Journal of Spinal Disorders & Techniques最新文献

{"title":"Type I, Type II, and Occasionally Type III: How Can We Go Wrong?","authors":"Mitchell Maltenfort","doi":"10.1097/BSD.0000000000000285","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000285","url":null,"abstract":"<p><p>An important part of planning a study is deciding what risk of drawing incorrect conclusions is acceptable. Type I error occurs when a study draws a false-positive conclusion. A false negative, not appreciating a difference when one exists, is known as type II error. This article reviews the difference between the 2 common types of error and discusses conventions used to set acceptable error levels. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"189"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33287850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Events With the Use of rhBMP-2 in Thoracolumbar and Lumbar Spine Fusions: A 9-Year Institutional Analysis.","authors":"Daniel Lubelski,&nbsp;Kalil G Abdullah,&nbsp;Michael P Steinmetz,&nbsp;Matthew D Alvin,&nbsp;Amy S Nowacki,&nbsp;Srita Chakka,&nbsp;Edward C Benzel,&nbsp;Thomas E Mroz","doi":"10.1097/BSD.0b013e318287f2e2","DOIUrl":"https://doi.org/10.1097/BSD.0b013e318287f2e2","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Objective: </strong>To describe the adverse outcomes associated with the use of rhBMP-2 in thoracolumbar and lumbar fusions.</p><p><strong>Summary of background data: </strong>rhBMP-2 has been increasingly used in spinal fusions over the past decade. Early studies reported that the use of rhBMP-2 is associated with decreased operative time, blood loss, and pain scores, as well as improved fusion rates. Recent investigations have shown rhBMP-2 to be associated with various complications occurring at incidences ranging from 0% to 100%.</p><p><strong>Methods: </strong>Using the institutional electronic medical records, we retrospectively reviewed all patients between January 2002 and September 2010 that underwent thoracolumbar and lumbar spine fusion with BMP. Patient demographics, operative, and outcome/complication information was collected.</p><p><strong>Results: </strong>A total of 547 patient charts were reviewed with a mean follow-up time of 17 months. Mean age was 58 years. Forty-one percent of patients had undergone previous spine surgery. Thirty-nine percent of patients had a PLIF/TLIF, 29% underwent a PLF, and 20% an ALIF. No relevant differences in the patient characteristics and complications were identified between the various surgical approaches. For all approaches, having undergone a previous spine surgery was associated with increased incidence of radiculitis, reoperation, and pseudoarthrosis (P=0.005, 0.0008, 0.05, respectively) as compared with those without previous spine surgery. Being a current smoker at the time of operation was associated with increased rate of radiculitis (P=0.03) as compared with nonsmokers.</p><p><strong>Conclusions: </strong>The use of rhBMP-2, in this study, had an incidence of radiculitis, pseudoarthrosis, and reoperation that was similar to the rates in historical controls without rhBMP-2. Complications do not differ by surgical approach, but are more likely in current smokers and those undergoing revision surgery. A prospective study is warranted to further delineate the adverse event profile of rhBMP-2 and the variables that are likely to affect it (ie, type of surgery, carrier, and dose).</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"E277-83"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e318287f2e2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31256072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgically treated cases of lumbar spondylolysis and isthmic spondylolisthesis: a multicenter study.","authors":"Kenichi Hirano,&nbsp;Shiro Imagama,&nbsp;Yukihiro Matsuyama,&nbsp;Noriaki Kawakami,&nbsp;Yasutsugu Yukawa,&nbsp;Fumihiko Kato,&nbsp;Yudo Hachiya,&nbsp;Tokumi Kanemura,&nbsp;Mitsuhiro Kamiya,&nbsp;Masao Deguchi,&nbsp;Zenya Ito,&nbsp;Norimitsu Wakao,&nbsp;Kei Ando,&nbsp;Ryoji Tauchi,&nbsp;Akio Muramoto,&nbsp;Naoki Ishiguro","doi":"10.1097/BSD.0b013e31827f4321","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31827f4321","url":null,"abstract":"<p><strong>Study design: </strong>Prospective database study.</p><p><strong>Objectives: </strong>To grasp the characteristics of surgically treated cases with lumbar spondylolysis or isthmic spondylolisthesis.</p><p><strong>Summary of background data: </strong>A detailed analysis of surgically treated cases with spondylolysis or isthmic spondylolisthesis has never been reported. An epidemiological study in Japan conducted on 2000 subjects found the incidence of lumbar spondylolysis in the Japanese general population (population-based study) to be 5.9% (males: 7.9%, females: 3.9%). Among 124 vertebrae with spondylolysis, there were 0.8% L2 lesions, 3.2% L3 lesions, 5.6% L4 lesions, and 90.3% L5 lesions, including 5 cases (4.3%) with multiple-level lesions.</p><p><strong>Methods: </strong>We have been registering surgically treated spine cases in our database since 2000. From this database, we prospectively collected cases with lumbar spondylolysis or isthmic spondylolisthesis that were treated surgically between January 2000 and December 2009. We determined the age at surgery, sex, and vertebral level of spondylolysis.</p><p><strong>Results: </strong>Of the 564 spondylolysis patients treated surgically, 66.8% were male and 33.2% were female. The mean age at surgery was 52.5 years (range, 13-84 y). There were 585 vertebrae with spondylolysis including 21 cases (3.7%) with multiple-level lesions. L5 spondylolysis affected 432 vertebrae and was the most common location (73.8%), followed by 125 L4 lesions (21.4%), 24 L3 lesions (4.1%), and 2 L2 lesions (0.7%).</p><p><strong>Conclusions: </strong>The percentage of L4 lesions in our study was significantly higher and of L5 lesions was significantly lower than those lesions' percentages in the population-based study. L4 spondylolysis may be more unstable or cause clinical symptoms more frequently leading to more surgical intervention. The percentage of multiple-level spondylolysis was similar between the 2 studies, suggesting these patients respond relatively well to conservative treatment. The male/female ratio was 2:1 in both studies, indicating that males and females require surgery at a similar frequency.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"193-7"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31827f4321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31108706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologics in spine arthrodesis.","authors":"Abhishek Kannan,&nbsp;Shah-Nawaz M Dodwad,&nbsp;Wellington K Hsu","doi":"10.1097/BSD.0000000000000281","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000281","url":null,"abstract":"<p><p>Spine fusion is a tool used in the treatment of spine trauma, tumors, and degenerative disorders. Poor outcomes related to failure of fusion, however, have directed the interests of practitioners and scientists to spinal biologics that may impact fusion at the cellular level. These biologics are used to achieve successful arthrodesis in the treatment of symptomatic deformity or instability. Historically, autologous bone grafting, including iliac crest bong graft harvesting, had represented the gold standard in spinal arthrodesis. However, due to concerns over potential harvest site complications, supply limitations, and associated morbidity, surgeons have turned to other bone graft options known for their osteogenic, osteoinductive, and/or osteoconductive properties. Current bone graft selection includes autograft, allograft, demineralized bone matrix, ceramics, mesenchymal stem cells, and recombinant human bone morphogenetic protein. Each pose their respective advantages and disadvantages and are the focus of ongoing research investigating the safety and efficacy of their use in the setting of spinal fusion. Rh-BMP2 has been plagued by issues of widespread off-label use, controversial indications, and a wide range of adverse effects. The risks associated with high concentrations of exogenous growth factors have led to investigational efforts into nanotechnology and its application in spinal arthrodesis through the binding of endogenous growth factors. Bone graft selection remains critical to successful fusion and favorable patient outcomes, and orthopaedic surgeons must be educated on the utility and limitations of various biologics in the setting of spine arthrodesis.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"163-70"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33187046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment.","authors":"Barrett I Woods,&nbsp;Alan S Hilibrand","doi":"10.1097/BSD.0000000000000284","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000284","url":null,"abstract":"<p><p>Cervical radiculopathy is a relatively common neurological disorder resulting from nerve root dysfunction, which is often due to mechanical compression; however, inflammatory cytokines released from damaged intervertebral disks can also result in symptoms. Cervical radiculopathy can often be diagnosed with a thorough history and physical examination, but an magnetic resonance imaging or computed tomographic myelogram should be used to confirm the diagnosis. Because of the ubiquity of degenerative changes found on these imaging modalities, the patient's symptoms must correlate with pathology for a successful diagnosis. In the absence of myelopathy or significant muscle weakness all patients should be treated conservatively for at least 6 weeks. Conservative treatments consist of immobilization, anti-inflammatory medications, physical therapy, cervical traction, and epidural steroid injections. Cervical radiculopathy typically is self-limiting with 75%-90% of patients achieving symptomatic improvement with nonoperative care. For patients who are persistently symptomatic despite conservative treatment, or those who have a significant functional deficit surgical treatment is appropriate. Surgical options include anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy. Patient selection is critical to optimize outcome. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"E251-9"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33313300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of navigated versus non-navigated pedicle screw placement in 260 patients and 1434 screws: screw accuracy, screw size, and the complexity of surgery.","authors":"Neal Luther,&nbsp;J Bryan Iorgulescu,&nbsp;Christian Geannette,&nbsp;Harry Gebhard,&nbsp;Tatianna Saleh,&nbsp;Apostolos J Tsiouris,&nbsp;Roger Härtl","doi":"10.1097/BSD.0b013e31828af33e","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31828af33e","url":null,"abstract":"<p><strong>Objective: </strong>Computer 3D navigation (3D NAV) techniques in spinal instrumentation can theoretically improve screw placement accuracy and reduce injury to critical neurovascular structures, especially in complex cases. In this series, we analyze the results of 3D NAV in pedicle screw placement accuracy, screw outer diameter, and case complexity in comparison with screws placed with conventional lateral fluoroscopy.</p><p><strong>Methods: </strong>Pedicle screws placed in the cervical, thoracic, or lumbar spine using either standard lateral fluoroscopy or 3D NAV using isocentric fluoroscopy were retrospectively analyzed. The accuracy of each individual screw was graded on a 4-tiered classification system. Screw and pedicle diameter measurements were also made in both cohorts, and case complexity was compared between the 2 cohorts. Complex cases were defined as deformity surgery, re-do cases, and minimally invasive surgery.</p><p><strong>Results: </strong>A total of 708 screws were placed under 3D NAV guidance and 726 screws were placed without stereotaxy. Eighty-eight percent of 3D NAV-guided pedicle screws were graded nonbreach versus 82% of cases with lateral fluoroscopy (P<0.001). The ratio of screw/pedicle diameter was significantly larger in the 3D NAV cohort (0.71 vs. 0.63, P<0.05). Seventy-six percent of 3D NAV cases had a predefined aspect of complexity, whereas 44% of non-3D NAV cases met criteria to be labeled complex (P<0.001). Reoperation occurred less frequently in 3D NAV cases than fluoroscopy alone.</p><p><strong>Conclusions: </strong>The use of 3D NAV was associated with improved screw placement accuracy, improved screw-to-pedicle diameter measurements, and was used in cases with a higher degree of surgical complexity. We conclude that 3D NAV is a valuable tool in current spinal instrumentation, especially for more complex surgeries.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"E298-303"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31828af33e","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31321490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with intramedullary MRI abnormalities in patients with ossification of the posterior longitudinal ligament.","authors":"Sun Qizhi,&nbsp;Yang Lili,&nbsp;Wang Ce,&nbsp;Chen Yu,&nbsp;Yuan Wen","doi":"10.1097/BSD.0b013e31828b2b59","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31828b2b59","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective clinical study of 113 patients with ossification of the posterior longitudinal ligament (OPLL), who underwent either anterior or posterior surgery between 2006 and 2009.</p><p><strong>Objective: </strong>To evaluate the risk factors affecting the intramedullary spinal cord changes in signal intensity on magnetic resonance imaging (MRI) for the patients with OPLL.</p><p><strong>Summary of background data: </strong>The relationship between the intramedullary spinal cord changes in signal intensity on MRI and neurological deficits, as well as the surgical outcomes, has been described. To obtain better prognosis, early surgery should be conducted in patients with OPLL who have potential abilities to develop intramedullary spinal cord changes in signal intensity on MRI. Various factors may be affecting the development of intramedullary spinal cord changes in signal intensity on MRI.</p><p><strong>Materials and methods: </strong>The clinical and radiographic data of 113 patients with OPLL who underwent either anterior or posterior surgery between 2006 and 2009 were reviewed. Age, sex, complication, mean occupying ratio of OPLL (the greatest thickness of OPLL divided by the anteroposterior diameter of the bony spinal canal), duration of symptoms, type of OPLL, preoperative Japanese Orthopedic Association (JOA) score, and range of motion of the cervical spine were collected. Logistic regression analysis was used.</p><p><strong>Results: </strong>Changes in the intramedullary signal intensity on MRI were observed in 33 of the 113 patients. Statistical results show that duration of symptoms, occupying ratio of OPLL, preoperative JOA score, kyphosis, and instability of the cervical spine are the relevant risk factors for intramedullary spinal cord changes in signal intensity on MRI, with regression coefficients of 2.437, 0.953, -1.952, 2.093, and 1.516, respectively. For patients with OPLL, the longer the duration of the symptoms, or the higher occupying ratio of OPLL, or the lower preoperative JOA score, the greater the likelihood of intramedullary spinal cord changes in signal intensity on MRI.</p><p><strong>Conclusions: </strong>As intramedullary spinal cord changes in signal intensity on MRI indicated severe damage to spinal cord and poor prognosis as we described before, early surgery is suggested for patients with OPLL who manifest one of the following factors: prolonged symptoms, high occupying ratio, low preoperative JOA score, kyphosis, or instability of the cervical spine. These factors are closely related to the intramedullary spinal cord changes in signal intensity on MRI.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"E304-9"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31828b2b59","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31322539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Stage Correction Surgery of Scoliosis Associated With Syringomyelia: Is it Safe to Leave Untreated a Syrinx Without Neurological Symptom?","authors":"Guodong Wang,&nbsp;Jianmin Sun,&nbsp;Zhensong Jiang,&nbsp;Xingang Cui,&nbsp;Jiangchao Cui","doi":"10.1097/BSD.0b013e3182821303","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182821303","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To investigate the safety to leave a syrinx untreated in 1-stage correction surgery of scoliosis associated with syringomyelia without progressive neurological symptom.</p><p><strong>Background material: </strong>The present protocol for patients with scoliosis secondary to syringomyelia advocated to treat the syrinx first because of the increased risk in correction surgery. However, in daily life, these patients could still do lateral bending, in which spinal cord distracted albeit without any neurological symptom occurred.</p><p><strong>Materials and methods: </strong>Twenty-one consecutive patients with scoliosis associated with syringomyelia with or without Chiari malformation underwent surgery in our department from 2003 to 2010 were included in this study. Patients with progressive neural deficits were excluded. Every patient received detailed neurological and radiologic examination before the surgery, including whole spine films, lateral-bending and fulcrum-bending films, 3-dimensional computed tomography scan, and magnetic resonance imaging. All the patients underwent 1-stage correction surgery without treatment of syrinx. During the surgery, Spinal Cord Monitor (SCM) and wake-up test were used to prevent serious neurological complications. At follow-up, patients received neurological examination and whole spine x-ray films.</p><p><strong>Results: </strong>There were 13 male and 8 female patients. Before the surgery, 3 patients complained wasting of the intrinsic muscles of hand, 1 complained numbness of left upper extremity, and 4 complained back pain. Negative abdomen reflex occurred on 12 of 21 patients. All the patients were single major curve, including 14 thoracic curves and 7 thoracolumbar curves. The mean preoperative Cobb angle of scoliosis was 68.05±20.1 degrees, on bending films was 39.48±21.56 degrees, postoperative was 23.19±14.14 degrees, at final follow-up was 25.76±14.46 degrees. The mean flexibility was 0.452±0.158, correction ratio was 0.685±0.140. During the operation, SCM showed motor evoked potential (MEP) loss transiently in 2 patients, and somatosensory evoked potential (SEP) was normal in all the patients. Wake-up test was normal for all the patients. No neurological complication was observed after the surgery and at follow-up; 2 patients complained back pain and 1 patient got early postoperative infection. The mean follow-up time was 4.5 years (1.6∼8.5 y).</p><p><strong>Conclusions: </strong>For scoliosis patients associated with syringomyelia without neurological deficits, it might be safe and could be an option to leave a syrinx untreated before 1-stage correction surgery. Besides, a residual scoliosis was important to make sure the neural safety. The correction procedure during the surgery should be controlled by about 15 degrees or 50% more than on the bending film. Not placing the pedicle screw in the apical region was be","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"E260-4"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182821303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31130796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of venous thromboembolic events after elective major thoracolumbar degenerative spine surgery.","authors":"Justin B Hohl,&nbsp;Joon Y Lee,&nbsp;Steven P Rayappa,&nbsp;Colin E Nabb,&nbsp;Clinton J Devin,&nbsp;James D Kang,&nbsp;William Timothy Ward,&nbsp;William F Donaldson","doi":"10.1097/BSD.0b013e31828b7d82","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31828b7d82","url":null,"abstract":"<p><strong>Study design: </strong>A case-control study.</p><p><strong>Objective: </strong>The purposes of this study were to establish the prevalence of venous thromboembolic disease in patients undergoing elective major thoracolumbar degenerative spine surgery and identify risk factors.</p><p><strong>Summary of background data: </strong>Venous thromboembolic events (VTE) are a serious complication of orthopedic surgery, but the prevalence of VTE after elective thoracolumbar degenerative spine surgery is not well known.</p><p><strong>Methods: </strong>This was a case-control study of 5766 consecutive elective thoracolumbar degenerative spine surgeries. Symptomatic pulmonary emboli (PE) were diagnosed by spiral chest CT scans, nuclear scintigraphic ventilation-perfusion, and angiography. Deep vein thromboses (DVT) were diagnosed by venous duplex scans. The prevalence of VTE was analyzed according to patient demographic variables and type of surgery performed.</p><p><strong>Results: </strong>The prevalence of developing a VTE was 1.5% (89/5766), with a prevalence of symptomatic PE of 0.88% (51/5766) and DVT of 0.66% (38/5766). There were 47% males and 53% females with a mean age of 60.3 years. In patients undergoing 5-segment fusions the prevalence of PE was 3.1% (P=0.022). Patients who had ≥4 segments fused had a prevalence of PE of 1.7% (P=0.014). The odds of having a PE in those above 65 years at the time of surgery were 2.196 times as large as for those below 65 years. Noncontributory factors included sex, instrumentation, and revision surgery.</p><p><strong>Conclusions: </strong>This case-control study of 5766 patients who underwent elective thoracolumbar degenerative spine surgery revealed a prevalence of VTE of 1.5%, with a prevalence of PE of 0.88% and DVT of 0.66%. Patients with increasingly extensive surgery had a higher risk of PE, specifically those undergoing fusion of ≥5 segments.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"E310-5"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31828b7d82","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31322541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of starting point and C2 nerve status on the safety and accuracy of C1 lateral mass screws: meta-analysis and review of the literature.","authors":"Robert E Elliott,&nbsp;Omar Tanweer,&nbsp;Anthony Frempong-Boadu,&nbsp;Michael L Smith","doi":"10.1097/BSD.0b013e3182898aa9","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182898aa9","url":null,"abstract":"<p><strong>Study design: </strong>Literature review and meta-analysis.</p><p><strong>Objective: </strong>To compare clinical and radiographic outcomes of patients treated with C1 lateral mass screws (C1LMS), analyzing the impact of screw starting point and C2 nerve sectioning on malposition, vertebral artery injury (VAI), and C2 neuralgia and numbness.</p><p><strong>Background: </strong>Various starting points have been suggested for C1LMS insertion. Some advocate sectioning the C2 nerve root to ease placement.</p><p><strong>Methods: </strong>Online databases were searched for English language articles between 1994 and 2012 reporting on C1LMS. Forty-two studies describing 1471 patients instrumented with 2905 C1LMS met inclusion criteria. Three surgical techniques included posterior arch starting point and center of lateral mass with nerve root preservation or sacrifice.</p><p><strong>Results: </strong>All studies provided class III evidence. Three injuries to the vertebral artery occurred secondary to C1LMS insertion (0.1%) and 5 instances of clinically significant screw malpositions (0.2%). Postoperative imaging revealed 45 malpositioned screws (1.6%) without clinical consequences. Meta-analysis techniques demonstrated that sacrifice of the C2 nerve root caused greater postoperative numbness but less neuralgia and fewer screw malpositions. Similar rates of screw malposition and VAI arose with posterior arch screws and those starting below the arch with C2 nerve preservation, but the latter had greater numbness and pain.</p><p><strong>Conclusion: </strong>A thorough understanding of atlantoaxial anatomy and modern surgical techniques renders the insertion of C1LMS safe and accurate. The incidence of clinically significant malpositioned screws or VAI is <0.5%. Sacrifice of the C2 nerve root did result in fewer malpositioned screws. Numbness occurred in 11% of patients, an outcome that may be unacceptable to certain patient populations, but neuropathic pain was nearly absent with nerve sectioning. C2 nerve preservation and retraction for C1 screw placement may have higher incidence of neuropathic pain. Posterior arch screws are a viable option for patients with arches that are of adequate height.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"171-85"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182898aa9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31255946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}