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[PMID]: 29521698
[Au] Autor:Cho SK; Kim JS; Overley SC; Merrill RK
[Ad] Address:From the Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY.
[Ti] Title:Cervical Laminoplasty: Indications, Surgical Considerations, and Clinical Outcomes.
[So] Source:J Am Acad Orthop Surg;, 2018 Mar 07.
[Is] ISSN:1940-5480
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Cervical laminoplasty was initially described for the management of cervical myelopathy resulting from multilevel stenosis secondary to ossification of the posterior longitudinal ligament. The general concepts are preservation of the dorsal elements, preservation of segmental motion, and expansion of the spinal canal via laminar manipulation. No clear evidence suggests that laminoplasty is superior to either posterior laminectomy or anterior cervical diskectomy and fusion. However, laminoplasty has its own advantages, indications, and complications. Surgeons have refined the technique to decrease complication rates and improve efficacy. Recent efforts have highlighted less invasive approaches that are muscle sparing and associated with less postoperative morbidity. Although the long-term outcomes suggest that cervical laminoplasty is safe and effective, continued research on the development of novel modifications that decrease common complications, such as C5 nerve palsy, axial neck pain, and loss of lordosis, is required.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.5435/JAAOS-D-16-00242

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[PMID]: 29330576
[Au] Autor:Langella F; Villafañe JH; Lafage V; Smith JS; Shaffrey C; Kim HJ; Burton D; Hostin R; Bess S; Ames C; Mundis G; Klineberg E; Schwab F; Lafage R; Berjano P
[Ad] Address:IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. Francesco.langella.md@gmail.com.
[Ti] Title:Xipho-pubic angle (XPA) correlates with patient's reported outcomes in a population of adult spinal deformity: results from a multi-center cohort study.
[So] Source:Eur Spine J;27(3):670-677, 2018 Mar.
[Is] ISSN:1432-0932
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:STUDY DESIGN: Retrospective multi-center cohort study. PURPOSE: Sagittal misalignment causes changes in the abdominal shape. Xipho-pubic angle (XPA) has been previously described to radiographically evaluate the shape of the abdominal cavity in patients with spine deformity. The aims of this study are to evaluate the correlation of XPA-to-spinopelvic sagittal parameters and to patients' health-related quality-of-life (HRQoL) scores. METHODS: 278 patients from a multi-center database with diagnosis adult spinal deformity (ASD) (one or more of: coronal Cobb angle > 20°, sagittal vertical axis (SVA) > 50 mm, pelvic tilt (PT) > 25°, and thoracic kyphosis > 60°) were included. Cut-off values for moderate and severe disability (ODI-Oswestry Disability Index-20 and 40%) were calculated. Pearson's correlation was tested between XPA and spinopelvic parameters and between XPA and HRQoL scores. RESULTS: The cut-off value of XPA to identify ODI severe disability (40/100) was identified with XPA smaller than 103°; minimal (20/100) disability was identified by XPA greater than 113°. XPA showed strong correlation to sagittal spinopelvic parameters-PT, SVA, lumbar lordosis (LL), pelvic incidence (PI) minus LL-and to HRQoL scores-ODI, SF-36 PCS and SRS-22 activity and pain. XPA was the parameter with the strongest correlation to HRQoL scores. CONCLUSIONS: Xipho-pubic angle reflects changes in spinal changes and has strong correlation to HRQoL and spinopelvic parameters. It can discriminate between patients with minimal, moderate, and severe disability as measured by ODI scores. These slides can be retrieved under Electronic Supplementary Material.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review
[do] DOI:10.1007/s00586-017-5460-5

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[PMID]: 29188373
[Au] Autor:Alzakri A; Boissière L; Cawley DT; Bourghli A; Pointillart V; Gille O; Vital JM; Obeid I
[Ad] Address:Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France. a.alzakri@gmail.com.
[Ti] Title:L5 pedicle subtraction osteotomy: indication, surgical technique and specificities.
[So] Source:Eur Spine J;27(3):644-651, 2018 Mar.
[Is] ISSN:1432-0932
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: To evaluate the radiographic, functional outcomes, complications and surgical specificities of L5 pedicle subtraction osteotomy for fixed sagittal and coronal malalignment. METHODS: A retrospective cohort of consecutive patients with prospectively collected data. Ten patients who underwent PSO at L5 were eligible for a 2-year minimum follow-up (average, 4.0 years). Patients were evaluated by standardized upright radiographs. Preoperative and postoperative radiographies, surgical data and complications were collected. RESULTS: All surgeries were revision surgeries. The mean lumbar lordosis before surgery was - 22.5° (range, 8° to - 33°) and improved to - 58.5° (range, - 40° to - 79°). The sagittal vertical axis demonstrated a preoperative mean sagittal malalignment of 13.7 cm (range 3.5 to 20 cm), with correction to 4.6 cm postoperatively. Three patients required additional surgery at the latest follow-up for rod breakage. CONCLUSIONS: PSO of L5 can be a safe and effective technique to treat and correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio of such a major surgery. Most patients are satisfied, particularly when sagittal balance is achieved.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review
[do] DOI:10.1007/s00586-017-5403-1

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[PMID]: 29514617
[Au] Autor:Liu S; Zhang Y; Bao H; Yan P; Zhu Z; Liu Z; Qian B; Qiu Y
[Ad] Address:Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, 210008, China.
[Ti] Title:Could pelvic parameters determine optimal postoperative thoracic kyphosis in Lenke type 1 AIS patients?
[So] Source:BMC Musculoskelet Disord;19(1):74, 2018 Mar 07.
[Is] ISSN:1471-2474
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: A proper restoration of sagittal alignment is essential in AIS patients, but few studies provided a formula to predict an optimal surgical thoracic kyphosis (TK) gain in adolescent idiopathic scoliosis (AIS) patients. A formula was recently proposed (LL = (PI+TK)/2 + 10) to predict the optimal lumbar lordosis (LL) in adult spinal deformity patients, which has not been validated in adolescents. The aim of this study is to establish a formula with TK and pelvic parameters in normal adolescents and predict an optimal TK with this formula pre- and post-operatively in Lenke 1 AIS patients. METHODS: A total of 60 asymptomatic adolescents were used to validate the proposed formula. The subject was considered to match with the formula, if the difference between the virtual TK and the theoretical TK was less than 10°. Then regression analysis was performed to establish a new formula to predict TK in adolescents. The predictive efficiency of the new formula was also validated in 40 Lenke 1 AIS patients. RESULTS: Of the 60 asymptomatic adolescents, only 26 (43.33%) asymptomatic adolescents matched with the adjusted formula: TK = 2 × (LL-10)-PI. The paired t test revealed a significantly different theoretical TK (tTK) compared to the virtual TK (41.23 ± 18.29° vs. 24.80 ± 8.75°, P < 0.001). Multiple linear regression showed that TK had a relationship with LL, SS and age (R = 0.331): TK = - 0.785 × LL-0.843 × SS + 0.858 × age + 3.754. There were 27 (67.50%), 32 (80.00%) and 35 (87.50%) Lenke 1 AIS patients matched this formula preoperatively, postoperatively and at the last follow-up. CONCLUSION: Our results revealed that the predictive formula for sagittal alignment for adults was not applicable in adolescents. This study established a new predictive formula for TK based on asymptomatic adolescents. In Lenke 1 AIS patients, post-op TK in 87.5% of patients matched the predictive value, indicating that the new formula can be considered as a reference when making a surgery strategy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1186/s12891-018-1992-z

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[PMID]: 29281113
[Au] Autor:Challier V; Henry JK; Liu S; Ames C; Kebaish K; Obeid I; Hostin R; Gupta M; Boachie-Adjei O; Smith JS; Mundis G; Bess S; Schwab F; Lafage V; International Spine Study Group
[Ad] Address:Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
[Ti] Title:Complication Rates and Maintenance of Correction After 3-Column Osteotomy in the Elderly: Report of 55 Patients With 2-Year Follow-up.
[So] Source:Neurosurgery;, 2017 Dec 21.
[Is] ISSN:1524-4040
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Three-column osteotomies (3CO) provide substantial correction for adult spinal deformity (ASD), but carry risks of complications and revisions. The risk-benefit balance of 3CO in the elderly remains unclear. OBJECTIVE: To evaluate sagittal alignment and complications after 3CO in a population over 70-yr old. METHODS: Radiographic retrospective review of consecutive patients over 70 yr ("Elderly") undergoing 3CO for ASD. Demographic, operative, and outcomes data were collected. Full-spine radiographs were analyzed at baseline and 2-yr postoperatively. Results were compared to a group of young controls ("Young") matched by global sagittal alignment. RESULTS: Elderly (n = 55) and Young (n = 52) were similar in operating room time, blood loss, levels fused, and revision surgeries. Elderly and Young groups had similar baseline radiographic malalignment for pelvic tilt, pelvic incidence-lumbar lordosis (PI-LL), and sagittal vertical axis (P > .5 for all). At 2-yr postoperatively, both groups underwent significant improvement in the setting of sagittal alignment parameters (Elderly: sagittal vertical axis 150 mm to 59 mm, P < .001; pelvic tilt 33° to 25°, P < .001; PI-LL 35° to PI-LL 6°, P < .001). However, the Elderly group underwent significantly greater correction in PI-LL than the Young group (-29° vs -20°, P = .024). There were no differences in total, intraoperative or postoperative complications or revisions between groups, though the Elderly group had more intraoperative complications when major blood loss was included. The Elderly group had more severe proximal junctional kyphosis (22.1° vs 9.6° in Young; P < .001). CONCLUSION: Compared to young patients, elderly patients may achieve the same, or even better, correction in radiographic spinopelvic parameters. In addition, not only the total intraoperative and postoperative complication rates but also revision rates were comparable between both groups.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/neuros/nyx580

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[PMID]: 29213141
[Au] Autor:Zwierzchowska A; Tuz J
[Ad] Address:Akademia Wychowania Fizycznego im. Jerzego Kukuczki w Katowicach / The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland Zaklad Specjalnej Edukacji Fizycznej / Department of Special Physical Education. a.zwierzchowska@awf.katowice.pl.
[Ti] Title:Ocena wplywu krzywizn kregoslupa w plaszczyznie strzalkowej na dolegliwosci miesniowo-szkieletowe u mlodych osób. [Evaluation of the impact of sagittal spinal curvatures on musculoskeletal disorders in young people].
[So] Source:Med Pr;69(1):29-36, 2018 01 01.
[Is] ISSN:0465-5893
[Cp] Country of publication:Poland
[La] Language:pol
[Ab] Abstract:BACKGROUND: In Poland, about 85% of the population report low back pain (LBP) symptoms overall. Moreover, 70-80% of people aged below 20 have already experienced back pain. The primary cause of LBP is the loss of spinal lordosis, which initiates changes in geometry of the spine and has impact on limb arrangement. The aim of the study was to attempt to verify the relationship between the 2 main curvatures of the spine and its relation to symptoms in different parts of the musculoskeletal system, in a group of adults. It was assumed that hyperlordosis of the lumbar spine and misbalance of the thoraco-lumbar junction are risk factors for LBP. MATERIAL AND METHODS: The study coverd 231 first-year students, (aged 19-21) of the University of Economics in Katowice. There were 103 men aged 19.5±0.8 years and 128 women aged 19.6±0.8 years. The students completed the Nordic Musculoskeletal Questionnaire (NMQ): 7 days (NMQ7) and 6 months (NMQ6). A Rippstein's plurimeter, was used to measure the angles of thoracic kyphosis (KTH) and lumbar lordosis (KLL). Cut of points was set at 30±5. RESULTS: The results indicate strong and very strong correlation (r = 0.6 and r = 0.8, p < 0.05) between the concave of the back and LBP, which may suggest the relationship between these symptoms and the increased lordosis. CONCLUSIONS: Postural defects in the sagittal plane may predict the occurrence of pain. The results of the study indicate a higher frequency of pain in people with a higher angle of lumbar lordosis. Med Pr 2018;69(1):29-36.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review

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[PMID]: 29483485
[Au] Autor:Qian S; Wang Z; Jiang G; Xu Z; Chen W
[Ad] Address:Centre for Orthopedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland).
[Ti] Title:Efficacy of Laminoplasty in Patients with Cervical Kyphosis.
[So] Source:Med Sci Monit;24:1188-1195, 2018 Feb 27.
[Is] ISSN:1643-3750
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND The efficacy of laminoplasty in patients with cervical kyphosis is controversial. The purpose of this study was to investigate the impact of the initial pathogenesis on the clinical outcomes of laminoplasty in patients with cervical kyphosis. MATERIAL AND METHODS A total of 137 patients with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) underwent laminoplasty from April 2013 to May 2015. The patients were divided into the following 4 groups: lordosis with CSM (LC), kyphosis with CSM (KC), lordosis with OPLL (LO), and kyphosis with OPLL (KO). The clinical outcome measures included the visual analogue scale (VAS) and modified Japanese Orthopedic Association (mJOA) scores, the range of motion (ROM), and the cervical global angle (CGA). RESULTS The mean VAS and mJOA scores improved significantly in all groups after surgery. The changes in VAS and mJOA scores were significantly smaller, and the JOA recovery rate was significantly lower, in the KC group than in the LC and KO groups. The mean change in the CGA was greatest in the KC group (>8° towards kyphosis). The preoperative ROM was negatively correlated with the change in CGA and the JOA recovery rate in the KO and KC groups. CONCLUSIONS We found that laminoplasty is suitable for patients with cervical lordosis and those with mild cervical kyphosis and OPLL, but is not recommended for patients with kyphosis and CSM, particularly those with a large ROM preoperatively.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Process

  8 / 6462 MEDLINE  
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[PMID]: 29508074
[Au] Autor:Zhao J; Yang M; Yang Y; Yin X; Yang C; Li L; Li M
[Ad] Address:Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
[Ti] Title:Proximal junctional kyphosis in adult spinal deformity: a novel predictive index.
[So] Source:Eur Spine J;, 2018 Mar 05.
[Is] ISSN:1432-0932
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Proximal junctional kyphosis (PJK) is a devastating complication for adult spinal deformity (ASD) after correction surgery. However, there is no consensus on the risk factors of PJK, and whether it can be predicted remains unknown. The aim of this study is to detect the primary risk factors for PJK in ASD, and introduce a novel index for prediction of PJK. METHODS: Medical records of 62 ASD patients receiving correction surgery from January 2010 to January 2015 were analyzed. Spino-pelvic parameters were evaluated on lateral films before surgery, at 2 weeks' and at follow-up. Primary factors for PJK were evaluated. PJK index was proposed and verified. RESULTS: Cervical lordosis at follow-up, postoperative C2-C7 SVA, C2-C7 SVA at follow-up, postoperative T1 slope, T1 slope at follow-up, preoperative TLK, LL at follow-up, preoperative PT, postoperative PT, PT at follow-up, preoperative SS, postoperative SS, SS at follow-up, preoperative PT/SS, postoperative PT/SS and PT/SS at follow-up were significantly different between ASD with and without PJK. Adjusted logistic regression analysis showed that preoperative TLK, LL at follow-up, preoperative PT/SS and PT/SS at follow-up were primary factors for PJK. PJK index was defined as 0.160*LL at follow-up-0.121*preoperative TLK-4.625*preoperative PT/SS-3.315*PT/SS at follow-up. On the basis of ROC curve, if PJK index was smaller and larger than - 2, the occurrence rate of PJK and non-PJK was 82 and 95%, respectively. CONCLUSIONS: Preoperative TLK, LL at follow-up, preoperative PT/SS and PT/SS at follow-up were primary factors for PJK. PJK index could be used to predict occurrence of PJK effectively. These slides can be retrieved under Electronic Supplementary Material.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1007/s00586-018-5514-3

  9 / 6462 MEDLINE  
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[PMID]: 29508007
[Au] Autor:Tateen A; Bogert J; Koller H; Hempfing A
[Ad] Address:Zentrum für Wirbelsäulenchirurgie, Werner-Wicker-Klinik, Im Kreuzfeld 4, 34537, Bad Wildungen - Reinhardshausen, Deutschland. tateen@werner-wicker-klinik.de.
[Ti] Title:Komplikationen des lumbosakralen Übergangs bei Korrektur von Erwachsenendeformitäten : Indikation und Technik dorsaler und ventraler Revisionsoperationen. [Complications of the lumbosacral junction in adult deformity surgery : Indications and technique for posterior and anterior revision surgery].
[So] Source:Orthopade;, 2018 Mar 05.
[Is] ISSN:1433-0431
[Cp] Country of publication:Germany
[La] Language:ger
[Ab] Abstract:BACKGROUND: Surgical correction of ASD can be challenging. The indication for surgery is individual and after specification of the therapeutic goals, detailed planning of the surgery is essential to achieve a good postoperative result. COMPLICATIONS AND INDICATION: The reasons for the comparatively high complication rate are well investigated and are often located at the lumbosacral junction. In addition to negative general factors like osteoporosis, especially undercorrection of the sagittal profile and insufficient lumbo-pelvic stabilization are causative. The main indications for revision surgery are a loss of lordosis due to progressive degeneration of the unfused segment L5/S1 or implant loosening and pseudarthrosis of a failed lumbosacral fusion. TREATMENT: The goals of revision surgery are restoration of the spinal balance as well as stable fixation and fusion in consideration of the general condition of the patient. Besides osteotomies in a previously fused region, especially reinstrumentation of the lumbosacral region can be challenging, although ala-ilium and ilium screws give the greatest stability. Additional anterior intersomatic cages allow for a better fusion rate, and, moreover they provide better lordozation. Each PLIF, TLIF, and ALIF cage has its own specific advantages. This article summarizes the reasons for complications of the lumbosacral junction after ASD correction and describes surgical principles for revision surgery.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1007/s00132-018-3534-7

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[PMID]: 29506275
[Au] Autor:Chou D; Lau D
[Ad] Address:Department of Neurosurgery, University of California San Francisco, San Francisco, California.
[Ti] Title:The Mini-Open Pedicle Subtraction Osteotomy for Flat-Back Syndrome and Kyphosis Correction: Operative Technique.
[So] Source:Oper Neurosurg (Hagerstown);12(4):309-316, 2016 Dec 01.
[Is] ISSN:2332-4260
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: The pedicle subtraction osteotomy (PSO) has been a mainstay treatment for flat-back syndrome. The morbidity of open deformity correction can be high, and minimally invasive applications may reduce such morbidity. OBJECTIVE: To describe an operative technique of the mini-open PSO. METHODS: Two patients underwent percutaneous fixation above and below the PSO, and the PSO was performed in a mini-open fashion. The correction was obtained by cantilever. RESULTS: The patient who underwent the L3 PSO had a prior fusion from T11 to L4 for scoliosis 35 years ago. On presentation at 62 years of age, he had a pelvic incidence of 54°, lumbar lordosis of 23°, sagittal vertical axis of +14 cm, and pelvic tilt of 25°. He underwent an anterior lumbar interbody fusion at L5-S1 followed by a min-open L3 PSO. He had a postoperative lumbar lordosis of 64° (correction of 41°), and his sagittal vertical axis went to +3 cm. His Oswestry Disability Index and visual analog scale scores decreased after surgery. The second patient was 64 years of age and underwent an L1 PSO. He had 43° of kyphosis from T10 to L2. He had a preoperative pelvic incidence of 63°, lumbar lordosis of 35°, pelvic tilt of 24°, and sagittal vertical axis of 3 cm. His postoperative kyphosis improved from 43° to 32°. CONCLUSION: The mini-open PSO can achieve significant lordosis, although it is heavily reliant on anterior arthrodesis. Larger studies are needed to compare this approach with an open PSO.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:In-Data-Review
[do] DOI:10.1227/NEU.0000000000001167


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