Radiological Determination of Postoperative Cervical Fusion: A Systematic Review.

Study Design: Systematic review.

Objective: To determine best criteria for radiological determination of postoperative subaxial cervical fusion to be applied to current clinical practice and ongoing future research assessing fusion to standardize assessment and improve comparability.

Summary Of Background Data: Despite availability of multiple imaging modalities and criteria, there remains no method of determining cervical fusion with absolute certainty, nor clear consensus on specific criteria to be applied.

Fundamentals of clinical outcomes assessment for spinal disorders: study designs, methodologies, and analyses.

Study Design A broad narrative review. Objective Management of spinal disorders is continuously evolving, with new technologies being constantly developed. Regardless, assessment of patient outcomes is key in understanding the safety and efficacy of various therapeutic interventions.

Towards the development of an outcome instrument for spinal trauma: an international survey of spinal surgeons.

Study Design: International web-based survey.

Objective: To identify the most relevant aspects of human function and health status from the perspective of health care professionals involved in the treatment of spinal trauma patients.

Summary Of Background Data: There is no universally accepted outcome instrument available that is specifically designed or validated for spinal trauma patients, contributing to controversies related to the optimal treatment and evaluation of many types of spinal injuries.

Is there a difference in neurologic outcome in medical versus early operative management of cervical epidural abscesses?

Background Context: The ideal management of cervical spine epidural abscess (CSEA), medical versus surgical, is controversial. The medical failure rate and neurologic consequences of delayed surgery are not known.

Purpose: The purpose of this study is to assess the neurologic outcome of patients with CSEA managed medically or with early surgical intervention and to identify the risk factors for medical failure and the consequences of delayed surgery.

Predicting surgical site infection after spine surgery: a validated model using a prospective surgical registry.

Background Context: The impact of surgical site infection (SSI) is substantial. Although previous study has determined relative risk and odds ratio (OR) values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of SSI, rather than relative risk or OR values, would greatly enhance the discussion of safety of spine surgery.

Pediatric cervical spondylolysis and American football.

Background Context: Cervical spondylolysis (CS) is a rare condition and is even more uncommon in pediatric patients. It is characterized by a disruption of the articular mass at the junction of the superior and inferior facet joints and often is diagnosed incidentally. The C6 level is most commonly involved, and the cause of CS remains unknown.

Effect of type II odontoid fracture nonunion on outcome among elderly patients treated without surgery: based on the AOSpine North America geriatric odontoid fracture study.

Study Design: Subgroup analysis of a prospective multicenter study.

Objective: Outcome analysis of nonoperatively treated elderly patients with type II odontoid fractures, including assessment of consequence of a fracture nonunion.

Summary Of Background Data: Odontoid fractures are among the most common fractures in the elderly, and controversy exists regarding treatment.

Predicting medical complications after spine surgery: a validated model using a prospective surgical registry.

Background Context: The possibility and likelihood of a postoperative medical complication after spine surgery undoubtedly play a major role in the decision making of the surgeon and patient alike. Although prior study has determined relative risk and odds ratio values to quantify risk factors, these values may be difficult to translate to the patient during counseling of surgical options. Ideally, a model that predicts absolute risk of medical complication, rather than relative risk or odds ratio values, would greatly enhance the discussion of safety of spine surgery.

Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases.

Background Context: Spinal epidural abscess (SEA) is a rare, serious and increasingly frequent diagnosis. Ideal management (medical vs. surgical) remains controversial.

Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study.

Background: Cervical spondylotic myelopathy is the leading cause of spinal cord dysfunction worldwide. The objective of this study was to evaluate the impact of surgical decompression on functional, quality-of-life, and disability outcomes at one year after surgery in a large cohort of patients with this condition.

Methods: Adult patients with symptomatic cervical spondylotic myelopathy and magnetic resonance imaging evidence of spinal cord compression were enrolled at twelve North American centers from 2005 to 2007.

Mild diabetes is not a contraindication for surgical decompression in cervical spondylotic myelopathy: results of the AOSpine North America multicenter prospective study (CSM).

Background Context: Cervical spondylotic myelopathy (CSM) is a chronic spinal cord disease and can lead to progressive or stepwise neurologic decline. Several factors may influence this process, including extent of spinal cord compression, duration of symptoms, and medical comorbidities. Diabetes is a systemic disease that can impact multiple organ systems, including the central and peripheral nervous systems.

Myelopathy and spinal deformity: relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy.

Surgical management of degenerative cervical myelopathy requires careful pathoanatomic consideration to select between various surgical options from both anterior and posterior approach. Hitherto, unexplored is the relevance of cervical deformity to the pathophysiology of such neurological disability, and whether correction of that deformity should be a surgical objective when planning for reconstruction after spinal cord decompression. Such correction could address both the static cord compression and the dynamic repetitive cord injury, while also restoring more normal biomechanics to the cervical spine.

Surgical management of degenerative cervical myelopathy: a consensus statement.

Degenerative cervical myelopathy (DCM), including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament, presents a heterogeneous set of variables reflecting its complex nature. Multiple studies in the past have attempted to elucidate an ideal surgical algorithm that surgeons may use when treating these patients, unfortunately all studies to date, including the rigorous systematic review used in this focus issue, have fallen short in identifying a superior approach when addressing DCM. Likely because of a superior approach being nonexistent because there are multiple pathoanatomical considerations.

Diagnosis, heritability, and outcome assessment in cervical myelopathy: a consensus statement.

This section of the cervical spondylotic myelopathy (CSM) Spine focus issue collates evidence related to diagnosis, outcome assessment, and genetics. Given that a variety of different disease states can present similarly, a guide for diagnosing and differentiating CSM from other neurological conditions is initially presented. Although the value of magnetic resonance imaging in diagnosing CSM is cemented, its value as a tool to predict future outcome is less well established.

Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: a systematic review.

Study Design: Systematic review.

Objective: We performed a systematic review to determine the comparative effectiveness and safety profiles of anterior versus posterior decompression procedures for multilevel cervical spondylotic myelopathy (CSM).

Summary Of Background Data: CSM is a common cause of neurological dysfunction.

Risk factors for readmission of orthopaedic surgical patients.

Background: Reducing hospital readmissions has become a priority in the development of policies aimed at patient safety and cost reduction. Evaluating the incidence of rehospitalization of orthopaedic surgical patients could help to identify targets for more efficient perioperative care. We addressed two questions: What is the incidence of thirty-day readmission for orthopaedic patients at an academic hospital? Can any risk factors for readmission be identified among rehospitalized patients?

Methods: This is a retrospective cohort study examining 3264 orthopaedic surgical admissions during two fiscal years from the hospital's quality-improvement database.

Traumatic dural tears: what do we know and are they a problem?

Background Context: Iatrogenic dural tears are common complications encountered in spine surgery with known ramifications. There is little information, however, with respect to the implications and complications of traumatic dural tears.

Purpose: To describe the demographics and characteristics of traumatically acquired dural tears and evaluate the complication rate associated with traumatic dural tears in patients who have undergone surgical treatment for spine injuries.

Predictors of treatment outcomes in geriatric patients with odontoid fractures: AOSpine North America multi-centre prospective GOF study.

Study Design: Multicenter prospective cohort study.

Objective: To identify patient and treatment characteristics associated with treatment success or failure in the management of odontoid fractures.

Summary Of Background Data: Odontoid fractures are the most common cervical spine fractures in the elderly and represent a significant management challenge with widely divergent views regarding operative versus nonoperative management.

Surgical management of Charcot spinal arthropathy: a single-center retrospective series highlighting the evolution of management.

Object: Charcot spinal arthropathy (CSA) is an uncommon disorder that occurs in the setting of conditions with decreased protective sensation of the vertebral column, resulting in vertebral joint degeneration, pain, and deformity. Historically, CSA treatment has been fraught with high failure rates. Over time, the authors' institution has trended toward a CSA treatment paradigm of intralesional debridement, circumferential fusion, and four-rod lumbopelvic fixation.