Spine

Background and Purpose— Hyperperfusion syndrome is a rare but well-described complication after endarterectomy or stenting in the carotid circulation. Summary of Case— A 66-year-old man who had vertebrobasilar insufficiency refractory to medical treatment because of an intracranial right side vertebral stenosis was referred to our institution for endovascular treatment. Stenting was performed, and after 24 hours, he became extremely agitated, and this was followed by a period of apathy without focal neurological deficits. MRI showed bilateral thalamic hemorrhage. Conclusion— To our knowledge, this is the first report of hyperperfusion syndrome with hemorrhagic presentation after intracranial vertebral artery stenting.

Study Design. Retrospective case control study.Objective. To evaluate the hemostatic benefits of using a kaolin impregnated dressing during pediatric spinal deformity correction surgery.Summary of Background Data. Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin impregnated haemostatic dressing.Methods. Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46F, 19M, 12.7±4.5 years, 10.2± 4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33F, 19M, 13.9±3.2 years, 10.4 ± 4.3 levels fused) who underwent intra-operative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgeries from July 2010 to August ...

 The purpose of this study was to provide objective information on the involvement of different abdominal and hip flexor muscles during various types of common training exercises used in rehabilitation and sport. Six healthy male subjects performed altogether 38 different static and dynamic training exercises – trunk and hip flexion sit-ups, with various combinations of leg position and support, and bi- and unilateral leg lifts. Myoelectric activity was recorded with surface electrodes from the rectus abdominis, obliquus externus, obliquus internus, rectus femoris, and sartorius muscles and with indwelling fine-wire electrodes from the iliacus muscle. The mean electromyogram amplitude, normalised to the highest observed value, was compared between static and dynamic exercises separately. The hip flexors were highly activated only in exercises involving hip flexion, either lifting the whole upper body or the legs. In contrast, the abdominal muscles showed marked activation both during trunk and hip flexion sit-ups. In hip flexion sit-ups, flexed and supported legs increased hip flexor activation, whereas such modifications did not generally alter the activation level of the abdominals. Bilateral, but not unilateral, leg lifts required activation of abdominal muscles. In trunk flexion sit-ups an increased activation of the abdominal muscles was observed with increased flexion angle, whereas the opposite was true for hip flexion sit-ups. Bilateral leg lifts resulted in higher activity levels than hip flexion sit-ups for the iliacus and sartorius muscles, while the opposite was true for rectus femoris muscles. These data could serve as a basis for improving the design and specificity of test and training exercises.

Systematic review and meta-analysis of observational studies. The aim of the study is to evaluate different treatment modalities in the management of sacrococcygeal chordoma. Chordomas are primary malignant bone tumors associated with considerable morbidity and mortality. We searched MEDLINE, EMBASE, Cochrane Central-Register of Controlled Trials, and Scopus from inception to July 2015. Eligible studies included patients with sacrococcygeal chordoma treated exclusively with surgery, radiotherapy, or both. Two reviewers independently assessed the eligibility of potential studies, risk of bias, and extracted data. Outcomes of interest were all-cause mortality, progression-free survival, and metastases. We analyzed further surgical outcomes by resection margin. All outcomes were assessed at 60 months and more than 60 months following intervention. We included 33 noncomparative studies reporting on 501 patients (mean age 57 years). Overall mortality rate was (16%) after surgical resecti...

Low back pain is a leading cause of disability, and there is a tremendous need for nonsurgical, nonpharmaceutical interventions to manage it. Versatile spinal exoskeletons have been proposed as a method of supporting or augmenting the wearer, but experimental data from human subjects are limited, and the effects of such exoskeletons remain poorly understood. We thus present a prototype of a reconfigurable spinal exoskeleton that features easily adjustable resistance and compression at multiple spinal levels, allowing us to study the effect of different exoskeleton configurations on the body. In a pilot evaluation with a single subject, both thoracic and abdominal compression were found to affect trunk angle, low back moment and the electromyogram of the erector spinae, though different exoskeleton configurations had different effects during different tasks. This supports the premise that intelligent mechanical adjustments of a spinal exoskeleton are necessary for optimal support or augmentation of the wearer, though the results need to be examined in a larger, varied sample of subjects.

Diagnostic testing. The goal of this study is to measure the accuracy and reliability of the Orthoscan (Orthoscan Technologies, Inc.) and to determine whether it can be substituted for radiographs in the surveillance of adolescent idiopathic scoliosis (AIS). AIS is usually followed using scoliosis radiographs, which offer the most reliable way to quantify the curve, but carry the risk of exposure to ionizing radiation. The Orthoscan is a nonradiographic topographic method for measuring spinal curves. There were 5 phases of this study that measured: the accuracy and reliability of the machine when used with a plastic model; the variability with a real patient; the intraobserver variability; the correlation between the measurements of the machine and that of the radiograph; and the correlation between the change in radiograph measurement over time and the change in Orthoscan measurement over time. In measurement of a static plastic model, the machine measured curves with a standard de...

Outcome study to determine the internal consistency, and validity of adapted Turkish version of Scoliosis Research Society-22 (SRS-22) Instrument. To evaluate the validity and reliability of adapted Turkish Version of SRS-22 questionnaire. The SRS-22 questionnaire is a widely accepted questionnaire to assess the health-related quality of life for scoliotic patients in the United States. However, its adaptation in languages other than the source language is necessary for its multinational use. Translation/retranslation of the English version of the SRS-22 was done, and all steps for cross-cultural adaptation process were performed properly by an expert committee. Later, SRS-22 questionnaires and previously validated Short Form-36 (SF-36) outcome instruments were mailed to 82 patients who had been surgically treated for idiopathic scoliosis. All patients had a minimum of 2 years follow-up. Fifty-four patients (66%) responded to the first set of questionnaires. Forty-seven of the first...