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Year of Publication
1.  Giant Chordoma of the Upper Thoracic Spine with Mediastinal Involvement: A Surgical Challenge 
Asian Spine Journal  2014;8(3):353-356.
Thoracic chordomas are very rare malignant tumours originating from notochordal remnants. These tumours develop within a vertebral body and enlarge involving the mediastinal compartment. Because of their slow-growing attitude, they become symptomatic only when they invade or compress the spinal cord and/or mediastinal organs. We present a rare case of a thoracic spine chordoma presenting with increasing paraparesis with a huge mediastinal component which was surgically debulked to decompress the spinal cord and medistinal organs.
doi:10.4184/asj.2014.8.3.353
PMCID: PMC4068856  PMID: 24967050
Chordoma; Spine; Bone neoplasms; Mediastinum; Surgery
2.  Management of Pyogenic Discitis 
Asian Spine Journal  2014;8(3):391.
doi:10.4184/asj.2014.8.3.391
PMCID: PMC4068862  PMID: 24967056
3.  Answer to the Topic "Management of Pyogenic Discitis" 
Asian Spine Journal  2014;8(3):392.
doi:10.4184/asj.2014.8.3.392
PMCID: PMC4068863  PMID: 24967057
4.  Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor 
Asian Spine Journal  2014;8(2):202-205.
Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor.
doi:10.4184/asj.2014.8.2.202
PMCID: PMC3996346  PMID: 24761204
Tarlov's cysts; Perineural cyst; Spinal cyst; spine; Cervical spine
5.  Tuberculosis of Sacrum 
Asian Spine Journal  2014;8(1):112.
doi:10.4184/asj.2014.8.1.112
PMCID: PMC3939363  PMID: 24596614
8.  Osteoblastoma of C2 Corpus: 4 Years Follow-up 
Asian Spine Journal  2012;6(2):136-139.
Osteoblastomas are rare neoplasms of the spine. The majority of the spinal lesions arise from the posterior elements and involvement of the corpus is usually by extension through the pedicles. An extremely rare case of isolated C2 corpus osteoblastoma is presented herein. A 9-year-old boy who presented with neck pain and spasmodic torticollis was shown to have a lesion within the corpus of C2. He underwent surgery via an anterior cervical approach and the completely-resected mass was reported to be an osteoblastoma. The pain resolved immediately after surgery and he had radiologic assessments on a yearly basis. He was symptom-free 4 years post-operatively with benign radiologic findings. Although rare, an osteoblastoma should be considered in the differential diagnosis of neck pain and torticollis, especially in patients during the first two decades of life. The standard treatment for osteoblastomas is radical surgical excision because the recurrence rate is high following incomplete resection.
doi:10.4184/asj.2012.6.2.136
PMCID: PMC3372549  PMID: 22708018
Osteoblastoma; Osteoid osteoma; C2 corpus; Anterior cervical approach
9.  Focal Ligamentum Flavum Hypertrophy with Ochronotic Deposits: An Unusual Cause for Neurogenic Claudication in Alkaptonuria 
Asian Spine Journal  2012;6(2):148-151.
Neurogenic claudication resulting from focal hypertrophy of the ligamentum flavum in the lumbar spine due to ochronotic deposits has not been reported till date. The authors discuss one such case highlighting the pathogenesis, histological and radiological features. Salient features of management are also emphasized upon.
doi:10.4184/asj.2012.6.2.148
PMCID: PMC3372552  PMID: 22708021
Spinal stenosis; Ligamentum flavum; Alkaptonuria
10.  Motion Induced Artifact Mimicking Cervical Dens Fracture on the CT Scan: A Case Report 
Asian Spine Journal  2012;6(3):216-218.
The diagnostic performance of helical computed tomography (CT) is excellent. However, some artifacts have been reported, such as motion, beam hardening and scatter artifacts. We herein report a case of motion-induced artifact mimicking cervical dens fracture. A 60-year-old man was involved in a motorcycle accident that resulted in cervical spinal cord injury and quadri plegia. Reconstructed CT images of the cervical spine showed a dens fracture. We assessed axial CT in detail, and motion artifact was detected.
doi:10.4184/asj.2012.6.3.216
PMCID: PMC3429615  PMID: 22977704
Reconstruction; Motion artifact; Mimicking; Cervical fracture
11.  Thirty Years after Paul Randall Harrington (September 27, 1911-November 29, 1980) 
Asian Spine Journal  2010;4(2):141-142.
doi:10.4184/asj.2010.4.2.141
PMCID: PMC2996628  PMID: 21165320
12.  Prevalence and Correlates of Low Back Pain in Primary Care: What Are the Contributing Factors in a Rapidly Developing Country 
Asian Spine Journal  2014;8(3):227-236.
Study Design
Cross-sectional.
Purpose
The purpose of the study was to determine the prevalence of low back pain (LBP) in the primary care setting with emphasis on the socio-demographic contributing factors and impact of LBP on lifestyle habits.
Overview of Literature
LBP is one of the most common medical conditions seen in the Primary Health Care Clinic.
Methods
A representative sample of 2,600 patients were approached and 1,829 subjects agreed to participate in this study (70.0%). Data on socio-demographic characteristics, life style habits and type of treatment were collected through a questionnaire.
Results
The prevalence of LBP in the study sample was 56.5% (95% confidence interval, 54.2-58.8). LBP was more prevalent among women (53.9%) compared to men (46.1%). There was significant difference between male and female patients of LBP in terms of ethnicity (p<0.001), marital status (p=0.010), occupation (p<0.001), monthly household income (p=0.004), and cigarette/sheesha smokers (p<0.001). The percentages of different aspects of functional disabilities were statistically significantly higher among females compared to male patients with LBP. Almost a quarter of female patients with LBP (26%) and 18% male patients with LBP reported pain in the arms and legs (p=0.002). In addition, gastrointestinal complaints such as abdominal pain and food intolerance were significantly higher among female patients with LBP as compared to males (31% vs. 24.6%, p=0.018; and 25% vs. 18%, p=0.008, respectively). Complaints about headache and fainting were also significantly higher among female patients as compared to male LBP patients (43% vs. 36%, p=0.029; and 26% vs. 20%, p=0.016, respectively). The multivariate logistic regression revealed that being female, prolonged standing, prolonged sitting, heavy weight lifting, weakness in the legs, regular exercise, and cigarette/sheesh a smoking had a significant effect on the presence of LBP.
Conclusions
LBP is highly prevalent among both genders and in older age. Also, weakness in the legs, smoking, prolonged standing and sitting had a significant effect on LBP. Furthermore, the current study findings support the fact that LBP continues to be an important clinical, social and economic, burden and a public health problem affecting the population of the entire world.
doi:10.4184/asj.2014.8.3.227
PMCID: PMC4068841  PMID: 24967035
Epidemiology; Low back pain; Roland-Morris disability; Risk factors; Life-style habits; Primary health care
13.  Accuracy of Free Hand Pedicle Screw Installation in the Thoracic and Lumbar Spine by a Young Surgeon: An Analysis of the First Consecutive 306 Screws Using Computed Tomography 
Asian Spine Journal  2014;8(3):237-243.
Study Design
A retrospective cross-sectional study.
Purpose
The purpose of this study is to evaluate the accuracy and safety of free-hand pedicle screw insertion performed by a young surgeon.
Overview of Literature
Few articles exist regarding the safety of the free-hand technique without inspection by an experienced spine surgeon.
Methods
The index surgeon has performed spinal surgery for 2 years by himself. He performed fluoroscopy-assisted pedicle screw installation for his first year. Since then, he has used the free-hand technique. We retrospectively reviewed the records of all consecutive patients undergoing pedicle screw installation using the free-hand technique without fluoroscopy in the thoracic or lumbar spine by the index surgeon. Incidence and extent of cortical breach by misplaced pedicle screw was determined by a review of postoperative computed tomography (CT) images.
Results
A total of 36 patients received 306 free-hand placed pedicle screws in the thoracic or lumbar spine. A total of 12 screws (3.9%) were identified as breaching the pedicle in 9 patients. Upper thoracic spine was the most frequent location of screw breach (10.8%). Lateral breach (2.3%) was more frequent than any other direction. Screw breach on the right side (9 patients) was more common than that on the left side (3 patients) (p<0.01).
Conclusions
An analysis by CT scan shows that young spine surgeons who have trained under the supervision of an experienced surgeon can safely place free-hand pedicle screws with an acceptable breach rate through repetitive confirmatory steps.
doi:10.4184/asj.2014.8.3.237
PMCID: PMC4068842  PMID: 24967036
Pedicle screw; Thoracic; Lumbar: Free hand; Accuracy; Safety
14.  Comparison of Unilateral versus Bilateral Kyphoplasty in Multiple Myeloma Patients and the Importance of Preoperative Planning 
Asian Spine Journal  2014;8(3):244-252.
Study Design
Retrospective comparative study and technical note.
Purpose
To determine if there is a difference in clinical and radiographic parameters between unilateral and bilateral kyphoplasty in a uniform cancer population and to stress the importance of preoperative planning.
Overview of Literature
While unipedicular kyphoplasty is gaining popularity, a few comparative studies have reported on superior kyphotic reduction with the bipedicular approach.
Methods
We reviewed 69 myeloma patients with 105 operated levels (51 levels were done bilaterally vs. 54 unilaterally). Pain reduction, height restoration, cement volume and complications were recorded up to three months postoperatively. A technical note to identify the skin entry point on the basis of the magnetic resonance imaging and fluoroscopy (lateral view) is being described.
Results
Both procedures resulted in significant pain reduction (5.4-5.6/10 points, p=0.8). There was significant height restoration after the operation (p<0.001), while there was no sustained difference between the procedures (p=0.5) up to three months postoperatively. More cement was injected in the bilateral group (4.1 mL vs. 4.9 mL, p=0.002); no difference in cement extravasation in the spinal canal was observed (p=0.5).
Conclusions
There was no difference in the clinical or radiological outcomes between the unilateral and bilateral approaches. Therefore, unilateral kyphoplasty may be performed whenever it is technically feasible and this may be determined preoperatively.
doi:10.4184/asj.2014.8.3.244
PMCID: PMC4068843  PMID: 24967037
Compression fracture; Magnetic resonance imaging; Multiple myeloma; Kyphoplasty; Unilateral
15.  Percutaneous Drainage Combined with Hyperbaric Oxygen Therapy for Pyogenic Spondylitis with Iliopsoas Abscess 
Asian Spine Journal  2014;8(3):253-259.
Study Design
A retrospective study.
Purpose
The purpose of this study was to evaluate outcomes in patients with pyogenic spondylitis accompanied by iliopsoas abscess who were treated by percutaneous drainage combined with hyperbaric oxygen (HBO) therapy.
Overview of Literature
To the best of our knowledge, there have been no previous reports of the use of percutaneous drainage combined with HBO therapy for the treatment of this condition.
Methods
Twenty-three patients (13 men, 10 women; mean age, 69.0 years; range, 45-85 years) were treated with percutaneous drainage combined with HBO therapy in addition to commonly used conservative therapy. Mean follow-up duration was 27.7 months (range, 12-48 months). Clinical outcomes and imaging examinations were retrospectively investigated.
Results
Symptoms such as low back pain, radicular pain, and hip pain resolved in all patients immediately after treatment. Mean time from the start of treatment to the return of C-reactive protein levels to normal or baseline values recorded before the onset of spondylitis was 28.3 days (range, 8-56 days). In the final set of follow-up radiographic studies, all patients were free from progressive destructive changes. Follow-up magnetic resonance images or computed tomography with contrast enhancement confirmed the disappearance or near-total resolution of the iliopsoas abscess cavity with healing of the pyogenic spondylitis in all 23 patients. No recurrences were observed during follow-up.
Conclusions
The present study suggests that patients with pyogenic spondylitis accompanied by iliopsoas abscess can be cured without a prolonged period of therapy or recurrence using this treatment.
doi:10.4184/asj.2014.8.3.253
PMCID: PMC4068844  PMID: 24967038
Psoas abscess; Spondylitis; Hyperbaric oxgen therapy; Drainage
16.  Interspinous Ligament Lidocaine and Steroid Injections for the Management of Baastrup's Disease: A Case Series 
Asian Spine Journal  2014;8(3):260-266.
Study Design
Prospective study.
Purpose
To examine the long-term effects of interspinous ligament injections of local anesthetics and steroids for the treatment of Baastrup's diseases.
Overview of Literature
Baastrup's disease is associated with axial low back pains. Baastrup's disease has been more recently described as the "kissing spinous processes" disease. Several authors have reported methods for the diagnosis and treatment of the disease. However, there has been only one report of patients receiving interspinous ligament injections of agents for the treatment of Baastrup's disease.
Methods
Seventeen patients showed severe low back pains between spinous processes at L3-L4 or L4-L5. X-ray imaging, computed tomography, and magnetic resonance imaging revealed kissing spinous processes, consolidation of spinous process, or inflammation of an interspinous ligament. Pain reliefs after lidocaine and dexamethasone administration into interspinous ligament as therapy for low back pains were being examined and followed up.
Results
Low back pain scores significantly improved immediately after injection of the agents into interspinous ligaments. At final follow-up (1.4 year), low back pain scores significantly improved as compared with before the treatment.
Conclusions
Findings from the current study indicate that lidocaine and dexamethasone administration into interspinous ligament in patients diagnosed with Baastrup's disease is effective for managing the pain associated with this disease.
doi:10.4184/asj.2014.8.3.260
PMCID: PMC4068845  PMID: 24967039
Pain; Local anesthetic; Steroid
17.  Outcomes after Surgery for Spinal Metastasis of Colorectal Origin: Case Series 
Asian Spine Journal  2014;8(3):267-272.
Study Design
Retrospective study.
Purpose
The aim of this study was to evaluate the clinical management and outcomes of patients who underwent surgical intervention for metastatic colorectal adenocarcinoma of the spine.
Overview of Literature
Gastrointestinal (GI) cancer metastasis to the spine are relatively rare and represent later manifestations of the disease. Studies and reports on the outcomes of patients who undergo surgery for spinal metastasis of GI origin are scarce.
Methods
A retrospective chart review of all patients who underwent surgery for spinal metastasis of colorectal origin was performed. Four patients were identified. Patient characteristics, outcomes, and survival were analyzed.
Results
Two patients experienced improvement in pain or myelopathic symptoms. Although the mean survival was 15.3 months, this average included a patient still living at 57.1 months. The mean survival was just 1.3 months for the 3 patients who expired.
Conclusions
In certain cases, symptomatic improvement with prolonged survival is possible after surgery for metastatic spinal lesions of colorectal origin; however, survival is poor in the majority of cases.
doi:10.4184/asj.2014.8.3.267
PMCID: PMC4068846  PMID: 24967040
Cancer; Colorectal; Gastrointestinal; Metastasis; Spine; Surgery
18.  Cervical Pedicle Screw Fixation: Anatomic Feasibility of Pedicle Morphology and Radiologic Evaluation of the Anatomical Measurements 
Asian Spine Journal  2014;8(3):273-280.
Study Design
All parameters were measured manually and with a computed tomography (CT) scanner. For the manual measurements, a Vernier scale instrument was used.
Purpose
This study evaluates quantitatively pedicles of middle and lower cervical spine (C3 to C7) and to evaluate the possibilities of using these structures as anchors in posterior cervical fusion.
Overview of Literature
Pedicle screws may be an alternative fixation technique for posterior cervical instrumentation.
Methods
Twenty-two bony sets of adult cervical spines were studied (110 vertebrae, 220 pedicles) from C3 down to C7.
Results
CT measurement of cervical pedicles appeared to be accurate and valuable for preoperative planning of cervical pedicle screw instrumentation. The study showed a high correlation between the values obtained by manual and CT measurements of pedicle dimensions. The technical challenge of insertion is the obvious theoretical drawback of the use of cervical pedicle screws. Many technical factors are important to consider, namely, the point of screw entry, the pedicle dimensions, the screw direction according to the pedicle angle and orientation, the screw diameter and length, and the method of screw introduction.
Conclusions
Transpedicular screw fixation of the cervical spine appears to be promising. Anatomic limitations should be clear to the surgeon. Further clinical and biomechanical studies are needed to settle this technique.
doi:10.4184/asj.2014.8.3.273
PMCID: PMC4068847  PMID: 24967041
Spine; Morphology; Screw; Pedicle
19.  Lumbar Transpedicular Implant Failure: A Clinical and Surgical Challenge and Its Radiological Assessment 
Asian Spine Journal  2014;8(3):281-297.
Study Design
It is a multicenter, controlled case study review of a big scale of pedicle-screw procedures from January 2000 to June 2010. The outcomes were compared to those with no implant failure.
Purpose
The purpose of this study was to review retrospectively the outcome of 100 patients with implant failure in comparison to 100 control-patients, and to study the causes of failure and its prevention.
Overview of Literature
Transpedicular fixation is associated with risks of hardware failure, such as screw/rod breakage and/or loosening at the screw-rod interface and difficulties in the system assembly, which remain a significant clinical problem. Removal or revision of the spinal hardware is often required.
Methods
Two hundred patients (88 women, 112 men) were divided into 2 major groups, with 100 patients in group I (implant failure group G1) and 100 patients in group II (successful fusion, control group G2). We subdivided the study groups into two subgroups: subgroup a (single-level instrumented group) and subgroup b (multilevel instrumented group). The implant status was assessed based on intraoperative and follow-up radiographs.
Results
Implant failure in general was present in 36% in G1a, and in 64% in G1b, and types of implant failure included screw fracture (34%), rod fracture (24%), rod loosening (22%), screw loosening (16%), and failure of both rod and screw (4%). Most of the failures (90%) occurred within 6 months after surgery, with no reported cases 1 year postoperatively.
Conclusions
We tried to address the problem and study the causes of failure, and proposed solutions for its prevention.
doi:10.4184/asj.2014.8.3.281
PMCID: PMC4068848  PMID: 24967042
Lumbar, fixation; Screw, failure; Fusion; Fracture fixations, prosthesis; Loosening
20.  Outcome of Pedicle Screw Fixation and Monosegmental Fusion in Patients with Fresh Thoracolumbar Fractures 
Asian Spine Journal  2014;8(3):298-308.
Study Design
Prospective clinical study.
Purpose
The present prospective study aims to evaluate the clinical, radiological, and functional and quality of life outcomes in patients with fresh thoracolumbar fractures managed by posterior instrumentation of the spine, using pedicle screw fixation and monosegmental fusion.
Overview of Literature
The goals of treatment in thoracolumbar fractures are restoring vertebral column stability and obtaining spinal canal decompression, leading to early mobilization of the patient.
Methods
Sixty-six patients (46 males and 20 females) of thoracolumbar fractures with neurological deficit were stabilized with pedicle screw fixation and monosegmental fusion. Clinical, radiological and functional outcomes were evaluated.
Results
The mean preoperative values of Sagittal index, and compression percentage of the height of the fractured vertebra were 22.75° and 46.73, respectively, improved (statistically significant) to 12.39°, and 24.91, postoperatively. The loss of correction of these values at one year follow-up was not statistically significant. The mean preoperative canal compromise (%) improved from 65.22±17.61 to 10.06±5.31 at one year follow-up. There was a mean improvement in the grade of 1.03 in neurological status from the preoperative to final follow-up at one year. Average Denis work scale index was 4.1. Average Denis pain scale index was 2.5. Average WHOQOL-BREF showed reduced quality of life in these patients. Patients of early surgery group (operated within 7 days of injury) had a greater mean improvement of neurological grade, radiological and functional outcomes than those in the late surgery group, but it was not statistically significant.
Conclusions
Posterior surgical instrumentation using pedicle screws with posterolateral fusion is safe, reliable and effective method in the management of fresh thoracolumbar fractures. Fusion helps to decrease the postoperative correction loss of radiological parameters. There is no correlation between radiographic corrections achieved for deformities and functional outcome and quality of life post spinal cord injury.
doi:10.4184/asj.2014.8.3.298
PMCID: PMC4068849  PMID: 24967043
Thoracolumbar; Fractures; Pedicle screws; Neurological involvement; Functional outcome; Radiological outcome
21.  Paraspinal Transposition Flap for Reconstruction of Sacral Soft Tissue Defects: A Series of 53 Cases from a Single Institute 
Asian Spine Journal  2014;8(3):309-314.
Study Design
Case series.
Purpose
To describe paraspinal transposition flap for coverage of sacral soft tissue defects.
Overview of Literature
Soft tissue defects in the sacral region pose a major challenge to the reconstructive surgeon. Goals of sacral wound reconstruction are to provide a durable skin and soft tissue cover adequate for even large sacral defects; minimize recurrence; and minimize donor site morbidity. Various musculocutaneous and fasciocutanous flaps have been described in the literature.
Methods
The flap was applied in 53 patients with sacral soft tissue defects of diverse etiology. Defects ranged in size from small (6 cm×5 cm) to extensive (21 cm×10 cm). The median age of the patients was 58 years (range, 16-78 years).
Results
There was no flap necrosis. Primary closure of donor sites was possible in all the cases. The median follow up of the patients was 33 months (range, 4-84 months). The aesthetic outcomes were acceptable. There has been no recurrence of pressure sores.
Conclusions
The authors conclude that paraspinal transposition flap is suitable for reconstruction of large sacral soft tissue defects with minimum morbidity and excellent long term results.
doi:10.4184/asj.2014.8.3.309
PMCID: PMC4068850  PMID: 24967044
Transposition flap; Pressure ulcer; Sacral defect
22.  Non-Surgical Management of Cord Compression in Tuberculosis: A Series of Surprises 
Asian Spine Journal  2014;8(3):315-321.
Study Design
Prospective study.
Purpose
We present a series of 50 patients with tuberculous cord compression who were offered systematic non-surgical treatment, and thereby, the author proposes that clinico-radiological soft tissue cord compression is not an emergency indication for surgery.
Overview of Literature
Spinal cord compression whether clinical or radiological has usually been believed to be an indication for emergency surgery in spinal tuberculosis.
Methods
Fifty adults were prospectively studied at our clinic for spinal cord compression due to tuberculous spondylitis, between May 1993 and July 2002. The inclusion criteria were cases with clinical and/or radiological evidence of cord compression (documented soft tissue effacement of the cord with complete obliteration of the thecal sac at that level on magnetic resonance imaging scan). Exclusion criteria were lesions below the conus level, presence of bony compression, severe or progressive neurological deficit (
Results
At the time of presentation, 10 patients had a motor deficit, 18 had clinically detectable hyper-reflexia and 22 had normal neurology. Forty-seven of the 50 patients responded completely to non-operative treatment and healed with no residual neurological deficit. Three patients with progressive neurological deficit while on treatment were operated on with eventual excellent recovery.
Conclusions
Radiological evidence of cord compression and early neurological signs need not be an emergency surgical indication in the management of spinal tuberculosis.
doi:10.4184/asj.2014.8.3.315
PMCID: PMC4068851  PMID: 24967045
Non-surgical management; Spinal tuberculosis; Spinal cord compression
Asian Spine Journal  2014;8(3):322-330.
Study Design
A retrospective study.
Purpose
To clarify the differences among the three major surgeries for osteoporotic vertebral fractures based on the clinical and radiological results.
Overview of Literature
Minimally invasive surgery like balloon kyphoplasty has been used to treat osteoporotic vertebral fractures, but major surgery is necessary for severely impaired patients. However, there are controversies on the surgical procedures.
Methods
The clinical and radiographic results of patients who underwent major surgery for osteoporotic vertebral fracture were retrospectively compared, among anterior spinal fusion (group A, 9 patients), single-stage combined anterior-posterior procedure (group AP, 8 patients) and posterior closing wedge osteotomy (group P, 9 patients). Patients who underwent revision surgery were evaluated just before the revision surgery, and the other patients were evaluated at the final follow-up examination, which was defined as the end point of the evaluations for the comparison.
Results
The operation time was significantly longer in group AP than in the other two groups. The postoperative correction of kyphosis was significantly greater in group P than in group A. Although the differences were not significant, better outcomes were obtained in group P in: back pain relief at the end point; ambulatory ability at the end point; and average loss of correction.
Conclusions
The posterior closing wedge osteotomy demonstrated better surgical results than the anterior spinal fusion procedure and the single-stage combined anterior-posterior procedure.
doi:10.4184/asj.2014.8.3.322
PMCID: PMC4068852  PMID: 24967046
Osteoporosis; Vertebral body fracture; Posterior closing wedge osteotomy; Single-stage combined anterior-posterior procedure; Anterior spinal fusion
Asian Spine Journal  2014;8(3):331-338.
Study Design
Retrospective study.
Purpose
We compared the accuracy of O-arm-based navigation with computed tomography (CT)-based navigation in scoliotic surgery.
Overview of Literature
No previous reports comparing the results of O-arm-based navigation with conventional CT-based navigation in scoliotic surgery have been published.
Methods
A total of 222 pedicle screws were implanted in 29 patients using CT-based navigation (group C) and 416 screws were implanted in 32 patients using O-arm-based navigation (group O). Postoperative CT was performed to assess the screw accuracy, using the established Neo classification (grade 0: no perforation, grade 1: perforation <2 mm, grade 2: perforation ≥2 and <4, and grade 3: perforation ≥4 mm).
Results
In group C, 188 (84.7%) of the 222 pedicle screw placements were categorized as grade 0, 23 (10.4%) were grade 1, 11 (5.0%) were grade 2, and 0 were grade 3. In group O, 351 (84.4%) of the 416 pedicle screw placements were categorized as grade 0, 52 (12.5%) were grade 1, 13 (3.1%) were grade 2, and 0 were grade 3. Statistical analysis showed no significant difference in the prevalence of grade 2.3 perforations between groups C and O. The time to position one screw, including registration, was 10.9±3.2 minutes in group C, but was significantly decreased to 5.4±1.1 minutes in group O.
Conclusions
O-arm-based navigation facilitates pedicle screw insertion as accurately as conventional CT-based navigation. The use of O-arm-based navigation successfully reduced the time, demonstrating advantages in the safety and accuracy of pedicle screw placement for scoliotic surgery.
doi:10.4184/asj.2014.8.3.331
PMCID: PMC4068853  PMID: 24967047
Scoliosis; Computer-assisted surgery; Image-guided surgery; Spine
Asian Spine Journal  2014;8(3):339-345.
Study Design
A retrospective study.
Purpose
The aim of present study was to investigate imaging findings suggestive of cauda equina entrapment in thoracolumbar and lumbar burst fractures.
Overview of Literature
Burst fractures with cauda equina entrapment can cause neurologic deterioration during surgery. However, dural tears and cauda equina entrapment are very difficult to diagnose clinically or radiographically before surgery.
Methods
Twenty-three patients who underwent spinal surgery for thoracolumbar or lumbar burst fractures were enrolled in this study. In magnetic resonance imaging T2-weighted images of the transverse plane, we defined cauda equina notch sign (CENS) as a v-shaped image that entrapped cauda equina gathers between lamina fractures. We evaluated the fractured spine by using CENS and lamina fractures and the rate of available space for the spinal canal at the narrowest portion of the burst fracture level. We classified patients into entrapment group or non-entrapment group, based on whether cauda equina entrapment existed.
Results
Lamina fractures were detected in 18 (78.3%) and CENS were detected in 6 (26.1%) of 23 burst-fracture patients. Cauda equina entrapment existed in all the patients with CENS. In addition, the rate of available space for the spinal canal increased according to logistic regression. The size of the retropulsed fragment in the spinal canal was the most reliable of all the factors, suggesting cauda equina entrapment.
Conclusions
CENS was the most predictable sign of cauda equina entrapment associated with burst fractures.
doi:10.4184/asj.2014.8.3.339
PMCID: PMC4068854  PMID: 24967048
Burst fracture; Dural tear; Cauda equina entrapment; Lamina fracture; Magnetic resonance imaging

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