Measurement techniques for upper cervical spine injuries: consensus statement of the Spine Trauma Study Group.

Study Design: Literature review.

Objectives: The Spine Trauma Study Group compiled a collection of clinically useful imaging methods used in upper cervical spine trauma and standardized how these measurements are documented.

Summary Of Background Data: Imaging of the upper cervical spine is crucial for injury detection, description, and treatment decision making.

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.

Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study.

Introduction: Considerable variability exists in the management of thoracolumbar (TL) spine injuries. Although there are many influences, one significant factor may be the treating surgeon's specialty and training (ie, orthopedic surgery vs. neurosurgery).

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.

Interobserver and intraobserver reliability of maximum canal compromise and spinal cord compression for evaluation of acute traumatic cervical spinal cord injury.

Study Design: Prospective, blinded validation study of an objective, quantitative measure to assess maximum canal compromise (MCC) and maximum spinal cord compression (MSCC) in individuals with acute cervical spinal cord injury (SCI).

Objective: To examine the intraobserver and interobserver reliability of MCC and MSCC in individuals with acute traumatic cervical SCI.

Summary Of Background Data: To date, few quantitative reliable radiologic methods for assessing the extent of spinal cord compression in the setting of acute SCI have been reported.

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.

Comparison of operative and nonoperative treatment for thoracolumbar burst fractures in patients without neurological deficit: a systematic review.

Object: Despite extensive published research on thoracolumbar burst fractures, controversy still surrounds which is the most appropriate treatment. The objective of this study was to evaluate the scientific literature on operative and nonoperative treatment of patients with thoracolumbar burst fractures and no neurological deficit.

Methods: In their search of the literature, the authors identified all possible relevant studies concerning thoracolumbar burst fracture without neurological deficit.

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.

Measurement techniques for lower cervical spine injuries: consensus statement of the Spine Trauma Study Group.

Study Design: Literature review.

Objectives: It was the purpose of the Spine Trauma Study Group to compile a collection of clinically useful imaging methods used in lower cervical spine trauma and to describe in detail how these measurements should be made.

Summary Of Background Data: Injury detection, description, and treatment decision-making rely on accurate imaging of the lower cervical spine.

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.

Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group.

Objectives: The optimal surgical approach and treatment of unstable thoracolumbar spine injuries are poorly defined owing to a lack of widely accepted level I clinical literature. This lack of evidence-based standards has led to varied practice patterns based on individual surgeon preferences. The purpose of this study was to survey the leaders in the field of spine trauma to define the major characteristics of thoracolumbar injuries that influence their surgical decision making.

A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status.

Study Design: A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management.

Objective: To devise a practical, yet comprehensive, classification system for TL injuries that assists in clinical decision-making in terms of the need for operative versus nonoperative care and surgical treatment approach in unstable injury patterns.

Summary Of Background Data: The most appropriate classification of traumatic TL spine injuries remains controversial.

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).

Strategies to promote neural repair and regeneration after spinal cord injury.

Study Design: Retrospective review of current literature regarding neuroprotection and axonal regeneration therapies for acute spinal cord injury.

Objectives: To provide an update for spine clinicians of the emerging therapeutic strategies for promoting neural repair and regeneration after spinal cord injury.

Summary Of Background Data: The neuroscientific community has generated a number of novel potential treatments for spinal injuries, some of which have entered clinical trials.

The surgical management of primary tumorsof the spine: initial results of an ongoing prospective cohort study.

Study Design: Prospective cohort study.

Objectives: To prospectively validate the application of appendicular surgical oncology principles to the treatment of primary bone tumors of the spine at a quaternary care spine center using local recurrence, survival, and health-related quality of life as outcome measures.

Summary Of Background Data: There is clear evidence that violating the margins of a sarcoma or other malignancy during surgical resection will risk local recurrence and diminish overall survival.

The thoracolumbar injury severity score: a proposed treatment algorithm.

Objective: Significant controversy exists regarding the optimal management of thoracolumbar injuries. This is in part due to the lack of understanding of the natural history of various injury subtypes and the absence of a universally accepted classification scheme that facilitates communication among care providers and assists in directing treatment. The Spine Trauma Study Group has developed an injury severity score based on three major variables: the mechanism of injury determined by radiographic appearance, the integrity of the posterior ligamentous complex, and the neurologic status of the patient.