Degenerative cervical myelopathy: Recent updates and future directions.

Advances in patient selection, surgical techniques, and postoperative care have facilitated spine surgeons to manage complex spine cases with shorter operative times, reduced hospital stay and improved outcomes. We focus this article on a few areas which have shown maximum developments in management of degenerative cervical myelopathy and also throw a glimpse into the future ahead. Imaging modalities, surgical decision making, robotics and neuro-navigation, minimally invasive spinal surgery, motion preservation, use of biologics are few of them.

Cancer and mortality risks of patients with scoliosis from radiation exposure: a systematic review and meta-analysis.

Purpose: The study aimed for unraveling the long-term health impact of cumulative radiation exposure from full-spine radiographs on children/adolescents with scoliosis.

Methods: All cohort, case-control or cross-sectional studies about radiation exposure to scoliosis patients with follow-up period as 20 years or more were included. Meta-analyses were performed for outcomes reported in two or more studies.

Sinew acupuncture for knee osteoarthritis: study protocol for a randomized sham-controlled trial.

Background: Sinew acupuncture is a new modality of acupuncture in which needles are inserted into acupoints, ashi points or spasm points of sinew and muscles along the meridian sinew pathway. A previous observational study revealed that sinew acupuncture has immediate analgesic effects on various soft tissue injuries, including knee injuries. However, no rigorous trials have been conducted.

Predictability of Supine Radiographs for Determining In-Brace Correction for Adolescent Idiopathic Scoliosis.

Study Design: Retrospective radiographic study.

Objective: To assess whether flexibility as revealed by the supine radiograph, predicts in-brace curve correction.

Summary Of Background Data: Currently there is no consensus regarding a standard method to assess curve flexibility and immediate brace effectiveness in treating adolescent idiopathic scoliosis (AIS).

Preventing Fusion Mass Shift Avoids Postoperative Distal Curve Adding-on in Adolescent Idiopathic Scoliosis.

Background: Surgery for adolescent idiopathic scoliosis (AIS) is only complete after achieving fusion to maintain the correction obtained intraoperatively. The instrumented or fused segments can be referred to as the "fusion mass". In patients with AIS, the ideal fusion mass strategy has been established based on fulcrum-bending radiographs for main thoracic curves.

Cervical spinal canal stenosis first presenting after spinal cord injury due to minor trauma: An insight into the value of preventive decompression.

Purpose: Patients with pre-existing cervical spinal canal stenosis (CSCS) may have minimal or no symptoms. However, performing preventive decompression is controversial as the incidence of CSCS leading to severe cord injury is unknown. Hence, this study aims to revisit the threshold for surgery in "silent" CSCS by reviewing the neurologic outcomes of patients with undiagnosed CSCS who sustained a cervical spinal cord injury (CSCI).

Efficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial.

Study Design Randomized controlled trial. Objective Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects every population. In severe deformity, surgical intervention is performed.

Antimicrobial prophylaxis to prevent surgical site infection in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion: 2 doses versus antibiotics till drain removal.

Purpose: There is much variation in the choice, timing and duration of antimicrobial prophylaxis for preventing surgical site infections (SSI) but no guideline exists for scoliosis surgery. The aim of study was to compare the efficacy of two antimicrobial prophylaxis (AMP) protocols with cephazolin in preventing SSI in adolescent idiopathic scoliosis (AIS).

Methods: A retrospective comparative analysis of two post-operative AMP protocols (two postoperative doses versus continued antibiotics till drain removal) was performed.

Selection of Fusion Levels Using the Fulcrum Bending Radiograph for the Management of Adolescent Idiopathic Scoliosis Patients with Alternate Level Pedicle Screw Strategy: Clinical Decision-making and Outcomes.

Objective: Selecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS.

Methods: A retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed.

A Lethal Sequelae of Spinal Infection Complicating Surgery and Radiotherapy for Head and Neck Cancer.

Patients who have undergone neck dissection and radiotherapy are at risk of cervical spine infections. Furthermore, previous radiotherapy and cervical spine infections can lead to fistula formation to the subarachnoid space and intracranial infection. This report discusses the serious consequences of a missed cervical spine infection including cerebrospinal fluid fistula formation and persistent central nervous system infection, and serves as a reminder to clinicians of the possible association between cervical spine infections and prior head and neck surgery and radiotherapy.

Normal values of cervical spinal cord diffusion tensor in young and middle-aged healthy Chinese.

Purpose: Lack of normal reference value of diffusion tensor imaging parameters hinders its application in clinical practice. In this study, we aim to establish a comprehensive normal DTI database of Chinese subjects.

Methods: Sixty-five healthy subjects aged 21-61 years were recruited and underwent 3T DTI scan of cervical spine.

Quantitative assessment of column-specific degeneration in cervical spondylotic myelopathy based on diffusion tensor tractography.

Purpose: Cervical spondylotic myelopathy (CSM) is a common spinal cord disorder in the elderly. Diffusion tensor imaging (DTI) has been shown to be of great value for evaluating the microstructure of nerve tracts in the spinal cord. Currently, the quantitative assessment of the degeneration on the specific tracts in CSM is still rare.

Potential use of diffusion tensor imaging in level diagnosis of multilevel cervical spondylotic myelopathy.

Study Design: A prospective study on a series of consecutive patients.

Objective: To investigate the use of diffusion tensor imaging (DTI) and orientation entropy in level localization in patients diagnosed with multilevel cervical spondylotic myelopathy (CSM).

Summary Of Background Data: Multilevel CSM presents complex neurological signs that make level localization difficult.

Diffusion tensor imaging of somatosensory tract in cervical spondylotic myelopathy and its link with electrophysiological evaluation.

Background And Context: Abnormal somatosensory evoked potential (SEP) (ie, prolonged latency) has been associated with poor surgical prognosis of cervical spondylotic myelopathy (CSM).

Purpose: To further characterize the extent of microstructural damage to the somatosensory tract in CSM patients using diffusion tensor imaging (DTI).

Study Design/setting: Retrospective study.

Is diffusion anisotropy a biomarker for disease severity and surgical prognosis of cervical spondylotic myelopathy?

Purpose: To explore the value of diffusion-tensor (DT) imaging in addressing the severity of cervical spondylotic myelopathy (CSM) and predicting the outcome of surgical treatment.

Materials And Methods: From July 2009 to May 2012, 65 volunteers were recruited for this institutional review board-approved study, and all gave informed consent; 20 volunteers were healthy subjects (age range, 41-62 years), and 45 were patients with CSM (age range, 43-86 years). Anatomic and DT 3.

Quantitative analysis of fiber tractography in cervical spondylotic myelopathy.

Background Context: Diffusion tensor fiber tractography is an emerging tool for the visualization of spinal cord microstructure. However, there are few quantitative analyses of the damage in the nerve fiber tracts of the myelopathic spinal cord.

Purpose: The aim of this study was to develop a quantitative approach for fiber tractography analysis in cervical spondylotic myelopathy (CSM).

Surgical treatment of acute TB spondylitis: indications and outcomes.

Introduction: Spinal tuberculosis represents a challenging disease to treat, not because of the technical expertise or the time required to cure it, but more so because of the decisions involved to treat it. The Medical Research Council (MRC) Working Party on Tuberculosis of the Spine designed trials to help address several questions.

Methods: A comprehensive literature search was performed using PubMed Medline, including English articles from 1934 to 1012, which pertain to spinal tuberculosis, with special effort in tracing the 13 MRC reports.

Magnetically controlled growing rods for severe spinal curvature in young children: a prospective case series.

Background: Scoliosis in skeletally immature children is often treated by implantation of a rod to straighten the spine. Rods can be distracted (lengthened) as the spine grows, but patients need many invasive operations under general anaesthesia. Such operations are costly and associated with negative psychosocial outcomes.

"Spring-back" closure associated with open-door cervical laminoplasty.

Background Context: Spring-back complication after open-door laminoplasty as described by Hirabayashi is a well-known risk, but its definition, incidence, and associated neurologic outcome remain unclear.

Objective: To investigate the incidence and the neurologic consequence of spring-back closure after open-door laminoplasty.

Study Design: A retrospective radiographic and clinical review.

Orientation entropy analysis of diffusion tensor in healthy and myelopathic spinal cord.

The majority of nerve fibers in the spinal cord run longitudinally, playing an important role in connecting the brain to the peripheral nerves. There is a growing interest in applying diffusion tensor imaging (DTI) to the evaluation of spinal cord microarchitecture. The current study sought to compare the organization of longitudinal nerve fibers between healthy and myelopathic spinal cords using entropy-based analysis of principal eigenvector mapping.