Mechanical and cellular processes driving cervical myelopathy.

Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment.

MR epidurography: distribution of injectate at caudal epidural injection.

Objective: To (a) evaluate the feasibility of MR epidurography (MRE) and (b) assess the distribution of injectate using two different volumes at caudal epidural steroid injection.

Materials And Methods: Twenty patients who were referred with symptomatic low back pain for caudal epidural steroid injection were assigned to have either 10 ml (9/20) or 20 ml (11/20) of injectate administered. Gadolinium was included in the injection.

Acute nontraumatic spinal intradural hematoma in a patient on warfarin.

Background: Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences.

Objective: The aim here was to report a case of this rare phenomenon and discuss the etiology, imaging, management, and outcome of intradural hematomas.

RhBMP-2 use in lumbar fusion surgery is associated with transient immediate post-operative leg pain.

Purpose: Supra-physiological rhBMP loads during spinal fusion may trigger local inflammation and post-operative radiculitis. MRI is an effective tool to detect nerve root compression in severe post-operative leg pain. The aim of this study was to determine if recombinant bone morphogenic protein 2 (rhBMP-2) is associated with immediate post-operative leg pain without evidence of root compression using MRI.

The natural history and clinical syndromes of degenerative cervical spondylosis.

Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing.

Nonoperative modalities to treat symptomatic cervical spondylosis.

Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means.

Cervical laminoplasty for multilevel cervical myelopathy.

Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes.

The meniscofemoral ligaments influence lateral meniscal motion at the human knee joint.

Purpose: The purpose of this study was to investigate the effect of the meniscofemoral ligaments on lateral meniscal motion during flexion and extension of the human knee joint.

Methods: A cadaveric biomechanical study was performed. The effect of meniscofemoral ligament tension on the dynamics of the posterior horn of the lateral meniscus was determined by image analysis.

Risk analysis of blood transfusion requirements in emergency and elective spinal surgery.

Spinal surgery has long been considered to have an elevated risk of perioperative blood loss with significant associated blood transfusion requirements. However, a great variability exists in the blood loss and transfusion requirements of differing patients and differing procedures in the area of spinal surgery. We performed a retrospective study of all patients undergoing spinal surgery who required a transfusion≥1 U of red blood cells (RBC) at the National Spinal Injuries Unit (NSIU) at the Mater Misericordiae University Hospital over a 10-year period.

Prevalence of Internet use amongst an elective spinal surgery outpatient population.

Nationally 62% of individuals in Ireland have internet access. Previous published work has suggested that internet use is higher among those with low back pain. We aimed to determine the levels of internet access and use amongst an elective spinal outpatient population and determine what characteristics influence these.

The evaluation of the inverted supinator reflex in asymptomatic patients.

Study Design: A prospective study was undertaken over a 6-month period to determine the incidence of the inverted supinator reflex in asymptomatic, neurologically normal individuals.

Objective: The objective of our study is to assess asymptomatic patients for the presence of the inverted radial reflex and to determine its clinical relevance.

Summary Of Background Data: The inverted radial reflex sign is commonly used in clinical practice to assess cervical myelopathy.

Central cord syndrome in Ireland: the effect of age on clinical outcome.

Central cord syndrome is an incomplete spinal cord injury first described by Schneider et al. (J Neurosurg 11:546-547, 1954). The typical neurological deficit is symmetrical incomplete quadriplegia affecting the upper more than the lower limbs; sensory impairment is variable and urinary retention is common.

Parathyroid hormone (1-34) augments spinal fusion, fusion mass volume, and fusion mass quality in a rabbit spinal fusion model.

Study Design: The posterolateral rabbit spinal fusion model was used to assess the effect of intermittent parathyroid hormone on spinal fusion outcomes.

Objective: To test the hypothesis that intermittent parathyroid hormone (PTH) improves spinal fusion outcomes in the rabbit posterolateral spinal fusion model.

Summary Of Background Data: Spinal fusion is the definitive management for spinal deformity or instability, yet despite current technology, 5% to 40% of lumbar fusions result in pseudarthrosis.

Viscosupplementation in lumbar facet joint arthropathy: a pilot study.

Background: Degeneration of the spine is a prevalent problem that generally advances with age, although its occurrence is not restricted to the elderly. Chronic low back pain is a common problem with several treatments, but rigorous evaluation of many interventions is still lacking. One of the most common methods of treating lumbar facet arthropathy is intra-articular injection of local anesthetic and steroid.

Thromboembolic disease after combined anterior/posterior reconstruction for adult spinal deformity: a prospective cohort study using magnetic resonance venography.

Study Design: Thromboembolic disease (TED) after anterior/posterior spinal reconstructions was prospectively evaluated in 66 consecutive patients.

Objective: Determine the incidence of TED after anterior/posterior spinal reconstruction.

Summary Of Background Data: Few studies have examined the rate of TED after potentially high-risk combined anterior/posterior reconstructions.

Analysis of meniscofemoral ligament tension during knee motion.

Purpose: The goal of this study was to show a functional role for the meniscofemoral ligaments (MFL) by analyzing MFL tension change through the full range of flexion and extension found at the human knee joint.

Methods: Ten fresh-frozen human knees containing both the anterior and posterior MFLs (aMFL and pMFL) were studied. An analysis of ligament tension during passive motion was undertaken using an isometric transducer.

Not all spondylolisthesis grading instruments are reliable.

Spondylolisthesis is the slippage of one vertebral body on an adjacent level, and occurs commonly at the lumbosacral junction in children. Many radiographic measurement instruments have been described to predict progression and need for intervention. We evaluated the reliability of eight common grading instruments.

Discography-induced acute lumbar disc herniation: a report of five cases.

The reported complication rate of provocative lumbar discography is low, ranging from 0-2.5%. We report five cases of acute lumbar disc herniation precipitated by discography, a previously unreported complication.

Kyphoplasty enhances function and structural alignment in multiple myeloma.

We prospectively evaluated 19 patients with multiple myeloma who had kyphoplasty for vertebral compression fractures. Functional status was assessed preoperatively and 3 months postoperatively using the Oswestry Disability Index. Restoration of anterior and midvertebral height was assessed using lateral radiographs.

Orthopedic management of vertebral and long bone fractures in patients with osteoporosis.

Because of the evolving demographics of the world's population, fracture surgeons must become experts in the treatment of fractures in osteoporotic bone. Toward this end, fracture surgeons are learning to modify the classic techniques of internal fixation to adapt them to the elderly population. Screws should be placed into the best quality of bone available, which, in most cases, is an opposing cortex.

Bovine thrombin induces an acquired coagulopathy in sensitized patients undergoing revision spinal surgery: a report of two cases.

Study Design: A report of two cases is presented.

Objective: To raise awareness of bovine thrombin-induced factor V deficiency.

Summary Of Background Data: Bovine thrombin is a frequently used hemostatic agent in spinal surgery.