Showing papers in "European Spine Journal in 2012"
TL;DR: In this paper, a systematic review of pedicle screw insertion techniques in the thoracic and lumbar human spine was performed, where the authors performed a systematic search of all available prospective evidence.
Abstract: Introduction
With the advances and improvement of computer-assisted surgery devices, computer-guided pedicle screws insertion has been applied to the lumbar, thoracic and cervical spine. The purpose of the present study was to perform a systematic review of all available prospective evidence regarding pedicle screw insertion techniques in the thoracic and lumbar human spine.
518 citations
TL;DR: Comparison of clinical and radiological outcomes of single-level open versus minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) at 6 months and 2-year follow-up is reported on.
Abstract: Prospective observational cohort study. Comparison of clinical and radiological outcomes of single-level open versus minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) at 6 months and 2-year follow-up. There is recognition that more data are required to ascertain the benefits and risks of MIS vis-a-vis open TLIF. This study aims to report on one of the largest currently available series comparing the clinical and radiological outcomes of the two procedures with a minimum follow-up of 2 years. From January 2002 to March 2008, 144 single-level open and MIS TLIF were performed at our centre, with 72 patients in each group. Clinical outcomes were based on patient-reported outcome measures recorded at the Orthopaedic Diagnostic Centre by independent assessors before surgery, at 6 months and 2 years post-operatively. These were visual analogue scores (VAS) for back and leg pain, Oswestry disability index (ODI), short form-36 (SF-36), North American Spine Society (NASS) scores for neurogenic symptoms, returning to full function, and patient rating of the overall result of surgery. Radiological fusion based on the Bridwell grading system was also assessed at 6 months and 2 years post-operatively by independent assessors. In terms of demographics, the two groups were similar in terms of patient sample size, age, gender, body mass index (BMI), spinal levels operated, and all the clinical outcome measures (p > 0.05). Perioperative analysis revealed that MIS cases have comparable operative duration (open: 181.8 min, MIS: 166.4 min, p > 0.05), longer fluoroscopic time (open: 17.6 s, MIS: 49.0 s, p 50.0 %) and similarly in terms of VAS, ODI, SF-36, return to full function and patient rating (p > 0.05). Radiological analysis showed similar grade 1 fusion rates (open: 52.2 %, MIS: 59.4 %, p > 0.05) with small percentage of patients developing asymptomatic cage migration (open: 8.7 %, MIS: 5.8 %, p > 0.05). One major complication (open: myocardial infarction, MIS: screw malpositioning requiring subsequent revision) and two minor complications in each group (open: pneumonia and post-surgery anemia, MIS: incidental durotomy and pneumonia) were noted. At 2 years, continued improvements were observed in both groups as compared to the preoperative state (p > 0.05), with 50.8 % of open and 58 % of MIS TLIF patients returning to full function (p > 0.05). Almost all patients have Grade 1 fusion (open: 98.5 %, MIS: 97.0 %, p > 0.05) with minimal new cage migration (open: 1.4 %, MIS: 0 %, p > 0.05). MIS TLIF is a safe option for lumbar fusion, and when compared to open TLIF, has similar operative duration, good clinical and radiological outcomes, with additional significant benefits of less perioperative blood loss and pain, earlier rehabilitation, and a shorter hospitalization.
244 citations
TL;DR: Improved understanding of risk profiles and procedure-related parameters may be useful for patient counseling and efforts to reduce complication rates.
Abstract: Purpose
Major peri-operative complications for adult spinal deformity (ASD) surgery remain common. However, risk factors have not been clearly defined. Our objective was to identify patient and surgical parameters that correlate with the development of major peri-operative complications with ASD surgery.
203 citations
TL;DR: BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs and is marginally favored over VP in disability improvement, and significantly favored in QOL improvement.
Abstract: Purpose
To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs).
196 citations
TL;DR: The use of 1 g of powdered intraoperative vancomycin placed in the wound prior to wound closure appears to associated with a low rate deep spinal wound infection for both instrumented and uninstrumented cases.
Abstract: Purpose
The purpose of this study is to evaluate the effect of intraoperative powdered vancomycin on the rates of postoperative deep spinal wound infection. The use of intraoperative powdered vancomycin as a prophylactic measure in an attempt to reduce the incidence of postoperative spinal wound infection has not been sufficiently evaluated in the existing literature. A retrospective review of a large clinical database was performed to determine the rates of deep wound infection associated with the use of intraoperative operative site powdered vancomycin.
192 citations
TL;DR: Older concepts have been integrated with newer scientific data available to give the reader the basis for a better understanding of both normal and abnormal spine and thoracic cage growth.
Abstract: Purpose
This article aims to provide an overview of how spinal deformities can alter normal spine and thoracic cage growth.
185 citations
TL;DR: The standard values and age-related changes in cervical anatomy, alignment, and ROM for males and females in each decade between the 3rd and 8th were established and cervical lordosis in the neutral position develops with aging, while extension ROM decreases gradually.
Abstract: Purpose
This study aimed to establish radiographic standard values for cervical spine morphometry, alignment, and range of motion (ROM) in both male and female in each decade of life between the 3rd and 8th and to elucidate these age-related changes.
172 citations
TL;DR: The most important risk factors affecting NVCFs were osteoporosis and intervertebral discal cement leakage.
Abstract: Introduction
Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are effective procedures to alleviate pain caused by osteoporotic vertebral compression fractures (VCFs). New vertebral compression fracture (NVCF) has been noted as a potential late sequela of the procedures. The incidence of NVCFs and affecting risk factors were investigated.
162 citations
TL;DR: A retrospective review of medical records and operative reports of patients undergoing LLIF between March 2006 and December 2009 found that LLIF is a valuable tool for achieving fusion through a minimally invasive approach with little risk to neurovascular structures.
Abstract: Purpose
Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that has gained growing interest in recent years. We performed a retrospective review of the medical records and operative reports of patients undergoing LLIF between March 2006 and December 2009. We seek to identify the incidence and nature of neurological deficits following LLIF.
152 citations
TL;DR: Using MRI data of 1,211 asymptomatic subjects, the standard values for the cervical spinal canal, dural tube, and spinal cord for healthy members of each sex and each decade of life and the age-related changes in these parameters were established.
Abstract: Purpose
The aim of this study is to establish standard MRI values for the cervical spinal canal, dural tube, and spinal cord, to evaluate age-related changes in healthy subjects, and to assess the prevalence of abnormal findings in asymptomatic subjects.
138 citations
TL;DR: The more artificial discs are implanted, the stronger the motion increase in flexion and extension was predicted with respect to the intact condition, and multilevel TDA should, if at all, only be performed in appropriate patients with good muscular conditions and by surgeons who can ensure optimal implant positions.
Abstract: Total disc arthroplasty (TDA) has been successfully used for monosegmental treatment in the last few years. However, multi-level TDA led to controversial clinical results. We hypothesise that: (1) the more artificial discs are implanted, the stronger the increases in spinal mobility and facet joint forces in flexion and extension; (2) deviations from the optimal implant position lead to strong instabilities. A three-dimensional finite element model of the intact L1–L5 human lumbar spine was created. Additionally, models of the L1–L5 region implanted with multiple Charite discs ranging from two to four levels were created. The models took into account the possible misalignments in the antero-posterior direction of the artificial discs. All these models were exposed to an axial compression preload of 500 N and pure moments of 7.5 Nm in flexion and extension. For central implant positions and the loading case extension, a motion increase of 51% for two implants up to 91% for four implants and a facet force increase of 24% for two implants up to 38% for four implants compared to the intact spine were calculated. In flexion, a motion decrease of 5% for two implants up to 8% for four implants was predicted. Posteriorly placed implants led to a better representation of the intact spine motion. However, lift-off phenomena between the core and the implant endplates were observed in some extension simulations in which the artificial discs were anteriorly or posteriorly implanted. The more artificial discs are implanted, the stronger the motion increase in flexion and extension was predicted with respect to the intact condition. Deviations from the optimal implant position lead to unfavourable kinematics, to high facet joint forces and even to lift-off phenomena. Therefore, multilevel TDA should, if at all, only be performed in appropriate patients with good muscular conditions and by surgeons who can ensure optimal implant positions.
TL;DR: The clinical and radiological outcomes of the stand-alone titanium box cage for the surgical treatment of one- or two-level degenerative cervical disc disease are satisfactory and the cervical lordosis may be more important for the long-term clinical outcome than cage subsidence.
Abstract: Objective
Clinical outcomes of the stand-alone cage have been encouraging when used in anterior cervical discectomy and fusion (ACDF), but concerns remain regarding its complications, especially cage subsidence. This retrospective study was undertaken to investigate the long-term radiological and clinical outcomes of the stand-alone titanium cage and to evaluate the incidence of cage subsidence in relation to the clinical outcome in the surgical treatment of degenerative cervical disc disease.
TL;DR: Surgical managements of 3- or 4-level CSM by ACDF or ACCF showed no significant differences in terms of achieved clinical symptom improvements, with the exception of better postoperative NDI scores in ACDF.
Abstract: Background
The optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM) has not been defined, and the relative merits of multilevel anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy (2-level or skip 1-level corpectomy) and fusion (ACCF) remain controversial However, few comparative studies have been conducted on these two surgical approaches
TL;DR: The results suggest that a considerable proportion of patients may be classified incorrectly by MRI for HNP and spinal stenosis, and the evidence for the diagnostic accuracy of MRI found by this review is not conclusive, since the results could be distorted due to the limited number of studies and large heterogeneity.
Abstract: Purpose
In about 5% of all cases LBP is associated with serious underlying pathology requiring diagnostic confirmation and directed treatment. Magnetic resonance imaging (MRI) is often used for this diagnostic purpose yet its role remains controversial. Consequently, this review aimed to summarize the available evidence on the diagnostic accuracy of MRI for identifying lumbar spinal pathology in adult low back pain (LPB) or sciatica patients.
TL;DR: Relevant parameters of sagittal imbalance have been identified and correlated with clinical outcomes and methods for calculation of surgical correction of imbalance have be proposed, but not validated in patients with mid-term follow-up.
Abstract: Purpose
To present in a single source the relevant information needed to assess spinopelvic balance and alignment, and to estimate the amount of correction needed in a patient during surgical treatment.
TL;DR: The findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system, and further research is needed to explore the coincidental factors influencing symptom improvement.
Abstract: Introduction
The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy.
TL;DR: A HA-pNIPAM composition suitable for nucleus pulposus repair that provides an injectable carrier for NPC, maintains their phenotype and promotes extracellular matrix generation was identified.
Abstract: Introduction
Thermoreversible hydrogels have potential in spine research as they provide easy injectability and mild gelling mechanism (by physical cross-link). The purpose of this study was to assess the potential of thermoreversible hyaluronan-based hydrogels (HA-pNIPAM) (pNIPAM Mn = 10, 20, 35 × 103 g mol−1) as nucleus pulposus cells (NPC) carrier.
TL;DR: The Italian ODI and RMDQ proved to be sensitive in detecting clinical changes after conservative treatment for subacute and chronic LBP, thus allowing cross-cultural comparisons and stimulating cross-national studies.
Abstract: Introduction
An ability to assess longitudinal changes in health status is crucial for the outcome measures used in treatment efficacy trials. The aim of this study was to verify the responsiveness of the Italian versions of the Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) in subjects with subacute or chronic low back pain (LBP).
TL;DR: KP may be superior to VP in patients with large kyphosis angles, vertebral fissures, fractures in the posterior edge of the vertebral body or significant height loss in the fractured vertebrae, which lowers confidence in their recommendations.
Abstract: Objective
To assess the safety and efficacy of balloon kyphoplasty (KP) compared with percutaneous vertebroplasty (VP) and provide recommendations for using these procedures to treat osteoporotic vertebral compression fractures (OVCF).
TL;DR: The improvement of pulmonary function and the restoration of sagittal and coronal balance are the main goals in the treatment of severe and rigid scoliosis and kyphoscoliosis and HGT is a useful tool for selected patients.
Abstract: Introduction
The treatment of rigid and severe scoliosis and kyphoscoliosis is a surgical challenge. Presurgical halo-gravity traction (HGT) achieves an increase in curve flexibility, a reduction in neurologic risks through gradual traction on a chronically tethered cord and an improvement in preoperative pulmonary function. However, little is known with respect to the ideal indications for HGT, its appropriate duration, or its efficacy in the treatment of rigid deformities.
TL;DR: The major difficulty in idiopathic scoliosis research is phenotypic and genetic heterogeneity, and the use of biological endophenotypes, as well as restricted clinical definitions, may help to partition variation and increase the power of studies to detect or confirm an effect.
Abstract: Purpose Idiopathic scoliosis is a complex developmental syndrome defined by an abnormal structural curvature of the spine. High treatment costs, chronic pain/discomfort, and the need for monitoring at-risk individuals contribute to the global healthcare burden of this musculoskeletal disease. Although many studies have endeavored to identify underlying genes, little progress has been made in understanding the etiopathogenesis. The objective of this comprehensive review was to summarize genetic associations/linkages with idiopathic scoliosis, as well as explore the strengths and weaknesses of each study, such that it may serve as a guide for the design and interpretation of future genetic studies in scoliosis. Methods We searched PubMed and Human Genome Epidemiology (HuGE) Navigator using the search terms ‘‘gene and scoliosis’’. Linkage or association studies published in English and available full-text were further analyzed as regards results, experimental design, and statistical approach. Results We identified and analyzed 50 studies matching our criteria. These consisted of 34 candidate gene studies (6 linkage, 28 association) and 16 genome-wide studies [14 pedigree-based linkage, 2 genome-wide association studies (GWAS)]. Findings involved genes related to connective tissue structure, bone formation/metabolism, melatonin signaling pathways, puberty and growth, and axon guidance pathways. Variability in results between studies suggested ethnic and/or genetic heterogeneity. Conclusions The major difficulty in idiopathic scoliosis research is phenotypic and genetic heterogeneity. Genetic research was overrepresented by underpowered studies. The use of biological endophenotypes, as well as restricted clinical definitions, may help to partition variation and increase the power of studies to detect or confirm an effect.
TL;DR: The normative score and the cut-offs value of the ODI were defined and the optimal cut-off value was estimated to be 12.07, which separates LBP with disability from LBP without disability.
Abstract: Purpose
The Oswestry Disability Index (ODI) is one of the most common scoring systems used for patients with low back pain (LBP). Although the normative score of the ODI was reported to be 10.19 in a review article, no study has calculated the normative score after adjusting the value based on the age distribution. In addition, none of the previous studies has estimated the cut-off value which separates LBP with disability from LBP without disability. The purpose of this study was to estimate the normative score by adjusting the data for age distribution in Japan, and to determine the cut-off value which separates LBP with disability from LBP without disability.
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TL;DR: While several theories regarding the pathogenesis of SNs have been proposed, an axial load model appears to have the greatest supporting evidence and there is no established treatment modality for symptomatic SNs.
Abstract: Introduction
First described in 1927, a Schmorl’s node (SN) is the herniation of nucleus pulposus (NP) through the cartilaginous and bony end plate into the body of the adjacent vertebra. SNs are common findings on imaging, and although most SNs are asymptomatic, some have been shown to become painful lesions. In this manuscript, we review the literature regarding the epidemiology, clinical presentation, pathogenesis, imaging, and management of SNs.
TL;DR: Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM, however,Multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.
Abstract: Purpose
We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM).
TL;DR: Higher prevalence of HO was observed following CTDA, although HO was reported to be unrelated to the clinical improvement, which suggests that cervical disc replacement should be performed cautiously before obtaining long-term supporting evidence.
Abstract: Background
Heterotopic ossification (HO) is a well-known complication after total hip and knee arthroplasty. But limited studies have focused on prevalence of HO following cervical total disc arthroplasty (CTDA) and the published data show controversial results.
TL;DR: The data indicates a higher male/female ratio overall for spinal cord tumors, a higher proportion of nerve sheath cell tumors, and a lower proportion of meningiomas and neuroepithelial tumors compared to reports from non-Asian countries.
Abstract: Purpose
To clarify the relative frequency of various histopathological primary spinal cord tumors and their features in Japanese people and to compare this data with other reports.
TL;DR: Greater PI may lead to the development and the progression of vertebral slip and different compensatory mechanisms may contribute to the maintenance of spinopelvic sagittal alignment in DS and non-DS patients.
Abstract: Introduction
To date, few studies have focused on spinopelvic sagittal alignment as a predisposing factor for the development of degenerative spondylolisthesis (DS). The objectives of this study were to compare differences in spinopelvic sagittal alignment between patients with or without DS and to elucidate factors related to spinopelvic sagittal alignment.
TL;DR: A citation rank list has been used within a particular field to measure the importance of an article as mentioned in this paper, and the purpose of this article is to report on the 100 most cited articles in the field of spine.
Abstract: Purpose
Spine-related research has evolved dramatically during the last century. Significant contributions have been made by thousands of authors. A citation rank list has historically been used within a particular field to measure the importance of an article. The purpose of this article is to report on the 100 most cited articles in the field of spine.
TL;DR: Thoracoscopic microdiscectomy for single level symptomatic thoracic disc herniation is a highly effective and reliable technique, it can be performed safely with low complication rate and after 2 years, 79% of the patients reported a excellent or good outcome for pain and 80% for motor function.
Abstract: Problem
Thoracic disc disease with radicular pain and myelopathic symptoms can have serious neurological sequelae. The authors present a relevant treatment option.
TL;DR: Rod derotation and DVR using pedicle screw instrumentation give true three dimensional deformity correction in the treatment of AIS, and Suk classification with these methods predicts exact fusion extent.
Abstract: Pedicle screw instrumentation in AIS has advantages of rigid fixation, improved deformity correction and a shorter fusion, but needs an exacting technique. The author has been using the K-wire method with intraoperative single PA and lateral radiographs, because it is safe, accurate and fast. Pedicle screws are inserted in every segment on the correction side (thoracic concave) and every 2–3 on the supportive side (thoracic convex). After an over-bent rod is inserted on the corrective side, the rod is rotated 90° counterclockwise. This maneuver corrects the coronal and sagittal curves. Then the vertebra is derotated by direct vertebral rotation (DVR) correcting the rotational deformity. The direction of DVR should be opposite to that of the vertebral rotation. A rigid rod has to be used to prevent the rod from straightening out during the rod derotation and DVR. The ideal classification of AIS should address all curve patterns, predicts accurate fusion extent and have good inter/intraobserver reliability. The Suk classification matches the ideal classification is simple and memorable, and has only four structural curve patterns; single thoracic, double thoracic, double major and thoracolumbar/lumbar. Each curve has two types, A and B. When using pedicle screws in thoracic AIS, curves are usually fused from upper neutral to lower neutral vertebra. Identification of the end vertebra and the neutral vertebra is important in deciding the fusion levels and the direction of DVR. In lumbar AIS, fusion is performed from upper neutral vertebra to L3 or L4 depending on its curve types. Rod derotation and DVR using pedicle screw instrumentation give true three dimensional deformity correction in the treatment of AIS. Suk classification with these methods predicts exact fusion extent and is easy to understand and remember.