Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
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Аннотация
Introduction: Cervical disc replacement (cTDR) is a popular treatment for cervical degenerative disc disease. While some devices have shown promising results in the early and midterm, long term results remain lacking. This study reports on patient outcomes at long term follow up for the Activ C@ prosthesis. Materials and Methods: Between 2007 and 2009, patients who underwent cTDR for cervical degenerative disc disease at a NHS district general hospital were included. All were assessed preoperatively and at 6, 12, 24 and 105 months after procedure with visual analogue score (VAS) for neck and arm pain severity and frequency, Neck Disability Index questionnaire (NDI) and Centre for Epidemiologic Studies Depression questionnaire (CES-D). We calculated the survival rate of implants (Kaplan- Meir curve) [end point of reoperation at same or adjacent level] and compared patient outcomes (paired t test; MedCalc@). Results: We had treated 72 patients (25 men, 47 women) with cTDR (61 radiculopathy and 11 myelopathy symptoms) with average age of 52.2 years. We were able to interview 47 patients (65% follow up rate) at long term follow up (average 105 month). VAS (mean) for neck pain improved from 6 to 2 at 12 and 24 months and comparable at 105 months (VAS =3) [p Conclusion: Cervical TDR improves pain and function in patients with cervical degenerative disc disease both in the early and long term. We are able to report a survival time of 8.6 years with the Activ C@ prosthesis with no revision surgery performed at the same level. However, the long term benefit of cTDR performed for myelopathy is not clear. Introduction: Total disc replacement (TDR) is expected to provide a more physiologic alternative to fusion. However, long term clinical data which proves the efficacy of current implant designs is somewhat lacking. There are inconsistencies between in-vivo clinical vs. in-vitro biomechanical data. Several factors may be contributing to these anomalies, one of which is the type of disc, metal on metal vs. a metal on polyethylene disc design, for example. This study investigates the biomechanical effects of the placement of a novel elastomer TDR in the cervical spine and compares it to natural spinal kinematics, using finite element analysis. Methods: An experimentally validated, ligamentous, three-dimensional, finite element model of C3-C7 cervical spine segments was used for this study, Figure 1 (Goel et al., 2009). To simulate the replacement of the FREEFORM cervical TDR, the CAD model of the device was meshed and placed into the disc space of the C4-C5 level following removal of anterior part of the annulus, the entire nucleus, and ALL ligament. The endplates of the TDR were affixed to the adjacent vertebral endplate. Properties of titanium alloy and CarboSil 20 80A silicone rubber were assigned to the endplates and implant’s flexible component, respectively. The intact and instrumented spines were subjected to 75 N compressive follower load, plus 1.5 Nm bending moments in anatomical planes to simulate physiological flexion, extension, left/right bending, and left/right rotation. The range of motion, intradiscal pressure, and facet loads were measured and compared for segments of intact and instrumented spines. Results Section: The kinematic data for index and superior adjacent levels are shown in Figure 1. The disc replacement did not significantly alter normal motion of the index level in flexion and left/right bending motions (Discussion: The elastomer TDR preserved the natural kinematics of the cervical spine following instrumentation specially in flexion and lateral bending motions. A study by Crawford et al. (IJSS 2012) showed that ProDisc-C increased the ROM of the spine by 11% in flexion and decreased by 30% in lateral bending. Deviation from normal spine kinematics is less substantial with this novel TDR design. Also, the FREEFORM TDR did not alter range of motion, intradiscal pressure, or facet joint stress at the adjacent segment. These biomechanical properties may lower the long-term risk of adjacent segment disc and facet degeneration.Figure 1. FREEFOMR Cervical Disc, FE model of C37 spine with disc replaced at C45, Range of motion at and IDP at index and adjacent segments. Introduction: The 9.4 T MRI is an advanced preclinical imaging system that provides superior resolution of anatomical and morphological detail. Our group has previously described the development and application of a 9.4 T MRI nucleus pulposus(NP)/annulus fibrosus(AF) distinction score and the correlation of this simplified scoring system with 3 T and 9.4 T MRI Pfirrmann grades. We describe the correlation of the simplified NP/AF distinction score with biochemical measures of intervertebral disc degeneration. Material and Methods: Eighteen adult ewes underwent surgical lumbar intervertebral disc injury via a lateral retroperitoneal approach. Disc injury was performed at two levels with the adjacent non-injured levels serving as controls. Non-operated lumbar discs served as normal controls. Necropsies were performed at six months. Lumbar spines underwent 9.4 T MRI axial imaging. Four observers graded the images using the NP/AF distinction score. Spinal columns were dissected, individual discs sectioned, subdivision of the discs into regional segments performed and NP tissues were analysed biochemically for their proteoglycan (as sulphated-glycosaminoglycans), collagen (as hydroxyproline) and DNA content. Statistical analysis was performed with SPSS statistical package consisting of Kappa scores for inter-observer reliability, Pearson correlation co-efficients and simple linear regression. Results: The 9.4 T NP/AF distinction score demonstrated good inter-observer reliability with a kappa score of 0.94. A moderately strong correlation between NP/AF distinction score and collagen was observed with a Pearson correlation co-efficient of 0.719 and R2 of 0.517 (both p Conclusion: The NP/AF distinction score is a simple system for classifying intervertebral disc degeneration on 9.4 T MRI that demonstrates high degree of inter-observer reliability. This study demonstrated a moderately strong correlation of NP/AF distinction score with NP collagen content and a weaker negative correlation with proteoglycan content. Increased NP collagen content is a well-described feature of intervertebral disc degeneration and typically occurs in tandem with reduced NP proteoglycan content. The advance in resolution afforded by the 9.4 T MRI affords the ability to detect subtle changes in intervertebral disc morphology reflective of underlying degenerative and biochemical changes. The strength of correlation observed between this simple radiological classification system and biochemical markers of intervertebral disc degeneration is suggestive of the potential of the 9.4 T MRI in the investigation and classification of disc degeneration in the future. Introduction: Proximal junctional kyphosis (PJK) is a common post-surgical complication following long spinal fusion for deformity. Multiple risk factors are associated with PJK, including patient, radiographic, and surgical variables. It is commonly hypothesized that PJK may result from increased post-operative loading of the posterior ligament complex or intra-operative damage to the ligaments themselves. The aim of this study was to investigate the effect of sub-laminar polyester tension bands on the biomechanics of the motion segment proximal to a long fusion construct. Material and Methods: Eight human thoracolumbar spines (T7-L2) were dissected and the end vertebrae were partially embedded in bone cement. Pure moments of 4 Nm and 8 Nm were applied to the native spine and the instrumented spine, respectively, in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). The increased load on the instrumented spines was designed to represent the increased post-operative loads that may result from decreased extensor muscle strength or inertial effects adjacent to a stiff fusion construct. The test conditions included: native spine (T7-L2), fused (T10-L2), fused + bilateral bands tensioned to 250 N at T9-T10 (Bands 250 N), fused + Bands tensioned to 350 N (Bands 350 N), fused (T11-L2) + Bands tensioned to 250 N at T9-T10 and 350 N at T10-T11 (2-Level Bands), fused (T10-L2) + hand-tied suture loop through the spinous processes at T9-T10 (Suture Loop), and fused (T10-L2) with the T9-T10 interspinous and supraspinous ligaments cut (Cut ISL/SSL). Results: The flexion range of motion (ROM) at T9-T10 of the fused spine, loaded at 8 Nm, increased to 162% of the native spine loaded at 4 Nm. The average flexion ROM at T9-T10 for Bands 250 N, Bands 350 N, 2-Level Tethers, Suture Loop, and Cut ISL/SSL were 85%, 70%, 93%, 141%, and 177% of the native spine at 4 Nm, respectively. Each of these conditions was significantly different from Fused (p Conclusion: Biomechanical models of PJK assume that an increased load exists at the proximal segment following fusion, as was observed in this model. As expected, cutting the ISL/SSL ligament complex significantly compromised the flexion stability of the spines, which may be associated with greater PJK risk. On the other hand, the flexion ROM was modulated by varying the tension of the sublaminar bands, which reduces the loads on the posterior ligament complex. However, future studies should identify the optimal tension that will not induce sagittal imbalance or fusion, but will support the spine while the patient adapts to the fusion. Introduction: There is growing interest in optimising pedicle screw pull-out strength. While primary pull-out strength has been heavily studied, little is known about revision pull-out strength of different pedicle screws. Our study aims to evaluate the difference in primary and revision pull-out strength using pedicle screws of different thread designs. Material and Methods: The pull-out strengths of three different pedicle screw designs (single-thread, mixed-thread, dual-thread) were tested in standardised polyurethane foam in three sequences. Sequence 1: A 6.5 mm screw was inserted into the foam block and the primary pull-out strength measured. Sequence 2: A 6.5 mm screw was inserted, removed, and then reinserted into the same foam block. The revision pull-out strength was then measured. Sequence 3: A 6.5 mm screw was inserted, removed and a 7.5 mm screw of the same thread design was reinserted. The revision pull-out strength was then measured. Results: The primary pull-out strength was similar across screw designs, although dual-thread screws showed higher primary pull-out strength (2628.80 N) compared to single-thread screws (2184.43 N, p Conclusion: Mixed-thread screws are more costly than single and dual thread screws and may not offer any advantage for primary pull-out strength. In cases where screws have to be revised, the revision pull-out strength drops by 18.6% compared to other screw designs. Surgeons should be cautioned and consider using larger diameter mixed-thread pedicle screws in a revision setting if appropriate. Introduction: A proper restoration of sagittal alignment is essential in AIS patients, but few studies provided a formula to predict an optimal surgical TK gain in 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 current study aims to establish a formula with thoracic kyphosis (TK) and pelvic parameters in normal adolescents and predict an optimal TK with this formula pre- and post-operatively in Lenke 1 adolescent idiopathic scoliosis (AIS) patients. Materials and 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 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. Introduction: Sagittal rebalancing of a fixated lumbar hypolordosis (kyphosis) is very important to gain satisfactory results. To correct a misalignment vertebral column resection or pedicle subtraction osteotomies are favored, disregarding the relatively high complication rates. The aim of this study was to evaluate the efficiency and safety of a new modified transforaminal lumbar fusion technique as an alternative. Methods: We conducted a retrospective review (06/2011-06/2015) of a prospective database at an University hospital. Inclusion criteria were adult patients with a fixated lumbar hypolordosis and the need of monosegmental correction of more than 10° with an mTLIF. Exclusion criteria consisted of minor aged patients and polysegmental corrections. Study parameters were the perioperative complications and the achieved postsurgical lordosis. The follow up period was 6 months. Results: A total of 11 patients could be included. The mean segmental lordosis was -2.3° ± 12.4° (range -22° to 14°) preoperative and 15.5° ± 10.5° (range 0° to 29°) postoperative. The degree of correction was 17° ± 5.7° in mean per treated segment (range 12° to 29°). No neurologic or vascular complications occurred. No substantial loss of correction or implant failure was noted during the 6-month follow-up. Conclusion: The modified transforaminal lumbar fusion technique is a safe method to correct a fixated lumbar kyphosis. The potential of segmental correction is comparable to pedicle subtraction osteotomies but sparing potentially healthy segments. Introduction: Proximal junction kyphosis (PJK) and proximal junctional failure are common complications of surgical treatment for adult spinal deformity. The incidence of PJK/PJF is reported at 20-40%; of these cases, about 50% will undergo revision surgery for PJK. Revision surgery for PJK/PJF approximately doubles the cost of surgical treatment for ASD and is estimated at 77 432 US dollars per revision surgery. Risk factors contributing to PJK have been extensively investigated. Both patient specific and modifiable risk factors have been identified. Important modifiable risk factors include implant design, construct design, degree of correction, disruptions of posterior elements, and combined anterior/posterior procedures. Despite known, construct specific, modifiable risk factors, the optimal construct design to prevent PJK remains elusive. Material and Methods: A total of 19 patients (3 men and 16 women) underwent posterior fusion using a unique, staggered technique for pedicle screw-rod construct, whereby the upper instrumented vertebra was varied by either 1 or 2 levels from the contralateral pedicle screw-rod construct. Patients were included if they were older than 18 years old and were undergoing either primary or revision surgery for ASD. Patients with previous surgery for ASD, including those with previous development of PJK were not excluded. Patients undergoing fixation for acute trauma, compression fracture, and neoplastic deformity were excluded. Follow-up ranged from 2 to 28 months. The primary outcome measure was defined as re-operation rate due to proximal junctional kyphosis. Secondary measures included the rate of complications such as PJK not requiring revision, pseudoarthrosis formation, instrumentation failure, infection, and upper instrumentation pain. Results: One patient required revision due to PJK. In this patient, PJK occurred concomitantly with infection and upper instrumentation failure at 23 months post-operatively. One additional patient developed radiographically significant PJK but remains clinically asymptomatic. Two additional patients required reoperation for infection. Minor complications included superficial wound infection (1 patient), temporary motor deficit (2 patients), and upper instrumentation pain (2 patients). The average number of instrumented levels was 9.74 (range 5 to 15). On average, kyphosis at the proximal instrumented vertebrae increased 4.26 degrees (range -8 to 24). 2 patients were lost to follow up. Conclusion: Asymmetric screw rod fixation is a safe technique with the potential to decrease proximal junctional kyphosis, proximal junctional failure, and therefore, revision spine surgery for adult spinal deformity. Introduction: to study the effect of the parameters of the local sagittal balance of the cervical spine on the quality of life of patients operated on for degenerative-dystrophic disease. Material and Methods: From 2014 till 2017 56 patients with lumbar spine scoliosis were operated in the Federal Neurosurgical Center (50 men and 50 women). The patients’ age was 49,8 ± 9,8 years. The mean follow-up period was 23.6 ± 12.4 months. Patients’ neurological status evaluation was performed according to Japanese Orthopedic Association 1994 (JOA). The severity of the pain syndrome was assessed by a visual analogue pain scale (VAS). To assess the quality of life, the Neck Disability Index (NDI) questionnaire was used (H. Veron, J. Mior, 1989) according to the scale of The Short Form-36 (SF36). Neuroimaging methods included MRI, MSCT and X-ray. According to the radiographs, the assessment of the Sagittal vertical axis (SVA) C2-C7, the SVA center gravity of the head (CGH) -C7, the Cobb angle C2-C7, the Spino-cranial angle (SCA), the Thoracic inlet angle (TIA) neck tilt NT), T1 slope, C7 slope, Cranial incidence (CI), Cranial slope (CS), Cranial tilt (CT). Results: During the follow-up period, a positive correlation was found between C7 Slope and NDI (r = 0.31, p = 0.02). Perhaps a negative relationship between C7 Slope and SF36-PH (r = -0.27, p = 0.06). Positive correlation (on the verge of significance) between SVA C2-C7 and NDI (r = 0.24, p = 0.08). The value of the NDI questionnaire (p = 0.03) is worse in the group of patients with SVA C2-C7 more than 40 mm. In the group with “front” surgery, more than 75% of patients have SVA CGH-C7 less than 40 mm, in the “back” - more than 40 mm in all patients (p = 0.01). The balance after surgery is compensated in the most patients in the group of ventral surgery. Meanwhile, SVA CGH-C7 and clinical studies have not been detected, although SVA CGH-C7 and C2-7 strongly correlate (SVA CGH-C7 and SVA C2-7 (p = 0.000)). Conclusion: The parameters of C7 slope, SVA C2-C7 of the local sagittal balance statistically significantly affect the patient’s quality of life (according to NDI, SF-36). A statistically significant threshold for SVA C2-C7 for decompensating the sagittal balance was 40 mm. In patients after ventral surgery SVA CGH-C7 is reliably below 40 mm, however, no statistically significant correlation was found with clinical outcomes. Introduction: To identify perioperative complications in the elderly undergoing single-level posterolateral fusion versus interbody fusion for spondylolisthesis. Materials and Methods: Retrospective data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the years 2012 – 2014 were used to evaluate 30 day outcomes. Adult patients who underwent single-level posterolateral fusion (PLF) and posterolateral interbody fusion (PLIF) for spondylolisthesis were identified. Outcomes were compared between current smokers (within one year of surgery) and non-smokers. Results: Between 2012 and 2014, 1,688 patients who underwent single-level PLF or PLIF for spondylolisthesis were identified from the ACS-NSQIP database. Among these, a total of 1,599 patients between the ages of 45 – 79 (94.7%) and 89 patients (5.3%) were 80 years or older. In the elderly group, there were 33 patients who underwent PLIF (37.1%). Overall, there were no significant differences in demographics or comorbidities between the PLF and PLIF groups. However, operative time was significantly longer for elderly patients who underwent PLIF vs PLF (3.0 ± 1.3 vs. 2.4 ± 1.0 hours, p = 0.036). In terms of 30-day outcomes, elderly patients who underwent PLIF had a higher complication rate (12.1% vs. 5.4%), though this did not reach statistical significance (p = 0.416). Similarly, readmission (6.1% vs. 5.4%, p = 1.00) and reoperation (3.0% vs. 0.0%, p = 0.371) rates were higher for PLIF vs PLF patients without reaching significance. Compared to middle-age patients, patients in the elderly group were significantly more likely to be hypertensive (80.9% vs. 59.8%, p Conclusion: Octogenarians, although make up a smaller percentage of operative patients, are not at a higher rate of complication compared to their younger counterparts. The findings of this study may help spine surgeons and patients for preoperative risk stratification and perioperative expectations. Introduction: Due to the significant shortage of Bone Morphogenic Protein (BMP-2) in Europe at the beginning of 2016, a new technique was developed to combine the osteoconductive, osteogenic and osteoinductive properties of bone grafts. Prior to 2016, a combination of fresh frozen femoral head (FFFH) (osteoconductive) and BMP-2 (osteoinductive) was used inside the fusion cage, with excellent results. The technique involved inserting BMP-2 into two drill holes inside the FFFH, a technique adopted from Gold Coast Spine, Australia. We describe a new technique of replacing the BMP-2 with a core of cancellous iliac crest bone autograft, obtained using a cannulated core biopsy needle. Inserting this autologous cancellous bone core inside a drilled tunnel in the cancellous FFFH allograft added osteogenic and osteoinductive properties to the structural osteoconductive FFFH graft. The fusion was assessed using fine cut CT scan. To our knowledge this technique has not been described before. Material and Methods: This is a prospective review of 50 consecutive patients (total 53 levels fused) who underwent Anterior Lumbar Interbody Fusion (ALIF) between 2016-2017. All patients had a routine fine cut CT scan at 4-5 months post-operatively to assess for fusion. The CT scan was reviewed by a consultant radiologist to assess the presence of fusion. All patients had ALIF at L4/5 and/or L5/S1 using a Brantigan® cage and Aegis® plate (Depuy-Synthes). A combination of FFFH allograft and iliac crest core autograft were used. Two blocks of cancellous FFFH allograft were cut to the size of the graft windows using an electric saw. A core of cancellous iliac crest bone was inserted through a drill hole in the middle of each block of FFFH. The autograft was obtained from the left iliac crest through a stab incision in the skin. Once the 10 gauge Stryker® biopsy needle was through the cortical bone, the stylet was removed and the needle advanced 4-5 cm, continuously rotating the needle. Results: 50 consecutive patients who underwent ALIF procedures for degenerative conditions were included. There were 32 females. The mean age was 44.2 (33.6-70.3) years. 29 patients had surgery at L5/S1, 18 patients at L4/5 and 3 at L4/5 and L5/S1. 11 patients had surgery for spondylolisthesis, 14 for recurrent disc prolapse, 20 for neuroforaminal stenosis due to significant loss of disc height, and 5 for DDD. There was radiological fusion in 49 patients (52 levels) (98%), and non-union in one. The patient who had radiological non-union was a 42 year old female, non-smoker, and had surgery for DDD. There were no complications at the donor site (pain or infection). There was no VTE, and no intra-operative complications. The average blood loss was 90 mls (40-160 mls). Conclusion: Combining iliac crest cancellous bone autograft, obtained through a minimally invasive technique, with cancellous allograft is effective with good union rate (98%), without complications from the donor site. Introduction: Indocyanine green (ICG) videoangiography is a new technique that allows for real-time evaluation of blood flow in the aneurysm and vessels. Intra-operative indocyanine green (ICG) videoangiography is a useful addition to cerebrovascular neurosurgery. We evaluate the usefulness and limitation of ICG videoangiography during the cervical posterior fixation to evaluate the patency of the vertebral artery in the cases with high risk of VA injury. Material and Methods: Twenty-three patients (15 female, 8 male; mean age, 54.4 years) were evaluated. Near infrared ICG angiography was applied after the posterior screw fixation in the cases of high riding VA at the level of C2 vertebra, V3 segment anomaly and the situation of the VA injury was suspected during the surgical procedure. Results: ICG videoangiography is useful in different types of upper cervical posterior surgery. This technique is useful to evaluate the VA patency after screw instrumentation especially in the cases of the VA anomaly and high riding VA. And it is useful to identify the vessel patency after the inevitable VA management during the procedure. Overall, the procedure interrupted the surgical procedure for less than 5 minutes. One case of adverse skin reaction to the dye was encountered due to the dye leakage outside the vessel during the injection. ICG videoangiography has some limitations such as its inability to be viewed outside of the observed plane of illumination with infrared light and inconsistent complete washout, making repeated viewing sometimes difficult in structures surrounded by thick and excessive tissue. Quantitative evaluation of vessel flow is not possible with ICG videoangiography. Conclusion: ICG angiography could be a simple intraoperative evaluating tool with which the patency of the extracranial vertebral artery can be assessed. Compared with digital subtraction angiography, ICG angiography requires less time, personnel, and equipment, is safer, and can resolve smaller vessels, but is limited by the surgeon’s viewing angle and the depth of penetration of the infrared light. Even though it is necessary to expose the VA above the C1 arch or lateral to the C1 lateral mass to identify the ICG flow in the cases of CVJ surgery, it can be a useful tool to verify the patency of the possibly damaged VA during the screw placement. Unlike ultrasound technology, this technique is a hands-off method that can inform the surgeon about the flow patency of the extracranial vertebral artery. Introduction: The incidence of serious cervical spine injuries is low but associated rates of death and disability are high. In both British and Chinese studies, cervical spine is the most commonly affected region among traumatic spinal cord injuries (Lenehan, 2012). Cervical spinal cord injury is a devastating event for the patient and family. Mortality associated with cervical spine fractures is less studied. This deficiency in the literature contributes to a lack of consensus on the optimal treatment of cervical fractures (Jackson, 2005). Materials and Methods: All patients admitted at Corazon Locsin Montelibano Memorial Regional Hospital (Negros Occidental, Philippines), Dr. Pablo O. Torre Memorial Hospital (Negros Occidental, Philippines), and Silliman Medical Center (Negros Oriental, Philippines), from January 2008 to December 2012 with cervical SCI secondary to trauma are included in the study. Charts of patients who met the inclusion and exclusion criteria were collected. Patients were categorized according to age group. After collection of data it was double entered in Excel file, and was analyzed using SPSS (version 16·0) software. Results: The study group comprised of 51 males (92.7%), and 4 females (7.3%). Patients’ age were from 15 to 76 years old, with mean age of 43.67 years ( ± 16.9, SD). Common cause of injury in 27 patients was fall (49.1%), followed by vehicular accident sustained by 25 patients (45.5%), and axial loading in remaining 3 (5.5%). Incomplete quadriplegia was sustained by 32 patients (58.2%), and complete quadriplegia (Frankel A) in the remaining 23 patients (41.8%). Eleven patients died in their hospital stay (20%), most had complete quadriplegia- Frankel A (n = 10; 43.5%), compared to incomplete quadriplegia (n = 1; 3.1%). Statistical analysis showed no significance between sexes (LRT = 0.064, df = 1, p = 0.8), as well as the cause of injury (x2 = 0.833, df = 2, p = 0.659) for mortality of the patient. Analysis however, showed a significant relationship of the extent of paralysis and mortality (x2 = 11.214, df = 1, p-0.001), as only 1 out of 31 patients with incomplete quadriplegia (3.1%) eventually expired, compared to 10 of 23 (43.5%) in completely quadriplegic patients. Last normal motor and sensory level did not show a significant statistical relationship to mortality (LR = 8.17, df = 6, p = 0.226). Radiographic abnormality, presence of spinal shock on admission, and patient’s age, showed no statistical significance to the mortality of the patient. Conclusion: This study showed that males of older adult group usually sustained cervical spinal cord injury either due to fall, or motor vehicular accident, with almost half having fracture-dislocation. Statistical analyses showed no significant relationship of age, sex, level of injury, and mechanism of injury to mortality. There is however a statistically significant relationship of extent of injury, particularly Frankel A, to eventual mortality of the patient. Surgical procedure can be a positive predictor for survival in cervical SCI patients. Introduction: Scoliosis has long been measured in the 2D AP plane using the Cobb angle, which does not account for axial vertebral rotation (VR). In the past, the Stagnara lateral has been used in attempt to correct for VR. To date, no similar view has been described for the AP plane. 3D CT imaging may allow for more accurate measurement of Cobb angles by compensating for axial VR. We hypothesized that Cobb angles obtained from the rotationally compensated images differ significantly from those on traditional AP radiograph. Methods: In this retrospective study, standard AP, lateral, and bending radiographs of 23 patients age 10-17 with AIS were obtained. Using multi-planar 3D CT, the coronal plane was reconstructed within the plane of the vertebral axis to form a rotationally compensated 3D CT image (RC-3DCT). The following measurements were made on both imaging modalities: PT, MT, TL/L curve, coronal balance, T/L-AVT, T/L-AVR, thoracic kyphosis, and sagittal balance. Results: The mean MT curve was found to be 52.50° on AP radiograph vs. 45.36° on RC-3DCT (P = 0.011). In 3 patients (13.04%), rotational compensation altered the end vertebra of the major curve by at least 1 level. The mean TL curve obtained on radiograph, was significantly larger than that of RC-3DCT (42.93 vs. 34.32°; P = 0.00 210). AP films overstated coronal balance by over 50% when compared to RC-3DCT (P = 0.0320). Mean T-AVT was measured to be 37.04 mm on conventional films and 29.8 mm on RC-3DCT (P = 0.028). RC-3DCT L-AVT was significantly smaller than that of standard films (P = 0.034). Mean T-AVR on standing film was 18.9 ± 11.2°. The mean thoracic kyphosis greatly differed between the two modalities: 33.69°on radiograph vs. 20.04° on RC-3DCT (P = 2.16x10-5). Conclusions: Measurements traditionally made on AP radiograph to evaluate scoliosis may be fundamentally inaccurate due to VR. Our data suggests that axial rotation of a patient 19° per Nash–Moe grade with respect to the coronal plane may adequately compensate for the rotational component of deformity without the need for CT. Additionally, rotational compensation may yield end vertebrae levels different from those obtained traditionally. Introduction: Spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. Staphylococcus aureus is the predominant pathogen, accounting for about half of non-tuberculous cases. Diagnosis is difficult and often delayed or missed due to the rarity of the disease, particularly in the cervical spine. Material and Methods: We present the case of a 57 year old female patient whose medical history was significant for nodal skin lesions encompassing her arms and forearms, her presternal region, and her back. Some lesions were encrusted due to previous hemorrhagic blistering from persistent scratching. She suffered from these skin lesions for twenty years, treated them withtopical ointments, and was followed up at dermatologists. She was also referred for allergy testing which proved negative for all common contact, nutritive and inhalational allergens, and so her condition was diagnosed as a neurodermatitis. She presented to the emergency neurological department with axial neck pain referring to the right shoulder and arm, she was non- febrile and with no neurological impairment. She was discharged with a diagnosis of cervicobrachial syndrome and referred to physical therapy and rehabilitation specialist. The next day she developed an increased temperature of 39.7 oC with rapidly worsening axial neck pain and symptoms of septicaemia and was admitted urgently in a clinic for infectious diseases. Bloodculture was positive for methicillin susceptible staphylococcus aureus (MSSA) and antibiotic therapy with cloxacillin was promptly initiated. Four days later she began manifesting motor deficits in the distribution of myotomes C4 - (strength ⅗), C5 - (⅗), C6 - (⅕), C7 - (⅘), C8 - (⅘). An emergency MRI of her cervical spine showed an paravertebral abscess in the right C3-C7 region and MRI characteristics of spondylodiscitis of her C5 and C6 vertebral bodies. She was then urgently transferred to our clinic for emergent surgical treatment. We performed a left sided anterior cervical approach, corpectomy of C5 and C6, drainage of the abscess, lavage and reconstruction of the anterior column with a MESH cage filled with autologous trabecular bone from her ipsilateral iliac crest and anterior cervical locking plate fixation from C4 to C7. Results: The immediate postoperative period was uneventful. Her neck was immobilized with neck collar. Immediate postoperative visual analog scale (VAS) pain score was 3-4/10 using NSAID only. Rifampicin was added to her anthibiotic regiment immediately postoperatively to prevent biofilm formation along the implant. Drainage was removed on the second postoperative day and her fever subsided. Neurologic improvement was witnessed by the third postoperative day. She was transferred back to the infectious diseases clinic from where she was initially transferred to us for further intravenous antibiotic treatment as per the spondylodiscitis protocol. Conclusion: Spondylodiscitis can be a rare complication of pyogenic skin infection, including one resulting from neurodermatitis due to breach in skin integrity from persistent scratching. Introduction: In the 21st century, there has been a significant increase in attention to the sacroiliac joint (SIJ) as a source of low back pain. Many studies have shown positive outcomes of minimally invasive (MIS) SIJ fusion. The purpose of this study is to examine patient reported outcomes for this procedure in a United States Military Veterans population. Previous studies on other health conditions have suggested differences between normal and veteran populations, with the latter having lower health scores in addition to being predominantly male. Material and Methods: This study is a retrospective case series of our experience with twenty-one MIS SIJ fusions using triangular ingrown titanium rods in twenty patients at our local Veterans Affairs Medical Center from August 2011 through February 2014. Of our twenty patients, seventeen were male and three were female and they had an average age of 56 years. Surgical indications were based on history, physical exam, and diagnostic sacroiliac joint injections. Primary diagnosis was degenerative sacroiliitis in all cases except one of chronic SIJ infection. Patient reported outcomes (numeric pain scores and Oswestry Disability Index [ODI]) were collected pre and post operatively with final outcomes at greater than two years for all patients. Final follow up was at an average of 3.3 years and was completed for 18/20 patients. Results: At final follow up, ODI improved from 57.9 pre-operatively to 44.3 (p = 0.02) at final follow up. Signifiant improvement was seen by three months post operatively and this was maintained through final follow up. The VAS score for back pain improved from 6.7 to 5.8 at final follow up. The VAS score showed regression after the first year of follow up. Mean operative time was 96 minutes (range 53-244). Mean blood loss was an average of 80 cc (range 25-350). Mean hospital stay was an average of 1.5 days (range 1-4) with all but one patient discharging home from the hospital. There was one complication noted in our series which was a return to OR secondary to pseudoarthrosis. Conclusion: Minimally invasive sacroiliac joint fusion is an effective treatment of low back pain in the right patient. Introduction: Minimally Invasive Lumbar Interbody Fusion is a retroperitoneal approach which uses corridor between psoas and great vessels. Here we have retrospectively analyzed its early radiological & clinical outcomes in degenerative lumbar spine disease. Methods: OLIF was carried out in 49 segments of 38 patients from May 2016 to August 2017. Patients with degenerative lumbar spine disease were included whereas patients with infection, trauma, lumbar disc prolapse, severe bony canal stenosis, lysthesis of grade 3 or more were excluded. 34 patients (45 segments) were included in this study. All patients were operated from left side. 40 segments had posterior percutaneous and 5 segments had anterior fixation. Auto graft was used in 21 patients (31 segments) and artificial bone graft was used in 13 patients (14 segments). Indirect decompression by distraction was achieved in all patients. Neuromonitioring was not used. Clinical assessment was done according to modified Macnab’s criteria. Radiological assessment was done on lateral radiographs of lumbosacral spine & MRI. Percentage improvement in foraminal height, disc height, reduction of lysthesis & increase in segmental lordosis were measured on radiographs and increase in overall area of spinal canal was evaluated on MRI scans. Results: Out of 34 patients 11 were male and 23 were female. Average age was 63 years. Single segment fusion was done in 24, 2 segment fusion in 9 and 3 segment fusion was done in 1 patient. Average follow up was 5 months. By modified Macnab’s criteria, 24 patients (70.59%) had excellent, 8 patients (23.53%) had good & 2 patients (5.88%) had fair outcomes. None required direct decompression. Per operative complications included rupture of iliolumbar vein in 1(2.94%), breach of peritoneum and fracture of superior endplate of inferior vertebrae in 2 (5.88%) patients. All patients had postoperative graft site pain in which autograft was taken. Graft site fracture occurred in 2 (5.88%) patients which got healed within 3 weeks. Ipsilateral psoas weakness/ pain was seen in 11 (32.35%) patients which got resolved within 3 weeks. 1 (2.94%) patient had superficial /deep infection. 6 (17.64%) had contralateral radiculopathy with motor deficit in 1 patient. 3(8.82%) of them required direct decompression. Conservatively managed patients recovered partial to fully within 1 month. 1(2.94%) patient had numbness in area distribution of left genitofemoral nerve. Overall complication rate was 40.12%. On radiological assessment, overall improvement in foraminal height was 20.78%, disc height improved by 97.32%, average lysthesis reduction was 7.1%, increase in segmental lordosis was 3.16o.36 segments were studied on T2 W MRI axial scans. Overall improvement in spinal canal area was 46.54%. Conclusion: Early clinical outcomes of this study have shown excellent to good results & also significant increase in foraminal height, disc height, segmental lordosis, spinal canal area and reduction of listhesis on radiological assessment with low rate of irreversible complications. Introduction: A retrospective and prospective analysis of the surgical treatment and results of 118 patients with benign and malignant craniocervical, atlantoaxial and high cervical lesions operated during 60 – month period (2011-2016) at our Department was performed. The aim of the analysis was to assess the factors affecting dorsal fusion as correction of craniocervical and high cervical instability. Material and Methods: We analyzed 84 patients with traumatic lesions, 10 patients with inflammatory lesions, 8 patients with degenerative instability, and 16 patients with high cervical tumors. Results: In 118 patients we performed 132 operations. We used posterior cervical, and craniocervical median approach. Because of craniocervical/cervical instability we made posterior screw fixation in all of 118 patients. In order to improve screw placement accuracy we performed intraoperative O-Arm in 102 cases. The operative duration was 2.15 h. in O-Arm operations and 4.35 h in C-arm operation. The blood loss was 300 ml in O-Arm and 550 ml in C-Arm procedures. The mean screw length in C1/C2 vertebras was 30 mm in O- Arm procedures and 24 mm in C-Arm procedures. The most common operative complications were: CSF leak – in 2 cases, postoperative infection – in 5 cases, screw misplacement - in 2 cases (in C- Arm procedures) without early operative mortality. The 12-monts follow-up showed good recovery in 79 patients, moderate disabling – 25 patients, severe disabling – 5 patients, vegetative state – 4 patients, death 5 patients with malignant lesions. Conclusion: Early correction of craniocervical and high cervical instability facilitated neurological recovery by preserving the existent neurological function. Using of O-Arm increase operative screw placement accuracy, and preserve intraoperative nerve and vertebral artery injury. Recently because of the improvement of neuroimaging techniques, operative approaches, surgical techniques and neurointensive care the results of treatment of these lesions are optimal. Introduction: Although pedicle screws have been regarded as the first-line choice for fixation of C7, they may require radiographic or fluoroscopic guidance, take time for placement, and have a potential risk of neurovascular complications. Given such limitations, C7 laminar screw might serve as a viable alternative. However, while laminar screws are widely used for C2 fixation, reports on the clinical experience of C7 laminar screws are quite limited. The purpose of this study was to determine the accuracy and safety of C7 laminar screw placement with a free-hand technique. Material and Methods: All patients who underwent posterior cervical fixation with C7 laminar screws by the last author were chosen. All screws were placed with a free-hand technique without radiographic or fluoroscopic guidance. The operating time for each screw placement was approximately 1-2 minutes. Clinical information and radiologic data of the patients were analyzed. Using postoperative CT scans, which were taken in all patients, the accuracy of screw placement was evaluated by two orthopedic surgeons by assessing the direction (dorsal versus ventral) and degree of laminar cortical breach. Results: Forty-three consecutive patients were enrolled. There were 26 males and 17 females, and the age averaged 59 years (range, 14-82). A total of 61 C7 laminar screws were used: twenty-five patients underwent unilateral C7 laminar screw fixation, and eighteen patients underwent bilateral fixation (Figs 1 and 2). All the laminar screws were 3.5 mm in diameter and 20 to 26 mm in length (3 20-mm, 13 22-mm, 38 24-mm, and 7 26-mm screws). Of the 61 screws, 14 screws (23%) breached the laminar cortical wall, including 3 dorsal and 11 ventral breaches. Of those 14 screws, 11 screws (18%) breached by less than 50% of screw diameter and 3 screws (5%) breached by more than 50% but less than 100% of screw diameter. Nine screws were one of the screws placed bilaterally, and 5 screws were unilaterally placed. No intraoperative neurovascular injury was observed, and none of the screws with cortical breaches resulted in worsening of neurologic symptoms. None of the patients required reoperation for any reason. Over the follow-up period of 20 months, mechanical failure such as loosening or fractures of screw-rod system has not been observed. Conclusion: To our knowledge, this is the largest clinical study ever performed on C7 laminar screw fixation. Although laminar cortical breach was common (25%) with our free-hand technique, most were trivial and none had clinically relevant neurovascular complications nor mechanical failures. Therefore, C7 laminar screws, which can be placed quickly and easily without the need of radiographic or fluoroscopic guidance, may provide a valuable alternative to pedicle screws for C7 fixation in terms of efficacy and safety. However, long-term outcomes, including fusion status, remains to be evaluated with further follow-up. Introduction: Severe pediatric deformity can be extremely challenging to treat due to difficulties with instrumentation placement in small patients, stress on implants due to correction of severe deformities, and use of three column osteotomies. This study analyzed the instrumentation and fusion related complications in complex spine deformity surgical cases. Hypotheses: pediatric patients with severe spinal deformities treated surgically have a high rate of revision surgery for instrument and fusion related complications. Material and Methods: This was a prospective observational multi center cohort of pediatric patients having surgical treatment for severe spinal deformity ( > 100° or planned VCR). 176 patients with severe complex spinal deformity were included from a prospective database with a min. 2 year follow-up. Complications with or without revision due to pseudoarthrosis, instrumentation failure, infection requiring instrumentation removal and progression of deformity were all analyzed. Results: 176 patients out of 313 pts reached a minimum of 2 years follow up. 21 patients (12%) had complications associated with the instrumentation. 15 patients (9%) required 16 revision surgeries because of instrumentation failure. 6 patients (3%) had complications but did not require any revisions. The 16 revision surgeries included 7 (43%) with loss of fixation. The average time for the revision surgery was 13 months (0-28) after the index surgery. Only one patient had 2 revisions. 4 patients were revised for pseudarthrosis at an average of 23 months (17-35). 2 patients (13%) had revisions for prominent instrumentation (both at 27 mos postop), 2 (13%) for infection (19 and 36 months respectively), and one patient had revision surgery for deformity progression at 2 months postoperatively. The patients that did not have revision surgeries included 2 with prominent implants both found at 18 months postop, 2 with progressive deformity/PJK at 18 months average (14-22), and 2 had loss of fixation at 6 months (0-12). Conclusion: Pediatric patients with severe spinal deformity are high risk for revision surgeries at 12% rate within 2 years. The average time for revision surgery was 19 months postoperatively. These patients require close follow-up and will require continued follow-up after 2 years. Introduction: Cervical spinal cord injury is a devastating consequence of high energy trauma and despite of advances in emergency care of quadriplegia patients it is associated with high in-hospital mortality. We conducted systematic review of current literature to identify the predictors of in-hospital mortality in patients with cervical spinal cord injury. Materials and Methods: Two independent reviewers conducted systematic review of English literature between period January 2000 and May 2017 for articles reporting predictors of in-hospital mortality after traumatic spinal cord injuries. Review was conducted according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using a PRISMA checklist. Inclusion criteria were studies with more than 50 adult patients (18 years or older) with traumatic spinal cord injury and reporting predictors of mortality. We included those predictors when at least two studies were available for those predictors. The method of best evidence synthesis for observational studies were used to analyse the quality of each studies and for synthesis of final evidence. Results: The search strategy resulted in 8 articles. Three studies were rated as ‘high quality’, one study as ‘moderate quality’ and four as ‘low quality’. Increasing age, higher cervical level, early surgical decompression, higher ASIA grade at presentation, ventilatory requirements and cardiovascular stability are all observed to be associated with high in-hospital mortality in this patient population. Increasing age and longer ventilatory support were consistently found to be associated with high in-hospital mortality with moderate grade of evidence. Conclusion: Whilst there is no conclusive strong evidence of the predictors for in-hospital mortality following cervical spinal cord injury, special attention should be paid to the above observed predictors. Further prospective studies are warranted in large samples that can delineate the most effective predictor or combination scheme of predictors to ultimately aid clinicians risk stratify the patients and improve the survival outcome. Introduction: Surgery in neurological deficit due to delayed collapse of non-healing osteoporotic fractures is often met with complication due to associated co-morbidity and potential of instrumentation failure. Management of OFND is controversial. Material and Methods: 40 patients with neurological deficit due to delayed osteoporotic vertebral collapse managed by posterior surgery (decompression + instrumentation + transpedicular bone graft) with minimum 2 years follow up included. Demographic data (age, sex, mode of injury, severity of osteoporosis, duration of delay in presentation); clinical parameters [Visual Analogous score (VAS), Oswestry Disability Index (ODI), Frankel grade], radiological parameters (local kyphosis), surgical variables (blood loss, surgery duration, intra-operative problems) recorded. Neurological worsening /improvement, complications, implant loosening /failures were noted. Results: Significant improvement noted in VAS (pre-op 8.20 ± 0.65/post-op 4.1 ± 0.64), ODI (Pre op 76.54 ± 6.96/Post op 30.5 ± 6.56). Complete neurological recovery noted in 37 patients (Frankel grade E), 3 patients remained non ambulatory (Frankel grade C). Significant improvement noted in local kyphosis angle (pre op = 21.80 ± 2.70; post op 11.40 ± 1.80), with 10% loss of correction (2.5+/-0.90) at final follow up. Symptomatic implant failure was noted in 2 patients and proximal junctional failure in 1 patient requiring revision. Conclusion: OFND can be managed with single posterior surgery (decompression + instrumentation+ transpedicular bone-graft) with significant improvement in neurology and functional scores of patient. Aggressive kyphosis correction often not required and significant correction of kyphosis is noticed due to positioning alone. Transpedicular grafting is safe and simple alternative to cement augmentation or anterior surgery for collapsed vertebrae. Introduction: Surgical and clinical outcomes were reviewed to determine the biological behavior and prognostic factors of atypical spinal meningioma. Because of the scarcity of atypical meningioma, there is a lack of research on this type of tumor and malignant transformation. Methods: We retrospectively reviewed the data from all patients on whom we performed spinal cord tumor removal between 1994 and 2016. Seventeen patients were pathologically proved to have atypical meningioma. Surgical extent and disease progression were established by the surgeon according to operative findings, postoperative MRI, and outpatient department (OPD) follow-up. Results: Seventeen patients were included in the analysis, 12 (70%) of whom had tumors in the thoracic region, 4 (24%) of whom had tumors in the cervical region, and 1 (6%) of whom had tumors in the sacral region. Complete resection was achieved in 15 (88%) patients, and subtotal resection was performed in 2 (12%) patients. 4 (24%) patients had metastatic meningioma from brain. Among 4 patients, 3 patients administered radiotherapy after surgery as adjuvant radiotherapy. One patient who underwent surgery for anaplastic meningioma in the brain recurred, and underwent three operations in the spine. The 5- and 10-year overall survival rates were 88.3%, while the 5- and 10-year recurrence-free survival rates were 83% and 52%, respectively. Additionally the mean Ki-67 index differed significantly between patients who did and did not develop recurrence (43% vs. 14%; p = 0.001). Conclusions: Total surgical resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma and if subtotal resection was performed, adjuvant radiotherapy is necessary.