and females significantly differed at all levels (<italic>p</italic>&lt;0.05). Females consistently required higher (<italic>p</italic>&lt;0.05) minimum lateral angulation and lateral angulation. While the minimum lateral angulation followed the order of C5&lt;C4&lt;C6&lt;C3, the lateral angulation followed the order of C3&lt;C5&lt;C4&lt;C6. The lateral mass becomes longer and narrower from C3 to C7. In axial cuts, the dimensions increased from C3 to C6. The sagittal cut thickness and diagonal length increased and the sagittal cut height decreased from C3 to C7. The sagittal cut height was consistently lower in the Indian population at all levels, especially at the C7 level, as compared with the Western population, thereby questioning the acceptance of a 3.5-mm lateral mass screw. A good correlation exists between X-ray- and CT-based assessments of the lateral mass.</p></sec><sec><title>Conclusions</title><p>Larger lateral angulation is required for Indian patients, especially females. The screw length can be effectively calculated by analyzing the lateral X-ray. A CT scan should be reserved for specific indications, and a caution must be exercised while inserting C7 lateral mass screws.</p></sec>
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Buckland, Aaron J., Bryan M. Beaubrun, Evan Isaacs, et al. "Psoas Morphology Differs between Supine and Sitting Magnetic Resonance Imaging Lumbar Spine: Implications for Lateral Lumbar Interbody Fusion." Asian Spine Journal 12, no. 1 (2018): 29–36. http://dx.doi.org/10.4184/asj.2018.12.1.29.
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<sec><title>Study Design</title><p>Retrospective radiological review.</p></sec><sec><title>Purpose</title><p>To quantify the effect of sitting vs supine lumbar spine magnetic resonance imaging (MRI) and change in anterior displacement of the psoas muscle from L1–L2 to L4–L5 discs.</p></sec><sec><title>Overview of Literature</title><p>Controversy exists in determining patient suitability for lateral lumbar interbody fusion (LLIF) based on psoas morphology. The effect of posture on psoas morphology has not previously been studied; however, lumbar MRI may be performed in sitting or supine positions.</p></sec><sec><title>Methods</title><p>A retrospective review of a single-spine practice over 6 months was performed, identifying patients aged between 18–90 years with degenerative spinal pathologies and lumbar MRIs were evaluated. Previous lumbar fusion, scoliosis, neuromuscular disease, skeletal immaturity, or intrinsic abnormalities of the psoas muscle were excluded. The anteroposterior (AP) dimension of the psoas muscle and intervertebral disc were measured at each intervertebral disc from L1–L2 to L4–L5, and the AP psoas:disc ratio calculated. The morphology was compared between patients undergoing sitting and/or supine MRI.</p></sec><sec><title>Results</title><p>Two hundred and nine patients were identified with supine-, and 60 patients with sitting-MRIs, of which 13 patients had undergone both sitting and supine MRIs (BOTH group). A propensity score match (PSM) was performed for patients undergoing either supine or sitting MRI to match for age, BMI, and gender to produce two groups of 43 patients. In the BOTH and PSM group, sitting MRI displayed significantly higher AP psoas:disc ratio compared with supine MRI at all intervertebral levels except L1–L2. The largest difference observed was a mean 32%–37% increase in sitting AP psoas:disc ratio at the L4–L5 disc in sitting compared to supine in the BOTH group (range, 0%–137%).</p></sec><sec><title>Conclusions</title><p>The psoas muscle and the lumbar plexus become anteriorly displaced in sitting MRIs, with a greater effect noted at caudal intervertebral discs. This may have implications in selecting suitability for LLIF, and intra-operative patient positioning.</p></sec>
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Aygun, Hayati, Osman Yaray, and Muren Mutlu. "Does the Addition of a Dynamic Pedicle Screw to a Fusion Segment Prevent Adjacent Segment Pathology in the Lumbar Spine?" Asian Spine Journal 11, no. 5 (2017): 715–21. http://dx.doi.org/10.4184/asj.2017.11.5.715.
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<sec><title>Study Design</title><p>Retrospective clinical cohort study.</p></sec><sec><title>Purpose </title><p>To investigate whether the combined use of dynamic pedicle screws and polyaxial pedicle screws was effective on adjacent segment pathology (ASP).</p></sec><sec><title>Overview of Literature</title><p>Various screw and rod models have been recently developed for preventing adjacent segment disease, and hybrid systems have been described along with posterior instrumentation in the fusion segment. In the literature, although the success of dynamic systems has been demonstrated in non-fusion posterior instrumentation, it remains unclear whether the addition of a screw-based dynamic system to a fusion segment would successfully prevent ASP in the long term.</p></sec><sec><title>Methods</title><p>The study included 101 patients who underwent surgery for degenerative spine diseases between 2007 and 2014 with lumbar stabilization that used either polyaxial pedicle screws alone or polyaxial pedicle screws plus dynamic stabilization screws (with hinged screw heads). These two patient groups were compared using retrospectively obtained postoperative new clinical findings, Oswestry disability index (ODI) scores, visual analog scale (VAS) scores, and radiological data.</p></sec><sec><title>Results</title><p>The proportion of patients with ASP who were radiologically assessed was low (<italic>p</italic> &lt;0.01) in the group that underwent lumbar stabilization along with dynamic screws. Treatment outcomes were clinically successful in both groups according to ODI and VAS scores, and no significant difference was determined between the groups in terms of clinical ASP (<italic>p</italic> &gt;0.05).</p></sec><sec><title>Conclusions</title><p>Although the combined use of dynamic screws and the static system was radiologically found to be effective for preventing ASP in patients who underwent lumbar fusion with posterior instrumentation, it did not completely eliminate ASP or result in a significant improvement in clinical ASP.</p></sec>
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Jakoi, Ande M., Gurpal Pannu, Anthony D'Oro, et al. "The Clinical Correlations between Diabetes, Cigarette Smoking and Obesity on Intervertebral Degenerative Disc Disease of the Lumbar Spine." Asian Spine Journal 11, no. 3 (2017): 337–47. http://dx.doi.org/10.4184/asj.2017.11.3.337.
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<sec><title>Study Design</title><p>Retrospective analysis of a nationwide private insurance database. Chi-square analysis and linear regression models were utilized for outcome measures.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to investigate any relationship between lumbar degenerative disc disease, diabetes, obesity and smoking tobacco.</p></sec><sec><title>Overview of Literature</title><p>Diabetes, obesity, and smoking tobacco are comorbid conditions known to individually have effect on degenerative disc disease. Most studies have only been on a small populous scale. No study has yet to investigate the combination of these conditions within a large patient cohort nor have they reviewed the combination of these conditions on degenerative disc disease.</p></sec><sec><title>Methods</title><p>A retrospective analysis of insurance billing codes within the nationwide Humana insurance database was performed, using PearlDiver software (PearlDiver, Inc., Fort Wayne, IN, USA), to identify trends among patients diagnosed with lumbar disc degenerative disease with and without the associated comorbidities of obesity, diabetes, and/or smoking tobacco. Patients billed for a comorbidity diagnosis on the same patient record as the lumbar disc degenerative disease diagnosis were compared over time to patients billed for lumbar disc degenerative disease without a comorbidity. There were no sources of funding for this manuscript and no conflicts of interest.</p></sec><sec><title>Results</title><p>The total number and prevalence of patients (per 10,000) within the database diagnosed with lumbar disc degenerative disease increased by 241.4% and 130.3%, respectively. The subsets of patients within this population who were concurrently diagnosed with either obesity, diabetes, tobacco use, or a combination thereof, was significantly higher than patients diagnosed with lumbar disc degenerative disease alone (<italic>p</italic> &lt;0.05 for all). The number of patients diagnosed with lumbar disc degenerative disease and smoking rose significantly more than patients diagnosed with lumbar disc degenerative disease and either diabetes or obesity (<italic>p</italic> &lt;0.05). The number of patients diagnosed with lumbar disc degenerative disease, smoking and obesity rose significantly more than the number of patients diagnosed with lumbar disc degenerative disease and any other comorbidity alone or combination of comorbidities (<italic>p</italic> &lt;0.05).</p></sec><sec><title>Conclusions</title><p>Diabetes, obesity and cigarette smoking each are significantly associated with an increased diagnosis of lumbar degenerative disc disease. The combination of smoking and obesity had a synergistic effect on increased rates of lumbar degenerative disc disease. Patient education and preventative care is a vital goal in prevention of degenerative disc disease within the general population.</p></sec>
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Wu, Yaohong, Yachao Zhao, Linghan Lin, et al. "Fifty top-cited spine articles from mainland China: A citation analysis." Journal of International Medical Research 46, no. 2 (2017): 773–84. http://dx.doi.org/10.1177/0300060517713804.
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Objective To identify the 50 top-cited spine articles from mainland China and to analyze their main characteristics. Methods Web of Science was used to identify the 50 top-cited spine articles from mainland China in 27 spine-related journals. The title, year of publication, number of citations, journal, anatomic focus, subspecialty, evidence level, city, institution and author were recorded. Results The top 50 articles had 29–122 citations and were published in 11 English-language journals; most (32) were published in the 2000s. The journal Spine had the largest number of articles and The Lancet had the highest impact factor. The lumber spine was the most discussed anatomic area (18). Degenerative spine disease was the most common subspecialty topic (22). Most articles were clinical studies (29); the others were basic research (21). Level IV was the most common evidence level (17). Conclusions This list indicates the most influential articles from mainland China in the global spine research community. Identification of these articles provides insights into the trends in spine care in mainland China and the historical contributions of researchers from mainland China to the international spine research field.
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Fortin, Maryse, Octavian Dobrescu, Peter Jarzem, Jean Ouellet, and Michael H. Weber. "Quantitative Magnetic Resonance Imaging Analysis of the Cervical Spine Extensor Muscles: Intrarater and Interrater Reliability of a Novice and an Experienced Rater." Asian Spine Journal 12, no. 1 (2018): 94–102. http://dx.doi.org/10.4184/asj.2018.12.1.94.
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<sec><title>Study Design</title><p>Reliability study.</p></sec><sec><title>Purpose</title><p>To examine the reliability of novice and experienced raters for measurements of the size and composition of the cervical extensor muscles using a thresholding technique.</p></sec><sec><title>Overview of Literature</title><p>Although some authors have reported on the dependability of magnetic resonance imaging (MRI) measurements of the cervical muscles, there remains some variability regarding intrarater and interrater reliabilities, and few studies have examined the associated measurement error. Whether the rater's experience noticeably influences the reliability and precision of such measurements has also not been examined.</p></sec><sec><title>Methods</title><p>A sample of 10 patients with cervical pathologies was selected. Muscle cross-sectional area (CSA), functional cross-sectional area (FCSA), and signal intensity of the cervical extensor muscles were acquired from axial T2-weighted MRIs by a novice and an experienced rater. All measurements were obtained twice, at least 5 days apart, while the raters were blinded to all earlier measurements.</p></sec><sec><title>Results</title><p>Interrater reliability estimates (intraclass correlation coefficients) varied between 0.84 and 0.99 for the novice rater and between 0.94 and 0.99 for the experienced rater, indicating excellent reliability. The standard error of measurement for the novice rater was, however, noticeably higher for all cervical muscle measurements. Most of the interrater estimates showed excellent agreement with the exception of CSA measurement of the semispinalis cervicis at C4–C7 and FCSA measurement of the multifidus and semispinalis cervicis at C4–C7, which showed poor interrater reliability.</p></sec><sec><title>Conclusions</title><p>The proposed method of investigating cervical muscle measurements was highly reliable; however, novice raters should receive adequate training before using this method for diagnostic, research, and clinical purposes.</p></sec>
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Nishizawa, Kazuya, Kanji Mori, Akira Nakamura, and Shinji Imai. "Novel Landmark for Cervical Pedicle Screw Insertion Point from Computed Tomography-Based Study." Asian Spine Journal 11, no. 1 (2017): 82–87. http://dx.doi.org/10.4184/asj.2017.11.1.82.
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<sec><title>Study Design</title><p>Cross-sectional study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate a novel landmark for the cervical pedicle screw insertion point.</p></sec><sec><title>Overview of Literature</title><p>To improve the accuracy of pedicle screw placement, several studies have employed the lateral mass, lateral vertical notch, and/or inferior articular process as landmarks; however, we often encounter patients in whom we cannot identify accurate insertion points for pedicle screws using these landmarks because of degenerative changes in the facet joints. The superomedial edge of the lamina is less affected by degenerative changes, and we hypothesized that it could be a new landmark for identifying an accurate cervical pedicle screw insertion point.</p></sec><sec><title>Methods</title><p>A total of 327 consecutive patients, who had undergone neck computed tomographic scanning for determination of neck disease in our institute, were included in the study. At first, the line was drawn parallel to the superior border of the pedicle in the sagittal plane and parallel to the vertical body in the coronal plane. The line was moved downward in 1-mm increments to the inferior border of the pedicle. We determined whether the line passing through the superomedial edge of the lamina (termed the “N-line”) was located between the superior and inferior borders of the pedicle in the sagittal plane.</p></sec><sec><title>Results</title><p>The percentages of N-lines located between the superior and inferior borders of the pedicle were 100% at C3, 100% at C4, 99% at C5, 96% at C6, and 97% at C7. The lower cervical spine has the higher N-line location.</p></sec><sec><title>Conclusions</title><p>The N-line was frequently located at the level of the pedicle of each cervical spine in the sagittal plane. The superomedial edge of the lamina could be a new landmark for the insertion point of the cervical pedicle screw.</p></sec>
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Ganesan, Sudhir, Anita Shankar Acharya, Ravi Chauhan, and Shankar Acharya. "Prevalence and Risk Factors for Low Back Pain in 1,355 Young Adults: A Cross-Sectional Study." Asian Spine Journal 11, no. 4 (2017): 610–17. http://dx.doi.org/10.4184/asj.2017.11.4.610.
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<sec><title>Study Design</title><p>Cross-sectional study.</p></sec><sec><title>Purpose</title><p>To evaluate the prevalence and various risk factors for low back pain (LBP) in young adults in India.</p></sec><sec><title>Overview of Literature</title><p>LBP is an emerging problem in adolescents, with an incidence that is the highest in the third decade of life worldwide. Various risk factors such as obesity, smoking, family history, stress, and exercise have been described in the literature. This study was conducted because of paucity of data in the Indian literature.</p></sec><sec><title>Methods</title><p>A total of 1,355 (741 males and 641 females) young Indian Administrative Service aspirants and medical postgraduate aspirants aged 18–35 years were enrolled in the study. The subjects completed a detailed, semi-structured questionnaire that gathered data regarding their sociodemographic profile and factors considered to be risk factors for LBP. Anthropometric measurements, including height and weight, were measured and body mass index was calculated.</p></sec><sec><title>Results</title><p>Most subjects (90.6%) were aged 20–29 years (mean, 24.49; range, 18–35 years). Results indicated that the following factors were associated with LBP in young adults: marital status, previous history of spine problems, strenuous exercise, job satisfaction, monotony, stress, daily number of studying hours, and family history of spine problems (<italic>p</italic>&lt;0.05). However, age, sex, smoking, alcoholism, coffee intake, mode and duration of travel, diet, frequency of weightlifting, wearing heels, studying posture, and frequency and type of sports activities were not associated with LBP.</p></sec><sec><title>Conclusions</title><p>The study identified various modifiable and non-modifiable risk factors that precipitated LBP in young adult Indians. Identifying these risk factors at an early stage will prevent LBP progression to a chronic disease state, thereby improving an individual's quality of life and increasing productivity.</p></sec>
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Kumar, Sachin, Satish Kumar, Rajender Kumar Arya, and Avinash Kumar. "Thoracolumbar Vertebral Injuries with Neurological Deficit Treated with Posterior Decompression, Short Segment Pedicle Screw Fixation, and Interlaminar Fusion." Asian Spine Journal 11, no. 6 (2017): 951–58. http://dx.doi.org/10.4184/asj.2017.11.6.951.
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<sec><title>Study Design</title><p>Prospective clinical study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate the effect of interlaminar fusion and short segment pedicle screw fixation on thoracolumbar vertebral injuries for preventing pain and post-traumatic kyphosis.</p></sec><sec><title>Overview of Literature</title><p>The treatment of thoracolumbar injuries continues to be one of the most controversial areas in spine care. The main aim of surgical treatment is to decompress the spinal cord or nerve roots, realign the spine, and correct or prevent post-traumatic kyphosis. We evaluated the outcome of interlaminar fusion along with posterior decompression and short segment pedicle screw fixation in patients with thoracolumbar fractures with neurological deficit.</p></sec><sec><title>Methods</title><p>Twenty-two patients with traumatic thoracolumbar vertebral injuries and neurological deficit underwent short segment pedicle screw fixation above and below the fractured vertebrae, posterior decompression, and interlaminar fusion using a bone graft.</p></sec><sec><title>Results</title><p>All patients were followed up for 12 months postoperatively. The average operative time and blood loss was 142 minutes and 214 mL, respectively. Of the 22 patients, 14 recovered completely. Of the nine patients with American Spinal Injury Association (ASIA) grade A disease, two improved by 1 grade, whereas one each improved by grades 2, 3, and 4, and four did not recover. Radiologically, vertebral kyphosis angle improved from 20.91 preoperatively to 15.73 postoperatively, sagittal index improved from 24.77 to 18.73, the sagittal plane kyphosis angle improved from 17.45 to 11.41, regional angle kyphosis improved from 14.73 to 10.14, the superior inferior end plate angle from 16.14 to 13.00, and mean anterior body compression improved from 36.26 to 27.64 postoperatively. No implant failed and no patient had neurological deterioration.</p></sec><sec><title>Conclusions</title><p>Short segment pedicle screw fixation with posterior decompression and interlaminar fusion provided considerable reduction in kyphosis, restored the vertebral height of patients with thoracolumbar vertebral injuries and neurological deficit, and prevented development of delayed kyphotic deformity.</p></sec>
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Reisener, Marie-Jacqueline, Alexander P. Hughes, Paul Schadler, et al. "Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users." Asian Spine Journal 14, no. 5 (2020): 663–72. http://dx.doi.org/10.31616/asj.2020.0114.
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<sec><title>Study Design</title><p>Matched cohort study.</p></sec><sec><title>Purpose</title><p>To compare and describe the effect of opioid usage on the expectations of lumbar surgery outcomes among patients taking opioids and patients not taking opioids.</p></sec><sec><title>Overview of Literature</title><p>Chronic opioid use is common among lumbar-spine surgery patients. The decision to undergo elective lumbar surgery is influenced by the expected surgery outcomes. However, the effects of opioids on patients’ expectations of lumbar surgery outcomes remain to be rigorously assessed.</p></sec><sec><title>Methods</title><p>A total of 77 opioid users grouped according to dose and duration (54 “higher users,” 30 “lower users”) were matched 2:1 to 154 non-opioid users based on age, sex, marital status, chiropractic care, disability, and diagnosis. All patients completed a validated 20-item Expectations Survey measuring expected improvement with regard to symptoms, function, psychological well-being, and anticipated future spine condition. “Greater expectations” was defined as a higher survey score (possible range, 0–100) based on the number of items expected and degree of improvement expected.</p></sec><sec><title>Results</title><p>The mean Expectations Survey scores for all opioid users and all non-users were similar (73 vs. 70, <italic>p</italic>=0.18). Scores were different, however, for lower users (79) compared with matched non-users (69, <italic>p</italic>=0.01) and compared with higher users (70, <italic>p</italic>=0.01). In multivariable analysis, “greater expectations” was independently associated with having had chiropractic care (<italic>p</italic>=0.03), being more disabled (<italic>p</italic>=0.002), and being a lower-dose opioid user (<italic>p</italic>=0.03). Compared with higher users, lower users were also more likely to expect not to need pain medications 2 years after surgery (47% vs. 83%, <italic>p</italic>=0.003).</p></sec><sec><title>Conclusions</title><p>Patient expectations of lumbar surgery are associated with diverse demographic and clinical variables. A lower dose and shorter duration of opioid use were associated with expecting more items and expecting more complete improvement compared with non-users. In addition, lower opioid users had greater overall expectations compared with higher users.</p></sec>
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WILLIAMS, R. B., and BERNADETTE G. CALLERY. "The states and printing history (1861–1864) of John Henry Gurney's A descriptive catalogue of the raptorial birds in the Norfolk and Norwich Museum." Archives of Natural History 35, no. 2 (2008): 339–59. http://dx.doi.org/10.3366/e0260954108000429.
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The first and only part published of A descriptive catalogue of the raptorial birds in the Norfolk and Norwich Museum by John Henry Gurney (senior) is usually dated 1864. But a copy with a variant title-page dated 1861 exists, raising the question of whether there are two editions or issues. Typographical errors indicate that all copies, whatever dated, constitute a single impression from one type setting. All copies dated 1864 have a cancelled title-leaf. The copy dated 1861 is apparently unique, an accidental survival that escaped the cancellation; its title-page never appeared in commercially available copies. Printing of the whole book, on three batches of paper, was demonstrated by internal evidence to have been protracted over three years from 1861 to 1864. Therefore, there is only one edition, published in 1864, with the title-page in two states. This study demonstrates how differences between batches of printing-paper can facilitate recognition of cancelled conjugate pairs of leaves that would otherwise be undetectable unless a copy without the cancellation were found. Examination of the cloth types, spine titles, endpapers and various printed insertions, indicates that probably two different casings of the whole edition were carried out simultaneously, rather than consecutively, contrary to the usual practice of Victorian publishers. The surviving original manuscript suggests that the protracted printing resulted from indecision about some taxonomic and nomenclatural points; but complications in Gurney's private life probably also contributed. No further parts of the catalogue were published, probably because of Gurney's disastrous business problems between 1866 and 1869. The potential relevance of the book to avian nomenclature is appraised.
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Kuhns, Craig A., Jonathan A. Harris, Mir M. Hussain, Aditya Muzumdar, Brandon S. Bucklen, and Saif Khalil. "Evaluation of Two Novel Integrated Stand-Alone Spacer Designs Compared with Anterior and Anterior-Posterior Single-Level Lumbar Fusion Techniques: An <italic>In Vitro</italic> Biomechanical Investigation." Asian Spine Journal 11, no. 6 (2017): 854–62. http://dx.doi.org/10.4184/asj.2017.11.6.854.
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<sec><title>Study Design</title><p><italic>In vitro</italic> biomechanical investigation.</p></sec><sec><title>Purpose</title><p>To compare the biomechanics of integrated three-screw and four-screw anterior interbody spacer devices and traditional techniques for treatment of degenerative disc disease.</p></sec><sec><title>Overview of Literature</title><p>Biomechanical literature describes investigations of operative techniques and integrated devices with four dual-stacked, diverging interbody screws; four alternating, converging screws through a polyether-ether-ketone (PEEK) spacer; and four converging screws threaded within the PEEK spacer. Conflicting reports on the stability of stand-alone devices and the influence of device design on biomechanics warrant investigation.</p></sec><sec><title>Methods</title><p>Fourteen cadaveric lumbar spines were divided randomly into two equal groups (n=7). Each spine was tested intact, after discectomy (injured), and with PEEK interbody spacer alone (S), anterior lumbar plate and spacer (AP+S), bilateral pedicle screws and spacer (BPS+S), circumferential fixation with spacer and anterior lumbar plate supplemented with BPS, and three-screw (SA3s) or four-screw (SA4s) integrated spacers. Constructs were tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). Researchers performed one-way analysis of variance and independent <italic>t</italic>-testing (<italic>p</italic>≤0.05).</p></sec><sec><title>Results</title><p>Instrumented constructs showed significantly decreased motion compared with intact except the spacer-alone construct in FE and AR (<italic>p</italic>≤0.05). SA3s showed significantly decreased range of motion (ROM) compared with AP+S in LB (<italic>p</italic>≤0.05) and comparable ROM in FE and AR. The three-screw design increased stability in FE and LB with no significant differences between integrated spacers or between integrated spacers and BPS+S in all loading modes.</p></sec><sec><title>Conclusions</title><p>Integrated spacers provided fixation statistically equivalent to traditional techniques. Comparison of three-screw and four-screw integrated anterior lumbar interbody fusion spacers revealed no significant differences, but the longer, larger-diameter interbody spacer with three-screw design increased stabilization in FE and LB; the diverging four-screw design showed marginal improvement during AR.</p></sec>
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Chaves, Bernardo José Moreira, Luis Eduardo Carelli Teixeira da Silva, Luis Antonio Medeiros Moliterno, and Renato Tavares. "Interobserver evaluation of TLICS system to treat thoracolumbar fractures." Coluna/Columna 14, no. 2 (2015): 125–28. http://dx.doi.org/10.1590/s1808-185120151402114422.
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<sec><title>OBJECTIVE:</title><p> To evaluate the interobserver agreement regarding the TLICS Classification (Thoracolumbar Injury Classification and Severity Score). Furthermore, evaluate the reliability, analyzing the correlation between the treatment indicated by TLICS system (surgical or conservative) and the treatment indicated by each evaluator surgeon.</p></sec><sec><title>METHODS:</title><p> Imaging tests and clinical data of 22 patients with thoracolumbar fractures were analyzed by eight spine surgeons, and two main analyzes were performed: the first compared the interobserver agreement related to TLICS and the second compared the agreement between the treatment indicated by TLICS classification (surgical or conservative) and treatment indicated by each surgeon - based on his personal experience and the preferred classification.</p></sec><sec><title>RESULTS:</title><p> Using the parameters of Landis and Koch for interpretation of Kappa value, the interobserver agreement of TLICS classification was considered moderate in our study (K=0.6). The agreement between the indications of treatment (surgical or conservative) dictated by the classification and the indication of each surgeon was considered excellent, with kappa value of 0.89.</p></sec><sec><title>CONCLUSION:</title><p> We believe that the classification is a good tool for the evaluation and the treatment indication in thoracolumbar fractures.</p></sec>
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Eguchi, Yawara, Satoshi Iida, Chiho Suzuki, et al. "Spinopelvic Alignment and Low Back Pain after Total Hip Replacement Arthroplasty in Patients with Severe Hip Osteoarthritis." Asian Spine Journal 12, no. 2 (2018): 325–34. http://dx.doi.org/10.4184/asj.2018.12.2.325.
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<sec><title>Study Design</title><p>Retrospective observational study.</p></sec><sec><title>Purpose</title><p>We examined change in lumbrosacral spine alignment and low back pain (LBP) following total hip arthroplasty (THA) in patients with severe hip osteoarthritis (OA).</p></sec><sec><title>Overview of Literature</title><p>Severe hip osteoarthritis has been reported to cause spine alignment abnormalities and low back pain, and it has been reported that low back pain is improved following THA.</p></sec><sec><title>Methods</title><p>Our target population included 30 patients (29 female, mean age 63.5 years) with hip OA who underwent direct anterior approach THA. There were 12 cases with bilateral hip disease and 18 cases with unilateral osteoarthritis. Visual analogue scale (VAS) scores for LBP and coxalgia, the Roland-Morris Disability Questionnaire (RDQ), and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were assessed before and after surgery. Spinal alignment metrics were measured before and after surgery.</p></sec><sec><title>Results</title><p>VAS for LBP change from preoperative to final postoperative observation was significantly improved (p &lt;0.05), as was VAS for hip pain (<italic>p</italic>&lt;0.001). RDQ improved significantly (<italic>p</italic>&lt;0.01). All five domains of JOABPEQ were significantly improved (<italic>p</italic>&lt;0.05). In terms of coronal alignment, lumbar scoliosis change from preoperative to last observation was significantly reduced (<italic>p</italic>&lt;0.05). There were no significant changes in the sagittal alignment metrics. In addition, there was a correlation between before and after RDQ difference and before and after lumbar scoliosis difference (<italic>p</italic>&lt;0.05). VAS for LBP (<italic>p</italic>&lt;0.05) as well as RDQ (<italic>p</italic>&lt;0.05) were significantly improved only in unilateral OA. Lumbar scoliosis was significantly improved in cases of unilateral OA (<italic>p</italic>&lt;0.05), but alignment did not improve in cases of bilateral OA (<italic>p</italic>=0.29).</p></sec><sec><title>Conclusions</title><p>The present study demonstrates improvements in VAS for LBP, RDQ, and all domains of JOABPEQ. There were also significant reductions in lumbar scoliosis and an observed correlation of RDQ improvement with lumbar scoliosis improvement. We were able to observe improvements in lumbar scoliosis and low back pain only in cases of unilateral OA. It has been suggested that the mechanism of low back pain improvement following THA is related to compensatory lumbar scoliosis improvement.</p></sec>
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Bazán, Pedro Luis. "Significance of SCIWORA in adults." Coluna/Columna 14, no. 2 (2015): 134–37. http://dx.doi.org/10.1590/s1808-1851201514020r130.
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<sec><title>OBJECTIVE:</title><p> Recognizing the importance of SCIWORA in adult age; analyze the usefulness of complementary studies; evaluating therapeutic options; learn about the evolution of the treated patients.</p></sec><sec><title>METHODS:</title><p> A prospective evaluation with a minimum follow-up of 5 years, eight elderly patients with cervical arthrosis and diagnosis of SCIWORA. The Japanese Orthopaedic Association (JOA) scale and ASIA were used on admission and at 6, 12, 24, 36, 48 and 60 months.</p></sec><sec><title>RESULTS:</title><p> The central cord syndrome (CCS) was the neurological condition at admission. One patient recovered after corticosteroid therapy, but later, his disability worsened, and he was operated at 18 months, another patient recovered and a third died. The other patients underwent laminoplasty in the first 72 hours; patients with partial severity condition had a minimum improvement of five points in JAO scale and those with severe conditions died.</p></sec><sec><title>CONCLUSIONS:</title><p> The low-energy trauma can decompensate the relationship between container and content in the spine with asymptomatic arthrosis, and can be devastating to the patient. The diagnosis of intramedullary lesion is made by magnetic resonance imaging. Patients with incomplete deficit undergoing laminoplasty reached at least one level in ASIA score. The potential postoperative complications can be serious.</p></sec>
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Queruz, Jean Carlo Frigotto, Allan Kato, Carlos Abreu de Aguiar, Luiz Muller Avila, and Luis Eduardo Munhoz da Rocha. "Evaluation of idiopathic scoliosis by anterior and posterior arthrodesis." Coluna/Columna 14, no. 2 (2015): 88–92. http://dx.doi.org/10.1590/s1808-185120151402145201.
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<sec><title>OBJECTIVE:</title><p> To evaluate comparatively surgical treatment of adolescent idiopathic scoliosis type 5CN by anterior and posterior approach.</p></sec><sec><title>METHODS:</title><p> The study consists of a comparative retrospective study of two groups of patients with the thoracolumbar spine arthrodesis technique by anterior and posterior approach. Twenty and two patients were sequentially selected, 11 operated by anterior approach - called Group I - and 11 by posterior approach - Group II. Anamnesis and physical examination were performed, as well as length of hospital stay and ICU stay, degree of correction, comorbidities and pre and postoperative radiographic images data were gathered.</p></sec><sec><title>RESULTS:</title><p> The mean age was 13.7 years in Group I and 14 years in Group II. The average hospital stay was 5.81 days for Group I and 5 for Group II. The average ICU stay was 2.81 and 2 days, respectively. Considering the operated levels, Group I presented an average of 4.81 vertebrae (4-6 levels), and Group II presented an average of 6.36 vertebrae (5-11 levels). Complications did not show statistically significant difference.</p></sec><sec><title>CONCLUSION:</title><p> Despite the limited number of patients in groups, it was demonstrated that the posterior approach reduces the number of days of hospitalization and ICU stay. However, it was found increased levels included in the arthrodesis.</p></sec>
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Aoude, Ahmed, Sultan Aldebeyan, Maryse Fortin, et al. "Prevalence and Complications of Postoperative Transfusion for Cervical Fusion Procedures in Spine Surgery: An Analysis of 11,588 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database." Asian Spine Journal 11, no. 6 (2017): 880–91. http://dx.doi.org/10.4184/asj.2017.11.6.880.
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<sec><title>Study Design</title><p>Retrospective cohort study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to assess the rate of blood transfusion after cervical fusion surgery, and its effect on complication rates.</p></sec><sec><title>Overview of Literature</title><p>Cervical spine fusions have gained interest in the literature since these procedures are now ever more frequently being performed in an outpatient setting with few complications.</p></sec><sec><title>Methods</title><p>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent cervical fusion from 2010 to 2013. Multivariate regression analysis was used to determine postoperative complications associated with transfusion and cervical fusion.</p></sec><sec><title>Results</title><p>We identified 11,588 patients who had cervical fusion between 2010 and 2013. The rate of blood transfusion following cervical fusion found to be 1.47%. All transfused patients were found to have increased risk of venous thromboembolism (TBE) (odds ratio [OR], 3.19; 95% confidence interval [95% CI], 1.16–8.77), myocardial infarction (MI) (OR, 9.12; 95% CI, 2.53–32.8), increased length of stay (LOS) (OR, 28.03; 95% CI, 14.28–55.01) and mortality (OR, 4.14; 95% CI, 1.44–11.93). Single level fusion had increased risk of TBE (OR, 3.37; 95% CI, 1.01–11.33), MI (OR, 10.5; 95% CI, 1.88–59.89), and LOS (OR, 14.79; 95% CI, 8.2–26.67). Multilevel fusion had increased risk of TBE (OR, 5.64; 95% CI, 1.15–27.6), surgical site infection (OR, 16.29; 95% CI, 3.34–79.49), MI (OR, 10.84; 95% CI, 2.01–58.55), LOS (OR, 26.56; 95% CI, 11.8–59.78), and mortality (OR, 10.24; 95% CI, 2.45–42.71). Patients who had anterior cervical discectomy and fusion surgery and received a transfusion had an increased risk of TBE (OR, 4.87; 95% CI, 1.04–22.82), surgical site infection (OR, 9.73; 95% CI, 2.14–44.1), MI (OR, 9.88; 95% CI, 1.87–52.2), increased LOS of more than 2 days (OR, 28.34; 95% CI, 13.79–58.21) and increase in mortality (OR, 6.3; 95% CI, 1.76–22.48). While, transfused patients who had posterior fusion surgery had increased risk of MI (OR, 10.45; 95% CI, 1.42–77.12) and increased LOS of more than 6 days (OR, 4.42; 95% CI, 2.68–7.29).</p></sec><sec><title>Conclusions</title><p>Our results demonstrate that although cervical fusions can be done as outpatient procedures special precautions and investigations should be done for patients who receive transfusion after cervical fusion. These patients are demonstrated to have higher rate of MI, TBE, wound infection and mortality when compared to those who do not receive transfusion.</p></sec>
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Bekhterev, V. "About fusion or stiffness of the spinal column, as a special form of disease." Neurology Bulletin V, no. 1 (2020): 147–59. http://dx.doi.org/10.17816/nb46647.
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In 1892 I published in Physician and in Neurol. Centralbl. work under the title: "Stiffness of the spine with its curvature, as a special form of the disease in which, on the basis of five observations presented to me, I tried to find out the symptomatology of a special and still very little known in the neuropathological literature of immobility of pain behind or of the spinal column and a whole series of nervous disorders characteristic of this form of the disease.
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Altun, Idiris, and Kasım Zafer Yüksel. "Histopathological Analysis of Ligamentum Flavum in Lumbar Spinal Stenosis and Disc Herniation." Asian Spine Journal 11, no. 1 (2017): 71–74. http://dx.doi.org/10.4184/asj.2017.11.1.71.
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<sec><title>Study Design</title><p>Histopathological analyses were performed in ligamentum flavum (LF) hypertrophy patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH).</p></sec><sec><title>Purpose</title><p>The aim of the present study was to evaluate histopathological changes in LF patients with LSS and LDH.</p></sec><sec><title>Overview of Literature</title><p>LSS is the most common spinal disorder in elderly patients. This condition causes lower back and leg pain and paresis, and occurs as a result of degenerative changes in the lumbar spine, including bulging of the intervertebral discs, bony proliferation of the facet joints, and LF thickening; among these, LF thickening is considered a major contributor to the development of LSS.</p></sec><sec><title>Methods</title><p>A total of 71 patients operated with the surgical indications of LSS and LDH were included. LF samples were obtained from 31 patients who underwent decompressive laminectomy for symptomatic degenerative LSS (stenotic group) and from 40 patients who underwent lumbar discectomy for LDH (discectomy group). LF materials were examined histopathologically, and other specimens were examined for collagen content, elastic fiber number and array, and presence of calcification.</p></sec><sec><title>Results</title><p>The stenotic and discectomy groups did not differ with regard to mean collagen concentration or mean elastic fiber number (p=0.430 and p=0.457, respectively). Mean elastic fiber alignment was 2.36±0.99 in the stenotic group and 1.38±0.54 in the discectomy group (<italic>p</italic>&lt;0.001). Mean calcification was 0.39±0.50 in the stenotic group, whereas calcification was not detected (0.00±0.00) in the discectomy group; a statistically significant difference was detected (<italic>p</italic>&lt;0.001) between groups.</p></sec><sec><title>Conclusions</title><p>LF hypertrophy in spinal stenosis may occur as a result of elastic fiber misalignment along with the development of calcification over time. Further studies determining the pathogenesis of LSS are needed.</p></sec>
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Pino-Almero, Laura, María Fe Mínguez-Rey, Rosa María Cibrián-Ortiz de Anda, María Rosario Salvador-Palmer, and Salvador Sentamans-Segarra. "Correlation between Topographic Parameters Obtained by Back Surface Topography Based on Structured Light and Radiographic Variables in the Assessment of Back Morphology in Young Patients with Idiopathic Scoliosis." Asian Spine Journal 11, no. 2 (2017): 219–29. http://dx.doi.org/10.4184/asj.2017.11.2.219.
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<sec><title>Study Design</title><p>Optical cross-sectional study.</p></sec><sec><title>Purpose</title><p>To study the correlation between asymmetry of the back (measured by means of surface topography) and deformity of the spine (quantified by the Cobb angle).</p></sec><sec><title>Overview of Literature</title><p>The Cobb angle is considered the gold standard in diagnosis and follow-up of scoliosis but does not correctly characterize the three-dimensional deformity of scoliosis. Furthermore, the exposure to ionizing radiation may cause harmful effects particularly during the growth stage, including breast cancer and other tumors.</p></sec><sec><title>Methods</title><p>Patients aged 13.15±1.96 years (range, 7–17 years; n=88) with Cobb angle greater than 10° were evaluated with X-rays and our back surface topography method through three variables: axial plane (DHOPI), coronal plane (POTSI), and profile plane (PC). Pearson's correlation was applied to determine the correlation between topographic and radiographic variables. One-way analysis of variance and Bonferroni correction were used to compare groups with different grades of scoliosis. Significance was set at <italic>p</italic>&lt;0.01 and, in some cases, at <italic>p</italic>&lt;0.05.</p></sec><sec><title>Results</title><p>We detected a positive, statistically significant correlation between Cobb angle with DHOPI (<italic>r</italic>=0.810) and POTSI (<italic>r</italic>=0.629) and between PC variables with thoracic kyphosis angle (<italic>r</italic>=0.453) and lordosis lumbar angle (<italic>r</italic>=0.275). In addition, we found statistically significant differences for DHOPI and POTSI variables according to the grade of scoliosis.</p></sec><sec><title>Conclusions</title><p>Although the back surface topography method cannot substitute for radiographs in the diagnosis of scoliosis, correlations between radiographic and topographic parameters suggest that it offers additional quantitative data that may complement radiologic study.</p></sec>
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Held, Michael F. G., Sven Hoppe, Maritz Laubscher, et al. "Epidemiology of Musculoskeletal Tuberculosis in an Area with High Disease Prevalence." Asian Spine Journal 11, no. 3 (2017): 405–11. http://dx.doi.org/10.4184/asj.2017.11.3.405.
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<sec><title>Study Design</title><p>Retrospective observational study.</p></sec><sec><title>Purpose</title><p>The aim of this study was to assess the distribution of age and site of infection in patients with musculoskeletal tuberculosis (TB) and determine the number of TB/human immunodeficiency virus (HIV) coinfections as well as the incidence of multidrugresistant (MDR) TB.</p></sec><sec><title>Overview of Literature</title><p>Of all TB cases, 1%–3% show skeletal system involvement and 30% are HIV coinfected. Although the reported distribution of skeletal TB is majorly in the spine, followed by the hip, knee, and foot/ankle, the epidemiology of extrapulmonary TB and especially musculoskeletal TB remains largely unknown, particularly in areas with a high prevalence of the disease.</p></sec><sec><title>Methods</title><p>This is a retrospective study of a consecutive series of patients admitted to a tertiary care facility in an area with the highest prevalence of TB worldwide. TB was confirmed on tissue biopsy with polymerase chain reaction testing (Xpert for Mycobacterium tuberculosis and rifampicin resistance), culturing, or histological analysis. Data were analyzed regarding demographic information, location of the disease, HIV coinfections, and drug resistance.</p></sec><sec><title>Results</title><p>In all, 125 patients (44 children; 35%) with a mean age of 27 years (range, 1–78 years) were included. Age peaks were observed at 5, 25, and 65 years. Spinal disease was evident in 98 patients (78%). There were 66 HIV-negative (53%) and 29 (23%) HIVpositive patients, and in 30 (24%), the HIV status was unknown. Five patients (4%) showed MDR TB.</p></sec><sec><title>Conclusions</title><p>The age distribution was trimodal, spinal disease was predominant, MDR TB rate in our cohort was high, and a large portion of TB patients in our hospital were HIV coinfected. Hence, spinal services with sufficient access to operating facilities are required for tertiary care facilities in areas with a high TB prevalence.</p></sec>
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Schadler, Paul, Jennifer Shue, Mohamed Moawad, et al. "Serotonergic Antidepressants Are Associated with Increased Blood Loss and Risk for Transfusion in Single-Level Lumbar Fusion Surgery." Asian Spine Journal 11, no. 4 (2017): 601–9. http://dx.doi.org/10.4184/asj.2017.11.4.601.
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<sec><title>Study Design</title><p>Retrospective case-control study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to examine the effect of antidepressants on blood loss and transfusion requirements in spinal surgery patients.</p></sec><sec><title>Overview of Literature</title><p>Several studies have shown an increase in perioperative bleeding in orthopedic surgery patients on antidepressant drug therapy, yet no study has examined the impact of these agents on spinal surgery patients.</p></sec><sec><title>Methods</title><p>Charts of patients who underwent single-level spinal fusion (posterior lumbar interbody fusion with posterior instrumentation) performed by five fellowship-trained surgeons at a tertiary spine center between 2008 and 2013, were retrospectively reviewed. Exclusion criteria included select medical comorbidities, select drug therapy, and Amercian Society of Anesthesiologists Physical Status Classification score of greater than 2. Serotonergic antidepressants were examined in multivariate analysis to assess their predictive value on estimated blood loss and risk of transfusion.</p></sec><sec><title>Results</title><p>A total of 235 patients, of which 52% were female, were included. Allogeneic blood was transfused in 7% of patients. The average estimated blood loss was 682±463 mL. Selective serotonin reuptake inhibitors were taken by 10% of all patients. Multivariable regression analysis showed that intake of selective serotonin reuptake inhibitors was a significant predictor for blood loss (average increase of 34%, <italic>p</italic>=0.015) and for the need of allogeneic blood transfusion (odds ratio, 4.550; <italic>p</italic>=0.029).</p></sec><sec><title>Conclusions</title><p>There was a statistically significant association between selective serotonin reuptake inhibitors and both increased blood loss and risk of allogeneic red blood cell transfusion. Surgeons and perioperative providers should take these findings into account when assessing patients' preoperative risk for blood loss and transfusion.</p></sec>