The use of diffusion tensor imaging in spinal pathology: a comprehensive literature review.

Study Design: We reviewed the available literature systematically without meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Objective: To evaluate contemporary literature on use of spinal diffusion tensor imaging(sDTI) in spinal pathology.

Background: sDTI reveals the location and functional state of critical long tracts and is a potentially useful adjunct in disease management.

Intrafacet Spacer Placement as a Mobility-Sparing Bailout Option in Atlantoaxial Fusion Construct Salvage.

Salvage revisions of atlantoaxial (AA) joint complex posterior segmental instrumented fusion constructs require careful individualized planning to prevent occipital extension. In this case report, we describe the use of bilateral intrafacet spacer placement as a mobility-sparing bailout option for the revision surgery. A 64-year-old male with a history of diffuse idiopathic skeletal hyperostosis, extremely limited baseline cervical mobility, and prior AA posterior segmental instrumented fusion presented with increasing pain at his 6-month follow-up.

What is the C2 pedicle, pars interarticularis, and isthmus? Anatomical study and review of the literature regarding these confusing terms with proposal of new nomenclature.

Introduction: The atypical anatomy of the C2 vertebra has led to terminological discrepancies within reports and studies in the literature regarding the location of its pedicle, pars interarticularis, and isthmus. These discrepancies not only limit the power of morphometric analyses, but they also confuse technical reports regarding operations involving C2, and thus confuse our ability to properly communicate this anatomy. Herein, we examine the variations in nomenclature regarding the pedicle, pars interarticularis, and isthmus of C2, and via an anatomical study, propose new terminology.

Ventral Subaxial Cervical Access Using Tailored Access Osteotomies, A Cadaveric Study.

Background: Ventral lesions of the subaxial cervical spine are challenging because approaches must circumvent endodermal and neurovascular structures.

Objective: To use cadaveric study to describe 4 posterolateral approaches to the ventral subaxial cervical spine with various facilitating techniques and osteotomies.

Methods: Three cadaveric specimens of the cervical spine were sequentially subjected to multilevel laminectomy (Type 1), transfacet (Type 2), transpedicular (Type 3), and extreme lateral transforaminal (Type 4) approaches.

Patient-reported outcome measures in spine surgery: A systematic review.

Background: Steadily increasing expenditure in the United States health-care system has led to a shift toward a value-based model that focuses on quality of care and cost-effectiveness. Operations involving the spine rank among some of the most common and expensive procedures performed in operating rooms nationwide. Patient-reported outcomes measures (PROMs) are a useful tool for reporting levels of outcome and analyzing patient recovery but are both under-utilized and nonstandardized in spine surgery.

Clip Ligation and Disconnection of a Ruptured Ventral Subaxial Cervical Isolated Spinal Aneurysm Using Tailored Access Osteotomies: An Operative Technique.

Background: Isolated spinal aneurysms (iSAs) are lesions of the spinal vasculature with no associated vascular malformation with difficult management paradigms limited by safe access.

Objective: To describe a case of an irregular fusiform ruptured distal subaxial cervical spine iSA with a complex angioarchitecture intimately associated with the ventral pial plexus (VPP), treated using open clip ligation and disconnection.

Methods: A 51-year-old woman presented with complete spinal cord injury with a C8 sensory level and ventral subarachnoid hemorrhage at the C6-T1 vertebral levels.

Anterior cervical discectomy and fusion in the setting of kissing carotids: A technical report and literature review.

Background: The "kissing carotids" (KCS) phenomenon refers to bilateral retropharyngeal displacement of the internal carotid arteries (ICA). This anomalous anatomy can impose a significant surgical challenge to spine surgeons.

Objective: In this report, we describe our approach for an anterior cervical discectomy and fusion in the setting of kissing carotids.

Novel Technique of Coregistered Intraoperative Computed Tomography and Preoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Navigation in Spinal Cord Tumor Resection.

Intradural spinal tumors are surgically challenging lesions, and intraoperative spinal navigation offers clear potential assistance. While intraoperative computed tomography (iCT) of bony anatomy is routinely performed, coregistration with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) to facilitate intradural spinal tumor resection is not widely described. We present 2 cases in which iCT was coregistered with MRI and DTI for navigational guidance in the resection of intradural spinal tumors to assess technical feasibility and surgical efficacy.

Indications and Techniques for Spinal Instrumentation in Thoracic Disk Surgery.

Study Design: Retrospective case series.

Objective: To identify the indications, techniques, and outcomes for instrumented fusion during thoracic discectomy.

Summary Of Background Data: Thoracic discectomy may require extensive bone removal to avoid spinal cord manipulation, but the indications and techniques for instrumented fusion during thoracic discectomy remain poorly delineated.

Technical advances in pediatric craniovertebral junction surgery.

Surgery for conditions in the craniovertebral junction in the pediatric population poses unique challenges. The posterior approach has emerged as the gold standard for arthrodesis in this region. Anterior fixation or decompression also may be indicated.

Surgical management and clinical outcomes of multiple-level symptomatic herniated thoracic discs.

Object: Symptomatic herniated thoracic discs (HTDs) are rare, and patients infrequently require treatment of 2 or more disc levels. The authors assess the surgical management and outcomes of patients with multiple-level symptomatic HTDs.

Methods: A retrospective review of a prospectively maintained database was performed of 220 consecutive patients treated surgically for symptomatic HTDs.

Doppler ultrasonography screening of poor-grade subarachnoid hemorrhage patients increases the diagnosis of deep venous thrombosis.

Background: Prophylactic anticoagulation greatly decreases the prevalence of deep venous thrombosis (DVT) in neurosurgical patients. Using Doppler ultrasonography (USG), recent studies demonstrate a 1% DVT detection rate following microsurgery or endovascular treatment for aneurysmal subarachnoid hemorrhage (aSAH). We hypothesize that reported statistics underestimate the DVT detection rate in this high risk cohort by accounting for only symptomatic thromboses.

Pupillary reactivity upon hospital admission predicts long-term outcome in poor grade aneurysmal subarachnoid hemorrhage patients.

Background: Historically, the prognosis for poor grade subarachnoid hemorrhage patients has been considered dismal. As a result, many hospitals have chosen conservative management over aggressive therapy. This guarded approach, however, is based on studies that do not take into account newer, more effective, management protocols and more recent long-term evidence that significant neurological recovery occurs in the months to years following discharge.

Patellofemoral evaluation after total knee arthroplasty. Validation of a new weight-bearing axial radiographic view.

Background: Radiographic assessment of the patella after total knee arthroplasty is typically performed with use of static, unloaded views that may not reproduce the in vivo patellofemoral kinematics. The purpose of the present study was to evaluate and validate the reliability and reproducibility of a weight-bearing radiographic assessment of the patellofemoral joint in patients who have undergone total knee arthroplasty.

Methods: Radiographs were made for 100 knees in sixty-nine patients who had undergone total knee arthroplasty.