Background: This study introduces a new fluoroscopy-guided intradiscal radiopaque gelified ethanol injection technique using the antero-posterior view and compare it to conventional oblique view. Intradiscal procedures, are minimally invasive techniques that aim to reduce pain associated with lumbar disc herniation by modifying the disc material and decreasing pressure on surrounding nerves. Objectives: This study introduces a new fluoroscopy-guided intradiscal radiopaque gelified ethanol injection technique using an anteroposterior view compared to the conventional oblique view. Study Design: This is a double blind, randomized trial. Setting: A tertiary care center. Methods: Patients with radicular leg pain were randomly assigned to receive a radiopaque gelified ethanol injection via an anteroposterior view or oblique view.. The primary outcomes were procedure time, complication rates, and radiation exposure. Results: A total of 70 patients were randomized to each group (35 for each group). There were no serious complications in either group. Radiation exposure was significantly lower in the anteroposterior view group (36.92 vs 50.46 mu Gray/m2 [mu Gy/m2; P = 0.007). The procedure time was also significantly lower in the anteroposterior group (171 vs 287 seconds; P = 0.001). Limitations: Limitations of our trial include the relatively small sample size, the single-center nature of the study, and the short follow-up period. We were also limited in only including patients with moderate body habitus, and patients with only L3 or L4 disc herniation, which might restrict the generalizability of the findings. Conclusion: An anteroposterior view radiopaque gelified ethanol injection is a promising alternative to the conventional oblique view technique for radicular leg pain management. This novel approach offers a safer and more efficient treatment option, reducing radiation exposure and procedure time without compromising clinical outcomes. Its potential to minimize patient discomfort and enhance overall management of radicular leg pain warrants further investigation and widespread adoption.

BACKGROUND CONTEXT The majority of scoliosis patients are subject to tremendous amounts of x-ray radiation in order to establish the diagnosis or follow the progression of the curves. There are different remedies to reduce the dose of delivered radiation or protect the body against such exposures. In addition, Bi-dimensional slot scattered technique (EOS) has provided some advantages, however, it is not available at all spine centers. The scoliosis patients are frequently requested to obtain MRI to discover neural axis abnormalities. As an attempt to find other alternatives for x-ray imaging, some authors demonstrated that the measured curve in the standing x-ray is correlated with the magnitude of the curve in the supine MRI. PURPOSE The supine MRI can illustrate the curve flexibility as obviously as the bending x-ray images in patients with idiopathic scoliosis. STUDY DESIGN/SETTING Retrospective analysis of imaging records. PATIENT SAMPLE N/A OUTCOME MEASURES N/A METHODS In this study, the imaging of 103 preoperative patients with idiopathic scoliosis were reviewed. The Cobb angle in the bending position toward the convex side was measured by an orthopedic resident. The curve of scoliosis in supine MRI and between the same levels was obtained by a spine flow, separately. The measured angles were entered into SPSS and the assessment was performed by the other researcher. RESULTS A total of 103 patients (33 male, 70 female) with idiopathic scoliosis from age 5 to 35 (mean 16.5 years) were included in the study. Pearson correlation between the curve angle in MRI and bending x-ray was calculated. (0.915°, P-value < 0.001). Then regression coefficient and R-Square was obtained (0.953, 0.837 respectively). (Standard error 0.042, P-value<0.001). Finally, a relation formula was yielded:bending curve magnitude = -11.583+ (0.953° MRI Cobb angle). CONCLUSIONS To diminish the radiation exposure in patients with scoliosis, we can take the advantages of the correlation between bending curve and supine MRI angle measurements. Consequently, the main goal of bending views to assess curve flexibility might be relatively fulfilled by supine MRI images, consistently. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. The majority of scoliosis patients are subject to tremendous amounts of x-ray radiation in order to establish the diagnosis or follow the progression of the curves. There are different remedies to reduce the dose of delivered radiation or protect the body against such exposures. In addition, Bi-dimensional slot scattered technique (EOS) has provided some advantages, however, it is not available at all spine centers. The scoliosis patients are frequently requested to obtain MRI to discover neural axis abnormalities. As an attempt to find other alternatives for x-ray imaging, some authors demonstrated that the measured curve in the standing x-ray is correlated with the magnitude of the curve in the supine MRI. The supine MRI can illustrate the curve flexibility as obviously as the bending x-ray images in patients with idiopathic scoliosis. Retrospective analysis of imaging records. N/A N/A In this study, the imaging of 103 preoperative patients with idiopathic scoliosis were reviewed. The Cobb angle in the bending position toward the convex side was measured by an orthopedic resident. The curve of scoliosis in supine MRI and between the same levels was obtained by a spine flow, separately. The measured angles were entered into SPSS and the assessment was performed by the other researcher. A total of 103 patients (33 male, 70 female) with idiopathic scoliosis from age 5 to 35 (mean 16.5 years) were included in the study. Pearson correlation between the curve angle in MRI and bending x-ray was calculated. (0.915°, P-value < 0.001). Then regression coefficient and R-Square was obtained (0.953, 0.837 respectively). (Standard error 0.042, P-value<0.001). Finally, a relation formula was yielded:bending curve magnitude = -11.583+ (0.953° MRI Cobb angle). To diminish the radiation exposure in patients with scoliosis, we can take the advantages of the correlation between bending curve and supine MRI angle measurements. Consequently, the main goal of bending views to assess curve flexibility might be relatively fulfilled by supine MRI images, consistently.

BACKGROUND CONTEXT The majority of patients with lumbar spinal stenosis (LSS) present with concomitant sagittal mal-alignment. The forward tilt of body occurs due to antalgic position, degenerative changes in the facets and disco-ligamentous elements or insufficiency fractures of the vertebral bodies. Frequently, considerable attempts are applied intra-operatively to restore sagittal alignment. PURPOSE Our purpose is to demonstrate that lumbar spine decompression with or without discectomy can affect the sagittal alignment of patients postoperatively. STUDY DESIGN/SETTING Retrospective analysis of imaging records. PATIENT SAMPLE N/A OUTCOME MEASURES N/A METHODS We looked at a cohort of patients with diagnosis of symptomatic lumbar spinal stenosis, with or without sagittal imbalance, who underwent simple decompression with or without discectomy. The exclusion criteria consisted of the patients with sagittal vertical axis (SVA) shift greater than 100mm, previous spine surgery, history of thoracolumbar fracture, spondylolisthesis higher than grade I, lumbar scoliosis greater than 20°, neuromuscular diseases and Parkinson's disease. The number of 50 patients were eligible to be included in the study. The diagnosis of LSS was documented based on clinical symptoms and confirmed by MRI findings. Based on preoperative imaging, patients were divided into two groups: those with normal sagittal alignment and SVA<40 mm (23 patients, 46%) and those with abnormal sagittal alignment defined as SVA of 40-100 mm, (27 patients, 54%). The following spinopelvic parameters were measured on a 36-inch-long lateral upright radiographs before surgery and on the last follow up visit including SVA shift, pelvic tilt (PT), sacral slope (SS), pelvic incidence(PI), lumbar lordosis (LL), PI-LL mismatch, thoracic kyphosis(TK), T1 spinopelvic inclination (T1SPi), T1 pelvic angle (T1PA) and spinopelvic angle (SPA). One, two and three levels of decompression were performed in 78.8%, 15.4% and 5.8% of cases, respectively. The mean of follow-up period was 757.6 days (ranging from 96-1358 days). The impact of BMI on the correction of sagittal alignment was also evaluated. RESULTS At last follow up visit, 47 patients (94%) had normal sagittal alignment and 3 patients (6%) remained malaligned. The PT and PI-LL mismatch dropped in both groups significantly (p-value 0.025, 0.000 respectively). SS and LL rose remarkably in both groups (p-value 0.024, 0.000 respectively). T1SP inclination shifted toward negative amounts in both group but it was considerable only in the malaligned group (p-value 0.000). TK and SPA increased in both groups but a remarkable rise occurred in the malaligned group (p-value 0.000, 0.006 respectively). SVA shift and T1PA decreased in both groups, but significant improvement presented in the malaligned group (p-value 0.000, 0.006 respectively). Additionally, improvement of SVA in the malaligned group was found significantly in both high and normal BMI patients. (p-value 0.034) CONCLUSIONS Regardless of the BMI, decompression alone can potentially improve lumbar lordosis, thoracic kyphosis and sagittal alignment of patients with lumbar spinal stenosis particularly those with SVA shift 40-100mm. Consequently, certain LSS patients can probably regain satisfactory sagittal alignment through minimal procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. The majority of patients with lumbar spinal stenosis (LSS) present with concomitant sagittal mal-alignment. The forward tilt of body occurs due to antalgic position, degenerative changes in the facets and disco-ligamentous elements or insufficiency fractures of the vertebral bodies. Frequently, considerable attempts are applied intra-operatively to restore sagittal alignment. Our purpose is to demonstrate that lumbar spine decompression with or without discectomy can affect the sagittal alignment of patients postoperatively. Retrospective analysis of imaging records. N/A N/A We looked at a cohort of patients with diagnosis of symptomatic lumbar spinal stenosis, with or without sagittal imbalance, who underwent simple decompression with or without discectomy. The exclusion criteria consisted of the patients with sagittal vertical axis (SVA) shift greater than 100mm, previous spine surgery, history of thoracolumbar fracture, spondylolisthesis higher than grade I, lumbar scoliosis greater than 20°, neuromuscular diseases and Parkinson's disease. The number of 50 patients were eligible to be included in the study. The diagnosis of LSS was documented based on clinical symptoms and confirmed by MRI findings. Based on preoperative imaging, patients were divided into two groups: those with normal sagittal alignment and SVA<40 mm (23 patients, 46%) and those with abnormal sagittal alignment defined as SVA of 40-100 mm, (27 patients, 54%). The following spinopelvic parameters were measured on a 36-inch-long lateral upright radiographs before surgery and on the last follow up visit including SVA shift, pelvic tilt (PT), sacral slope (SS), pelvic incidence(PI), lumbar lordosis (LL), PI-LL mismatch, thoracic kyphosis(TK), T1 spinopelvic inclination (T1SPi), T1 pelvic angle (T1PA) and spinopelvic angle (SPA). One, two and three levels of decompression were performed in 78.8%, 15.4% and 5.8% of cases, respectively. The mean of follow-up period was 757.6 days (ranging from 96-1358 days). The impact of BMI on the correction of sagittal alignment was also evaluated. At last follow up visit, 47 patients (94%) had normal sagittal alignment and 3 patients (6%) remained malaligned. The PT and PI-LL mismatch dropped in both groups significantly (p-value 0.025, 0.000 respectively). SS and LL rose remarkably in both groups (p-value 0.024, 0.000 respectively). T1SP inclination shifted toward negative amounts in both group but it was considerable only in the malaligned group (p-value 0.000). TK and SPA increased in both groups but a remarkable rise occurred in the malaligned group (p-value 0.000, 0.006 respectively). SVA shift and T1PA decreased in both groups, but significant improvement presented in the malaligned group (p-value 0.000, 0.006 respectively). Additionally, improvement of SVA in the malaligned group was found significantly in both high and normal BMI patients. (p-value 0.034) Regardless of the BMI, decompression alone can potentially improve lumbar lordosis, thoracic kyphosis and sagittal alignment of patients with lumbar spinal stenosis particularly those with SVA shift 40-100mm. Consequently, certain LSS patients can probably regain satisfactory sagittal alignment through minimal procedures.

Study Design: Retrospective chart analysis.Objective: In the current report, we present a new technique for the placement of lateral mass screws from C3 to C7. The safety, complications, and long-term clinical and imaging follow-up were analyzed. To address potential risk factors for this technique, relevant literature was reviewed and discussed herein.Summary of Background Data: Multiple techniques have been reported to place lateral mass screws in the subaxial cervical spine. The trajectory used aims to avoid the vertebral artery and the exiting nerve root. Because of inherent differences in determining the screw trajectory for placement, there can be considerable differences among surgeons.Methods: A retrospective analysis of our experience over the period from 2003 to 2006 was undertaken. Standard practices for obtaining institutional review board approval were followed. Radiographs, hospital records, and office charts of 34 patients were reviewed. There was an equal distribution between males and females and the mean age was 56.3 years. Pain was the most frequent presentation. The indications for posterior instrumentation included instability secondary to pseudoarthrosis, infection, spondylosis, osseous metastasis, trauma, and iatrogenic etiologies.Results: The follow-up period ranged from 1 to 30 months (average 9.1 mo). Postoperative complications included wound infection (3 cases), malpositioned screw (1 case), cerebrospinal fluid leak (1 case), and dislodged rod (1 case). There were no mortalities directly related to the procedure.Conclusions: This technique for placement of lateral mass screws yielded adequate fixation without any appreciable neurovascular complications. It provides a useful alternative for screw placement in patients with intact spinous processes.

BACKGROUND CONTEXT: Vertebral compression fractures may be stabilized using an expandable balloon followed by cement injection. There are small but finite risks of endplate fracture and cement extravasation with this procedure. Alternative techniques may affect cement injection volumes, height maintenance and biomechanical stability but require investigation.

BACKGROUND CONTEXT: ROM and heterotopic ossification issues following lumbar arthroplasty have been documented separately, at 2- and 5-year follow-up.

Background: We compared the outcomes in patients with a low ejection fraction (EF) and multivessel coronary artery disease (CAD) who either underwent coronary artery bypass grafting (CABG) or received medical treatment (MT) after a viability study via dobutamine stress echocardiography (DSE).Methods: We considered patients with CAD and left ventricular ejection fraction (LVEF) <40% who were referred for DSE, and enrolled 106 patients (89% male, mean age: 55.8±9.7 years) with ≥4 viable segments. According to DSE, all the 106 patients were suitable for revascularization. We compared the outcomes between the patients who underwent CABG and those who received MT at a mean follow-up time of 8 months. Results: Both groups had similar baseline characteristics and rest EF. Thirty-three (31.1%) patients underwent CABG and 73 (68.9%) received MT. There was no significant difference between the CABG and MT groups in terms of mortality rate (9.1% vs. 11.0 %) and improvement in New York Heart Association functional class at follow-up. In the CABG group, patients with LVEF ≤25% had higher mortality compared to patients with LVEF >25% (100% vs. 40%, P< 0.05). Conclusion: The patients with CAD and a low EF had the same survival rate after both CABG and MT at mid-term follow-up. Long-term follow-up is needed to show the survival benefit of CABG in such patients with an acceptable extent of viable myocardium.

BACKGROUND CONTEXT: Lumbar Disc Arthroplasty has been performed with some success and results are reported equal or superior to that of spinal fusion. It is felt preservation of motion leads to decreased juxtafusional change and stress as compared to fusion, and this is the benefit of arthroplasty surgery. To date there are no prospective studies looking at the natural history of adjacent lumbar discs or facets after lumbar disc arthroplasty.

Background: In cases of moderate(2 or 3+ on a scale of 0 to 4+) nonorganic mitral regurgitation (MR) and coronary artery disease, operative strategy continues to be debated between coronary artery bypass grafting alone (CABG) or concomitant valve repair. To clarify the optimal management of these patients, we evaluated the mid-term results of isolated CABG in the study group. Methods: From March 2002 to February 2005, 40 consecutive patients (57.5% male, mean age: 62.45±8.7 years, mean ejection fraction: 44.15±12.6%, mean New York Heart Association class 2.5±0.78) with coronary artery disease and moderate MR without organic mitral valve disease (prolapse, rheumatism, etc.) underwent CABG alone. Thirty one (77.5%) patients had either postoperative or follow-up transthoracic echocardiography with mean follow up time of 10.82±8.12 months. Patient's pre and postoperative data were compared to evaluate the results of isolated CABG on moderate MR. Results: MR was ischemic (with persistent wall motion abnormality) in 25(62.5%) patients and functional (without persistent wall motion abnormality) in 15(31.5%). Considering postoperative and follow up transthoracic echocardiography, 54.8% had no or mild MR (29% MR 1+, 25.8% no MR) and 45.2% had moderate MR (16.1% MR 3+, 29% MR 2+). Resolution of MR was significant (p<0.001), but it had no correlation with ischemic MR (p=0.46), preoperative ejection fraction (p=0.09), LV systolic (p=0.70) and diastolic dimensions (p=0.80). Seven patients died, 2 in hospital and 5 later. Conclusion: Although for coronary artery disease accompanying moderate nonorganic MR, CABG alone reduces severity of MR significantly, many patients are left with moderate MR. Preoperative diagnosis of moderate nonorganic MR may warrant concomitant mitral repair.

BACKGROUND CONTEXT: An undefined amount of facet arthropathy excludes patients from consideration for lumbar disc arthroplasty. Facet arthropathy needs to be clearly defined with respect to arthroplasty.

BACKGROUND CONTEXT:Osteoporosis is a major cause of morbidity in worldwide elderly populations. Patients may become susceptible to vertebral compression fractures (VCFs) from low-impact situations. For patients who have failed conventional, palliative medical therapy, kyphoplasty not only reduces pain associated with vertebral fractures, but also offers a minimally invasive procedure with the potential to address fracture reduction and spinal sagittal alignment. Kyphoplasty involves expanding an inflatable balloon tamp to create a cavity within a vertebral body before cement deposition.PURPOSE:To evaluate the safety and efficacy of kyphoplasty to reduce and fix painful osteoporotic VCFs.STUDY DESIGN/SETTING:A retrospective, single-arm cohort study of consecutive kyphoplasty patients treated at a single center.PATIENT SAMPLE:Three hundred sixty VCFs were treated during 254 kyphoplasty procedures on 222 osteoporotic patients (mean age, 76 years [range, 28-98]; 28% male and 72% female).OUTCOME MEASURES:Patient-reported pain ratings were examined. Cement extravasation was monitored by intraoperative fluoroscopy and on postoperative radiographs. Anterior and midline vertebral height were assessed from standing, lateral radiographs obtained preoperatively and postoperatively. The number of patients who returned with symptomatic, new fractures was monitored. Perioperative complications were recorded. Mean follow-up occurred 21 months after kyphoplasty (range, 6 months through 36 months).RESULTS:Immediate pain relief was reported by 89% of patients by the first follow-up visit. One patient experienced postoperative pain as a result of radiculopathy related to bone filler leakage into the foramen. The remaining patients had persistent pain and were diagnosed with either a new fracture or underlying degenerative disc disease. Greater than or equal to 20% restoration of lost vertebral height (anterior) was observed in 63% of fractures with an overall mean restoration of 30%, and > or = 20% restoration of lost vertebral height (midline) was detected in 69% of fractures with an overall mean restoration of 50%. In this cohort, 12% (30/254) of the patients required additional kyphoplasty procedures to treat 36 symptomatic, new adjacent and remote fractures. No device-related complications occurred.CONCLUSIONS:Kyphoplasty is a safe and effective, minimally invasive procedure for relief of pain associated with VCF. In our series we also demonstrated some restoration of vertebral height and partial correction of sagittal alignment.

BACKGROUND CONTEXT: The use of bone morphogenic protein has been described to induce fusion when used as a substitute for autograft in the intervertebral space of the lumbar spine. The fusion rate of patients who had bone morphogenic protein used is described.

BACKGROUND CONTEXT: Kyphoplasty is a minimally invasive procedure for treating vertebral compression fractures (VCFs) associated with incapacitating pain and/or not responsive to medical therapy. This treatment involves using an inflatable bone tamp to reduce the fracture after which bone cement is injected to fix the fracture. While it is generally thought that correcting spinal deformity should reduce pathological biomechanical stresses on the spine, the increased stiffness of a vertebral body augmented with cement has been hypothesized to place adjacent vertebrae at increased risk for fracture.

Pseudarthrosis remains a significant problem in spinal fusion. The objective of our study was to investigate the effects of autologous growth factors (AGF) in instrumented transforaminal lumbar interbody spinal fusion (TLIF). A prospective review was carried out of 23 patients who underwent TLIF with application of AGF, with a minimum 2-year follow-up. Comparison with our historical cohort (without AGF application) was performed. Mean age at surgery was 44.3 years in the AGF treatment group. Twelve had a positive smoking history. Fourteen had undergone previous spinal surgeries. Thirteen received one-level fusions and ten received two-level fusions. The radiographic results showed a fusion rate of 100% in one-level fusions and 90% in two-level fusions. There was no significant difference in pseudarthrosis rates between the AGF treatment group and historical cohort. Excluding the cases with pseudarthrosis, there was faster bony healing in patients who had been treated with AGF application. This study indicates that although AGF may demonstrate faster fusions, it does not result in an overall increase in spinal fusion rates. Further studies are needed before AGF can routinely be used as an adjunct in spinal fusion.

This retrospective study was designed to document the incidence and types of perioperative complications that occurred with anterior spinal fusion surgery performed solely by an orthopedic spine surgeon. This study is contrasted to previous studies that document complications from anterior approaches performed by an orthopedic surgeon with the assistance of a general or a vascular surgeon. Specifically, the procedures included thoracotomies, thoracolumbar retroperitoneal, and lumbosacral approaches. Our sample consisted of 450 patients who underwent anterior spinal fusion between levels T1 and S1, from 1985 to 1997. Patient and surgery characteristics included age, sex, diagnosis, levels of fusion, blood loss, operative time, hospitalization time, complications, American Society of Anesthesiologists state, assessment of risk factors, previous surgery, and surgical approach used. Average follow-up was 41.69 months, with a minimum of 12 months and a maximum of 132 months. Our results indicated that anterior procedures performed solely by our senior orthopedic surgeon had a lower incidence of complications, less blood loss, and shorter operative time than anterior procedures performed by an orthopedic surgeon and a vascular or a general surgeon. Our findings suggest that the anterior spinal exposure is a safe approach that may be performed solely by a spinal surgeon who is knowledgeable and experienced.