An assessment of the reliability of the Enneking and Weinstein-Boriani-Biagini classifications for staging of primary spinal tumors by the Spine Oncology Study Group.

Study Design: Reliability analysis based on expert panel case series review and grading per the Enneking and Weinstein-Boriani-Biagini classification systems.

Objective: To assess the reliability of the Enneking and Weinstein-Boriani-Biagini classification systems.

Summary Of Background Data: The Enneking and Weinstein-Boriani-Biagini (WBB) classifications were developed to stage and facilitate treatment planning in patients with primary spine tumors.

The effect of cement augmentation and extension of posterior instrumentation on stabilization and adjacent level effects in the elderly spine.

Study Design: An in vitro cadaveric study comparing different implant fixation techniques using a repeated measures design.

Objective: To compare the effects of cement augmentation of pedicle screws and extension of posterior fixation on (i) 3-dimensional stabilization, and (ii) adjacent level effects in the aging spine.

Summary Of Background Data: Device loosening and adjacent level effects are concerns in implant fixation in the elderly spine.

Clinical outcomes of 90 isolated unilateral facet fractures, subluxations, and dislocations treated surgically and nonoperatively.

Study Design: A retrospective outcomes study.

Objective: The purposes of this study were 1) to identify plausible patient and interventional variables that influence the outcome of unilateral facet injuries and 2) to determine if patients return to normal general health status after unilateral facet injuries.

Summary Of Background Data: The management of unilateral subaxial cervical facet fractures and dislocations lacks agreement on treatment options and the variables that influence outcome.

The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system.

Study Design: Systematic review of literature and expert clinical opinions of the members of the Spine Trauma Study Group were combined to develop and refine this algorithm.

Objective: To develop an evidence-based algorithm for surgical approaches to manage subaxial cervical injuries using a systematic review of the literature, expert opinion, and anticipated patient preferences.

Summary Of Background Data: There is lack of consensus in the management of subaxial cervical spine trauma, in part, because of the lack of a clinically relevant system for classifying these injuries.

Introduction to and techniques of evidence-based medicine.

Study Design: : Literature review.

Objective: : To outline the components and application of evidence-based medicine (EBM) with an emphasis on the critical components of conduct and appraisal of clinical research.

Summary Of Background Data: : "Evidence-based medicine" is now a commonplace phrase representing the hallmark of excellence in clinical practice.

Translational constraint influences dynamic spinal canal occlusion of the thoracic spine: an in vitro experimental study.

Mechanical constraints to spine motion can arise in a variety of real-world situations such as when shoulder belts prevent anterior translation of the thorax during automotive collisions. The effect of such constraint on spinal column-spinal cord interaction during injury remains unknown. The purpose of the present study was to compare maximal dynamic spinal canal occlusion, measured via a specialized transducer, in cadaveric upper thoracic spine specimens under a variety of anterior-posterior constraint conditions.

A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine.

Object: Unilateral facet injuries can be treated with either anterior or posterior fixation techniques with reportedly good outcomes. The two approaches have not been directly compared, however, and consensus is lacking as to which is the optimal method. The primary objective of this study was to determine whether acute postoperative morbidity differed between anteriorly and posteriorly treated patients with unilateral facet injuries.

Outcome evaluation of surgical and nonsurgical management of lumbar disc protrusion causing radiculopathy.

Study Design: Prospective cohort study.

Objective: To assess health-related quality of life (HRQOL) following either lumbar discectomy or nonoperative care for lumbar disc protrusion causing radiculopathy (LDPR).

Summary Of Background Data: Although LDPR is a prevalent disorder, little progress has been made in defining the optimal treatment strategy.

Cement augmentation of vertebral screws enhances the interface strength between interbody device and vertebral body.

Study Design: An in vitro cadaveric study comparing cage-vertebra interface strengths for 3 different screw-cement configurations.

Objectives: To determine the effects of cement augmentation of pedicle screws on cage-vertebra interface failure properties for 2 interbody device shapes (elliptical or cloverleaf); and to compare between pedicle and anterior vertebral body screws with cement augmentation.

Summary Of Background Data: Pedicle or anterior screw fixation is commonly used with interbody device fixation.

Accuracy and safety of pedicle screw fixation in thoracic spine trauma.

Object: The authors evaluated the accuracy of placement and safety of pedicle screws in the treatment of unstable thoracic spine fractures.

Methods: Patients with unstable fractures between T-1 and T-10, which had been treated with pedicle screw (PS) placement by one of five spine surgeons at a referral center were included in a prospective cohort study. Postoperative computed tomography scans were obtained using 3-mm axial cuts with sagittal reconstructions.

Cost-effectiveness of surgery plus radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression.

Purpose: A recent randomized clinical trial has demonstrated that direct decompressive surgery plus radiotherapy was superior to radiotherapy alone for the treatment of metastatic epidural spinal cord compression. The current study compared the cost-effectiveness of the two approaches.

Methods And Materials: In the original clinical trial, clinical effectiveness was measured by ambulation and survival time until death.

Impact of surgical intervention on quality of life in patients with spinal metastases.

Study Design: Prospective clinical study.

Objective: To assess Health-Related Quality of Life outcomes in patients undergoing surgery for spinal metastases.

Summary Of Background Data: Increasing life expectancy of patients with spinal metastases has resulted in greater interest in overall quality of life, including pain and neurologic impairment.

Progressive junctional kyphosis at the caudal end of lumbar instrumented fusion: etiology, predictors, and treatment.

Study Design: Clinical case series.

Objective: To describe a series of patients with progressive sagittal decompensation caused by failure at the caudal end of an instrumented lumbar fusion.

Summary Of Background Data: Lumbar kyphosis in association with global sagittal decompensation can be a disabling problem, particularly as a late complication of distraction instrumentation.

En bloc marginal excision of a multilevel cervical chordoma. Case report.

The purpose of this case report is to demonstrate that an en bloc resection with negative surgical margins can be successfully achieved in a case of a seemingly unresectable C-2 chordoma if appropriate preoperative staging and planning are performed. The management of chordomas is controversial and challenging because of their location and often large size at presentation. Because chordomas are malignant and will aggressively recur locally if intralesional resection is conducted, wide or true en bloc resection is generally recommended.

Changing face of spine trauma care in North America.

Study Design: An evidence-based review and summary of literature from multiple disciplines involved in spine trauma.

Objectives: To outline epidemiologic, clinical, and research issues influencing spine trauma in a longitudinal perspective. In addition, to provide guidance to clinicians and researchers to ensure that philosophies pertaining to the betterment of spine trauma care are understood and supported.

Confidence in spine training among senior neurosurgical and orthopedic residents.

Study Design: A cross-sectional survey of senior neurosurgical and orthopedic residents.

Objective: To evaluate the confidence of senior orthopedic and neurosurgery residents in performing spinal surgical procedures and their need for further training. The content and exposure to spine training as well as anticipated practice profile were characterized.

Radiographic measurement parameters in thoracolumbar fractures: a systematic review and consensus statement of the spine trauma study group.

Study Design: Systematic review.

Objectives: To review the various radiographic parameters currently used to assess traumatic thoracolumbar injuries, emphasizing the validity and technique behind each one, to formulate evidence-based guidelines for a standardized radiographic method of assessment of these fractures.

Summary Of Background Data: The treatment of thoracolumbar fractures is guided by various radiographic measurement parameters.

Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005.

Object: A new classification and treatment algorithm for thoracolumbar injuries was recently introduced by Vaccaro and colleagues in 2005. A thoracolumbar injury severity scale (TLISS) was proposed for grading and guiding treatment for these injuries. The scale is based on the following: 1) the mechanism of injury; 2) the integrity of the posterior ligamentous complex (PLC); and 3) the patient's neurological status.

Subaxial cervical spine trauma.

Subaxial cervical spine injuries are common, ranging in severity from minor ligamentous strain or spinous process fracture to complete fracture-dislocation with bone and ligament failure, resulting in severe spinal cord injury. Understanding the epidemiology, anatomy, biomechanics, and classification of subaxial cervical spine injuries is important. Emergent management of such injuries is based on obtaining an accurate clinical history, careful physical examination, and organized radiographic evaluation.

Factors predicting motor recovery and functional outcome after traumatic central cord syndrome: a long-term follow-up.

Study Design: A prospectively maintained database-generated retrospective review and cross-sectional outcome analysis was performed at a single academic center.

Objectives: To assess the improvement in ASIA motor score (AMS) and secondarily to assess generic health related quality of life (HRQoL) and functional status; correlating these with variables that may predict outcome.

Summary Of Background Data: Many variables are potential contributors to motor recovery, patient function, and outcome following cervical trauma.

Motor recovery, functional status, and health-related quality of life in patients with complete spinal cord injuries.

Study Design: A retrospective cohort with cross- sectional follow-up.

Objectives: The primary objective was to determine motor recovery in patients with complete traumatic spinal cord injury (SCI). Secondary objectives included: 1) determining which factors predict local recovery, 2) assessing functional status using the Functional Independence Measure (FIM), and 3) assessing generic health-related quality of life using the Short Form-36 (SF-36).

The effect of interbody cage positioning on lumbosacral vertebral endplate failure in compression.

Study Design: A biomechanical investigation using a human cadaver, multisegmental lumbosacral spine model.

Objectives: To determine if 2 small, posterolaterally positioned titanium mesh interbody cages would provide superior construct strength and stiffness in compression compared to central cage placement. In addition, determine construct stiffness with interbody cages as opposed to an intact spine and assess the effect of bone mineral density (BMD).