Cervical interfacet spacers and maintenance of cervical lordosis

OBJECT The cervical interfacet spacer (CIS) is a relatively new technology that can increase foraminal height and area by facet distraction. These offer the potential to provide indirect neuroforaminal decompression while simultaneously enhancing fusion potential due to the relatively large osteoconductive surface area and compressive forces exerted on the grafts. These potential benefits, along with the relative ease of implantation during posterior cervical fusion procedures, make the CIS an attractive adjuvant in the management of cervical pathology. One concern with the use of interfacet spacers is the theoretical risk of inducing iatrogenic kyphosis. This work tests the hypothesis that interfacet spacers are associated with loss of cervical lordosis. METHODS Records from patients undergoing posterior cervical fusion at Rush University Medical Center between March 2011 and December 2012 were reviewed. The FacetLift CISs were used in all patients. Preoperative and postoperative radiographic data were reviewed and the Ishihara indices and cervical lordotic angles were measured and recorded. Statistical analyses were performed using STATA software. RESULTS A total of 64 patients were identified in whom 154 cervical levels were implanted with machined allograft interfacet spacers. Of these, 15 patients underwent anterior-posterior fusions, 4 underwent anterior-posterior-anterior fusions, and the remaining 45 patients underwent posterior-only fusions. In the 45 patients with posterior-only fusions, a total of 110 levels were treated with spacers. There were 14 patients (31%) with a single level treated, 16 patients (36%) with two levels treated, 5 patients (11%) with three levels treated, 5 patients (11%) with four levels treated, 1 patient (2%) with five levels treated, and 4 patients (9%) with six levels treated. Complete radiographic data were available in 38 of 45 patients (84%). On average, radiographic follow-up was obtained at 256.9 days (range 48–524 days). There was no significant difference in the Ishihara index (5.76 preoperatively and 6.17 postoperatively, p = 0.8037). The analysis had 80% power to detect a change of 4.25 in the Ishihara index at p = 0.05. There was no significant difference in the preand postoperative cervical lordotic angles (35.6° preoperatively and 33.6° postoperatively, p = 0.2678). The analysis had 80% power to detect a 7° change in the cervical lordotic angle at p = 0.05. The ANOVA of the Ishihara index and cervical lordotic angle did not show a statistically significant difference in degree of change in cervical lordosis among patients with a different number of levels of CIS insertion (p = 0.25 and p = 0.96, respectively). CONCLUSIONS In the authors' experience of placing CISs in more than 100 levels, they found no evidence of significant loss of cervical lordosis. The long-term impacts of these implants on fusion rates and clinical outcomes (particularly radiculopathy and postoperative C-5 palsies) remain active areas of interest and fertile ground for further studies.

Download Full-text

Posterior Cervical Fusion Using Cervical Interfacet Spacers in Patients With Symptomatic Cervical Pseudarthrosis

Neurosurgery ◽

10.1227/neu.0000000000001087 ◽

2015 ◽

Vol 78 (5) ◽

pp. 661-668 ◽

Cited By ~ 11

Author(s):

Manish K. Kasliwal ◽

Jacquelyn A. Corley ◽

Vincent C. Traynelis

Keyword(s):

Neck Pain ◽

Outcome Measures ◽

Vertical Axis ◽

Mean Difference ◽

Cervical Fusion ◽

Cervical Lordosis ◽

Sagittal Vertical Axis ◽

Arm Pain ◽

Vas Score ◽

Posterior Cervical Fusion

Abstract BACKGROUND: Posterior cervical fusion with cervical interfacet spacer (CIS) is a novel allograft technology offering the potential to provide indirect neuroforaminal decompression while simultaneously enhancing fusion by placing the allograft in compression. OBJECTIVE: To analyze the clinical and radiological outcomes after posterior cervical fusion with CIS in patients with symptomatic anterior cervical pseudarthroses. METHODS: Medical records of patients who underwent posterior cervical fusion with CIS for symptomatic pseudarthrosis after anterior cervical diskectomy and fusion were reviewed. Standardized outcome measures such as visual analog scale (VAS) score for neck and arm pain, Neck Disability Index (NDI), and upright lateral cervical radiographs were reviewed. RESULTS: There were 19 patients with symptomatic cervical pseudarthrosis. Preoperative symptoms included refractory neck or arm pain. The average follow-up was 20 months (range, 12-56 months). There was improvement in VAS score for neck pain (P < .004), radicular arm pain (P < .007), and NDI score (P < .06) after surgery, with 83%, 72%, and 67% of patients showing improvement in their VAS neck pain, VAS arm pain, and NDI scores, respectively. Fusion rate was high, with fusion occurring at all levels treated for pseudarthrosis. There was a small improvement in cervical lordosis (mean difference, 2 ± 5.17°; P = .09) and slight worsening of C2-7 sagittal vertical axis after surgery (mean difference, 1.89 ± 7.87 mm; P = .43). CONCLUSION: CIS provides an important fusion technique, allowing placement of an allograft in compression for posterior cervical fusion in patients with anterior cervical pseudarthroses. Although there was improvement in clinical outcome measures after surgery, placement of CIS had no clinically significant impact on cervical lordosis and C2-7 sagittal vertical axis.

Download Full-text

Assessment of T1 Slope Minus Cervical Lordosis and C2-7 Sagittal Vertical Axis Criteria of a Cervical Spine Deformity Classification System Using Long-Term Follow-up Data After Multilevel Posterior Cervical Fusion Surgery

Operative Neurosurgery ◽

10.1093/ons/opy055 ◽

2018 ◽

Vol 16 (1) ◽

pp. 20-26 ◽

Cited By ~ 3

Author(s):

Seung-Jae Hyun ◽

Sanghyun Han ◽

Ki-Jeong Kim ◽

Tae-Ahn Jahng ◽

Hyun-Jib Kim

Keyword(s):

Vertical Axis ◽

Spine Deformity ◽

Cervical Fusion ◽

Cervical Lordosis ◽

Sagittal Vertical Axis ◽

Fusion Surgery ◽

Long Term Follow Up ◽

Posterior Cervical Fusion

Download Full-text

Clinical Impact of T1 Slope Minus Cervical Lordosis After Multilevel Posterior Cervical Fusion Surgery

Spine ◽

10.1097/brs.0000000000002250 ◽

2017 ◽

Vol 42 (24) ◽

pp. 1859-1864 ◽

Cited By ~ 12

Author(s):

Seung-Jae Hyun ◽

Ki-Jeong Kim ◽

Tae-Ahn Jahng ◽

Hyun-Jib Kim

Keyword(s):

Clinical Impact ◽

Cervical Fusion ◽

Cervical Lordosis ◽

Fusion Surgery ◽

T1 Slope ◽

Posterior Cervical Fusion

Download Full-text

Effect of Bio and Organic Fertilizers on Pumpkin's (Cucurbita pepo L.) Leave Content of N, P, and K

Al-Qadisiyah Journal For Agriculture Sciences (QJAS) (P-ISSN 2077-5822 E-ISSN 2617-1479) ◽

10.33794/qjas.vol10.iss1.104 ◽

2020 ◽

Vol 10 (1) ◽

pp. 241-245

Author(s):

Ammar Hameed Madi ◽

Jawad A. Kamal Al-Shibani

Keyword(s):

Cucurbita Pepo ◽

Sandy Loam ◽

Block Design ◽

Organic Fertilizers ◽

Flowering Stage ◽

College Of Agriculture ◽

Significant Difference ◽

Randomized Complete Block Design ◽

Loam Soil ◽

Four Levels

This study was conducted to investigate the effect of bacterial bio-fertilization A. chroococcum and P. putide and four levels of compost (0, 1, 2, 3) tons.h-1 on the leaves content of N.P.K elements. The experiment was carried out in one of the greenhouses of the College of Agriculture - University of Al-Qadisiyah during fall season 2018-2019. It designed in accordance with the Randomized Complete Block Design (RCBD) with three replicates in sandy loam soil. The means of treatments were compared with the least significant difference (LSD) at (5)% probability level. The results present that the treatments of A. chroococcum, P. putide and compost at (3) tons.kg-1 significantly increases the leaves content of K.P.K compared to all other treatments in the flowering stage (4.970, 0.5000, and 4.930) mg.kg-1, respectively. This treatment was followed by the effect of the treatment of A. chroococcum and compost at (3) tons.kg-1, which increases the values of all traits except the leaf content of (P). Bio-fertilizer with P. putide + A. chroococcum significantly increases the leaves' content of P.

Download Full-text

Preliminary analysis of prostate positional displacement using hydrogel spacer during the course of proton therapy for prostate cancer

Journal of Radiation Research ◽

10.1093/jrr/rraa115 ◽

2020 ◽

Author(s):

Hiroki Sato ◽

Takahiro Kato ◽

Tomoaki Motoyanagi ◽

Kimihiro Takemasa ◽

Yuki Narita ◽

...

Keyword(s):

Prostate Cancer ◽

Proton Therapy ◽

Rectal Dose ◽

Prostate Motion ◽

Significant Difference ◽

Risk Prostate Cancer ◽

Bony Anatomy ◽

Study Population ◽

Planning Ct ◽

Anterior Posterior

Abstract In recent years, a novel technique has been employed to maintain a distance between the prostate and the rectum by transperineally injecting a hydrogel spacer (HS). However, the effect of HS on the prostate positional displacement is poorly understood, despite its stability with HS in place. In this study, we investigated the effect of HS insertion on the interfraction prostate motion during the course of proton therapy (PT) for Japanese prostate cancer patients. The study population consisted of 22 cases of intermediate-risk prostate cancer with 11 cases with HS insertion and 11 cases without HS insertion. The irradiation position and preparation were similar for both groups. To test for reproducibility, regular confirmation computed tomography (RCCT) was done four times during the treatment period, and five times overall [including treatment planning CT (TPCT)] in each patient. Considering the prostate position of the TPCT as the reference, the change in the center of gravity of the prostate relative to the bony anatomy in the RCCTs of each patient was determined in the left–right (LR), superior–inferior (SI) and anterior–posterior (AP) directions. As a result, no significant difference was observed across the groups in the LR and SI directions. Conversely, a significant difference was observed in the AP direction (P < 0.05). The proportion of the 3D vector length ≤5 mm was 95% in the inserted group, but 55% in the non-inserted group. Therefore, HS is not only effective in reducing rectal dose, but may also contribute to the positional reproducibility of the prostate.

Download Full-text

Retrospective analysis of pediatric patients with multiple rare-earth magnets ingestion: a single-center experience from China

BMC Pediatrics ◽

10.1186/s12887-021-02642-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yucan Zheng ◽

Zhihua Zhang ◽

Kunlong Yan ◽

Hongmei Guo ◽

Mei Li ◽

...

Keyword(s):

Rare Earth ◽

Digestive Tract ◽

Foreign Bodies ◽

Clinical Symptoms ◽

Medical Center ◽

Rare Earth Magnet ◽

Gastrointestinal Obstruction ◽

Asymptomatic Patients ◽

Significant Difference ◽

Surgical Group

Abstract Background The aim of this study was to characterize patients who ingested multiple rare-earth magnets, reveal the harm of rare-earth magnet foreign bodies in the digestive tract, and develop a clinical management algorithm. Methods This was a retrospective review of patients with rare-earth magnet foreign bodies in the digestive tract admitted to a university-affiliated pediatric medical center in China, between January 2016 and December 2019; the subset of medical data evaluated included clinical symptoms, signs, treatments and outcomes. Results A total of 51 cases were included in this study, including 36(70.6%) males and 15(29.4%) females. The magnets were passed naturally in 24(47.1%) patients and removed by intervention in 27(52.9%) patients, including 5(9.8%) cases by endoscopy and 22(43.1%) cases by surgery. Twenty-two (43.1%)cases had gastrointestinal obstruction, perforation, and fistula. Compared with the non-surgical group, the time of the surgical group from ingestion to arriving at the hospital was longer([80(5–336) vs 26(2–216)]hours, p < 0.001) while there was no significant difference in the mean age or the number of magnets swallowed. Conclusions Magnets are attractive to children, but lead to catastrophic consequences including gastrointestinal obstruction, perforation, and surgical interventions when ingested multiple magnets. Endoscopic resection should be urgently performed in the presence of multiple magnets as early as possible within 24 h, even in asymptomatic patients.

Download Full-text

Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia

BMC Women s Health ◽

10.1186/s12905-021-01360-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tilahun Fufa Debela ◽

Zerihun Asefa Hordofa ◽

Aster Berhe Aregawi ◽

Demisew Amenu Sori

Keyword(s):

Quality Of Life ◽

Surgical Repair ◽

Obstetric Fistula ◽

Medical Center ◽

Mean Value ◽

Significant Difference ◽

Before And After ◽

The Mean ◽

Jimma University

Abstract Background The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair. Methods Institutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019–October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance. Result The overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains. Conclusion The overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.

Download Full-text

Sleeve gastrectomy is the most common cause of Gastro-esophageal Reflux Disease in comparison with other bariatric operations

Digestive Diseases ◽

10.1159/000514377 ◽

2021 ◽

Author(s):

majdi abu sneineh ◽

malek abu sneineh ◽

Monther Abu Sneineh ◽

mustafa abu sneineh ◽

muneer abu snineh ◽

...

Keyword(s):

Bariatric Surgery ◽

Medical Center ◽

Bariatric Procedure ◽

P Value ◽

Significant Difference ◽

Symptomatic Gerd ◽

Swallow Study ◽

Contrast Swallow ◽

Gerd Symptoms

Abstract Introduction GERD is one of the complications of bariatric operations that might affect the quality of life. We aim to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. Besides, we are attempting to identify the risk factors of GERD after bariatric surgery. Methods Medical records of 729 patients undergone bariatric operations between January 2010 and June 2019 at Shamir (Assaf Harofeh) Medical Center were reviewed. Results There was a significant difference between the type of bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher compared to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P-value <0.001) and to our knowledge this was never reported in the literature. Conclusion SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.

Download Full-text

Cooking Education Improves Cooking Confidence and Dietary Habits in Veterans

The Diabetes Educator ◽

10.1177/0145721719848429 ◽

2019 ◽

Vol 45 (4) ◽

pp. 442-449 ◽

Cited By ~ 1

Author(s):

Ashley S. Dexter ◽

Janet F. Pope ◽

Dawn Erickson ◽

Catherine Fontenot ◽

Elizabeth Ollendike ◽

...

Keyword(s):

Primary Care ◽

Nutrition Education ◽

Weight Status ◽

Dietary Habits ◽

Medical Center ◽

Laboratory Data ◽

Dietary Quality ◽

Group Setting ◽

Lipid Panel ◽

Significant Difference

Purpose The purpose of the study was to evaluate a 12-week cooking education class on cooking confidence, dietary habits, weight status, and laboratory data among veterans with prediabetes and diabetes. Methods The sample for this study included 75 veterans within the Overton Brooks Veteran Affairs Medical Center who completed the 12-week class in an in-person group setting in Shreveport, Louisiana, or via Clinical Video Telehealth (CVT) in Longview, Texas. Veterans were referred to the Healthy Teaching Kitchen by their primary care provider or primary care dietitian. Enrollment in the class was on a volunteer basis. The cooking and nutrition education classes included topics such as carbohydrate counting, safety and sanitation, meal planning, and creating budget-friendly recipes. Participants completed 2 questionnaires for assessment of healthy dietary habits and confidence related to cooking. Changes in body weight, lipid panel, and hemoglobin A1C were assessed. Differences in class settings were tested via independent samples t tests. Paired samples t tests were completed to compare changes in mean laboratory results, weight, and questionnaire responses. Results Subjects lost a mean 2.91 ± 5.8 lbs ( P < .001). There was no significant difference in percent change in laboratory data and weight between subjects participating via CVT and subjects in the live class. Overall, there was significant improvement in the confidence questionnaire ratings and Healthy Habits Questionnaire responses. Conclusions Cooking and nutrition education can increase cooking confidence and dietary quality. These results provide support for the need for further research on the long-term effects of nutrition cooking education and for the benefits of using CVT software to provide education to remote facilities.

Download Full-text