Validation of the Disabilities of the Arm, Shoulder, and Hand in Patients Undergoing Cervical Spine Surgery.

Study Design: Retrospective cohort study.

Objective: To evaluate the performance and convergent validity of the disabilities of the arm, shoulder, and hand (DASH) in comparison with the visual analog scale (VAS) for pain, and neck disability index (NDI) in patients undergoing cervical spine surgery.

Summary Of Background Data: Neck-specific disability scales do not adequately assess concurrent upper extremity involvement in patients with cervical spine disorders.

Modular cervical plate system for adjacent segment disease.

Background: Adjacent-level disease after anterior cervical discectomy and fusion (ACDF) occurs in a significant proportion of patients and frequently requires revision operation. Methods using traditional plates typically require removal of the plate with anecdotally increased operative-time and morbidity. We review our experience in treating symptomatic adjacent-segment disease using both traditional plate removal and modular-plate system which allows for add-on plate components rather than removal of the entire plate.

Outcomes and effectiveness of posterior occipitocervical fusion for suboccipital spinal metastases.

OBJECTIVE The incidence of suboccipital spinal metastases is rare but has increased given cancer patients' longer life expectancies. Operative treatment in this region is often challenging because of limited fixation points due to tumor lysis, as well as adjacent neural and vascular anatomy. Few studies have reported on this population of cancer patients.

Reconstruction of the C-1 lateral mass with a titanium expandable cage after resection of eosinophilic granuloma in an adult patient.

Spinal involvement occurs frequently in cases of eosinophilic granuloma (EG), but surgical treatment is limited primarily to those with spinal instability. Involvement of the cervical spine is rare, but primarily occurs in the vertebral bodies, and is normally amenable to anterior corpectomy and spinal reconstruction. The authors describe a 27-year-old man with pathologically proven EG who presented with complete destruction of the C-1 lateral mass requiring spinal stabilization.

Fractional anisotropy to quantify cervical spondylotic myelopathy severity.

Background: A number of clinical tools exist for measuring the severity of cervical spondylotic myelopathy (CSM). Several studies have recently described the use of non-invasive imaging biomarkers to assess severity of disease. These imaging markers may provide an additional tool to measure disease progression and represent a surrogate marker of response to therapy.

An update on civilian spinal gunshot wounds: treatment, neurological recovery, and complications.

Study Design: Retrospective analysis of inpatient and outpatient data from a single academic trauma center.

Objective: To test the effectiveness of a conservative treatment algorithm for civilian spinal gunshot wounds (CSGSWs) by comprehensively evaluating neurological status and recovery, fracture type, concomitant injuries, indications for surgery, and complications.

Summary Of Background Data: Few large studies exist to guide treatment of CSGSWs, and none have been published in nearly 20 years.

Simpson Grade I-III Resection of Spinal Atypical (World Health Organization Grade II) Meningiomas is Associated With Symptom Resolution and Low Recurrence.

Background: Because of their rarity, outcomes regarding spinal atypical meningiomas (AMs) remain unclear.

Objective: To describe the recurrence rate and postoperative outcomes after resection of spinal AMs, and to discuss an appropriate resection strategy and adjuvant therapy for spinal AMs.

Methods: Data from all patients who presented with spinal AMs to 2 tertiary referral centers between 1998 and 2013 were obtained by chart review.

Spinal sealant system provides better intraoperative watertight closure than standard of care during spinal surgery: a prospective, multicenter, randomized controlled study.

Study Design: Prospective, 3:1 randomized, single-blind, multicenter investigational study.

Objective: To assess the safety and efficacy of a low-swell spinal sealant when used as an adjunct to sutured dural repair compared with standard of care methods to obtain watertight dural closure in subjects undergoing spinal surgery.

Summary Of Background Data: Watertight dural closure is paramount in spinal surgery to avoid complications of cerebrospinal fluid leak.

Symptomatic thoracic spinal cord herniation: case series and technical report.

Background And Importance: Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes.

Polyethylene glycol hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair in the spine: results of a prospective, multicenter, randomized controlled study.

Study Design: A prospective, multicenter, randomized, two-arm, single-blind, investigational device exemption pivotal study.

Objective: To assess the efficacy and the safety of a polyethylene glycol (PEG) hydrogel spinal sealant (DuraSeal Spinal Sealant) as an adjunct to sutured dural repair compared with standard of care methods (control) to obtain a watertight dural closure in patients undergoing an intentional durotomy during spinal surgery.

Summary Of Background Data: If a watertight dural closure is not achieved, cerebrospinal fluid leak with associated complications may occur.

The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis.

Background: Biopsy specimens are often obtained in the evaluation of hematogenous vertebral osteomyelitis. The effect of prebiopsy antibiotic exposure on pathogen recovery is unknown.

Methods: We conducted a retrospective cohort study of adult inpatients with hematogenous vertebral osteomyelitis at a tertiary care hospital from 1 January 2003 through 31 July 2007.

Seven years of experience with C2 translaminar screw fixation: clinical series and review of the literature.

Background: C2 translaminar screws offer biomechanical stability similar to that of other C2 fixation methods but with minimal risk to neural and vascular structures.

Objective: To report our experience with the technique since 2002 and to review the pertinent literature to advance the understanding of C2 translaminar screw fixation.

Methods: Fifty-two consecutive adult patients with disorders requiring axis stabilization were treated with C2 translaminar screws by a single surgeon.

The epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital.

Background: Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Limited data exist regarding hematogenous vertebral osteomyelitis. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis.

Techniques of posterior C1-C2 stabilization.

Instability of the atlantoaxial complex may result from inflammatory, traumatic, congenital, neoplastic, or degenerative disorders and often requires surgical stabilization. Initial dorsal wiring techniques allow safe fixation but require rigid external immobilization and have been associated with high fusion failure rates. Rigid screw fixation techniques including transarticular screw fixation and C1-C2 rod-cantilever fixation offer higher fusion rates and less need for rigid immobilization but are more technically demanding.

Anatomic considerations for the placement of C2 laminar screws.

Study Design: Cadaveric study.

Objective: To study the applicability of C2 laminar screw placement in the general adult population and to provide useful guidelines for their safe placement.

Summary Of Background Data: Laminar screws for fixation into the second cervical vertebra are becoming an increasingly used technique since they eliminate the risk of vertebral artery injury.

Pneumocephalus after a lumbar epidural steroid injection.

Lumbar epidural steroid injections are a routine therapeutic procedure provided by pain management physicians. Despite a known low morbidity, significant acute events can occur. We report a patient who developed symptoms mimicking a stroke after an epidural injection, and provide an evaluation and assessment of this patient plus other rare complications that occur with epidural injections.

Resection of a giant anterior sacral meningocele via an anterior approach: case report and review of literature.

Background: An anterior sacral meningocele is a rare form of spinal dysraphism that is sometimes associated with syndromes such as Currarino and Marfan syndromes. These lesions rarely cause neurological complications, but meningitis, sepsis, obstetric problems, and bowel and bladder difficulties are common secondary conditions. The lesions can even be fatal.

Pediatric atlantoaxial fixation with bilateral, crossing C-2 translaminar screws. Technical note.

The authors describe the cases of three children in whom atlantoaxial instability was caused by os odontoideum, all requiring surgical fixation. Although C1-2 rod/cantilever constructs involving C-2 pedicle screws and C1-2 transarticular screws have been widely applied in adults, only C1-2 transarticular screw fixation has been reported in children. Both of these constructs potentially place the vertebral artery (VA) at risk because of the variable location of the transverse foramen.

Translaminar rigid screw fixation of the axis. Technical note.

Rigid fixation of the axis with C1-2 transarticular screws or C-2 pedicle screws results in high fusion rates but remains technically demanding because of the risk of injury to the vertebral artery (VA) and the limitations imposed by anatomical variability. Translaminar fixation of the axis with crossing bilateral screws provides rigid fixation and is technically simple, is not affected by variations in individual anatomy, and does not place the VA at risk. The long-term results in 20 patients treated with translaminar fixation for craniocervical, atlantoaxial, and axial-subaxial instability are presented, with 100% fusion rates and no neurological or vascular complications.

Bone morphogenetic proteins and spinal fusion.

Bone morphogenetic proteins (BMPs) have increasingly become a focus of research in the laboratory, with animal models, and in human clinical trials for the treatment of spinal disorders. Basic science research has elucidated the putative mechanism of action of BMPs, and the efficacy of BMPs in inducing bone formation has been evaluated in multiple animal models of anterior and posterior spinal fusion. Not only has BMP been shown to improve the quality and amount of bone formation when used as a supplement to autograft, it has also been shown to promote superior fusion in the absence of autograft, even in high-risk fusion models involving the use of nicotine or nonsteroidal antiinflammatory agents.

Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note.

Rigid screw fixation of the axis, for either atlantoaxial fixation or for incorporation of C2 into subaxial cervical constructs, provides significant stability and excellent long-term fusion results but remains technically demanding due to the danger of injury to the vertebral artery. Anatomic variability of the foramen transversarium in the body of the axis can preclude safe transarticular C1-C2 screw placement in up to 20% of patients. Although more recent methods of C2 screw fixation with pedicle screws allow safer fixation in a higher number of patients, there remains a significant risk to the vertebral artery with C2 pedicle screw placement.

Symptomatic intraosseous synovial cyst in the cervical spine: a case report.

Study Design: A case report and review of the literature are presented.

Objective: To describe an unusual location for a cervical synovial cyst and to review characteristic presentations and findings of synovial cysts in the cervical spine.

Summary Of Background Data: Synovial cysts in the cervical spine are rare.

Thoracoscopic intradiscal spine fusion using a minimally invasive gene-therapy technique.

Background: Gene therapy has been utilized to achieve posterior intertransverse process fusion in rodents. To our knowledge, however, no one has previously reported on the use of this technique to achieve anterior spinal fusion in mammals. The purpose of the present study was to determine if a gene-therapy technique can be utilized to achieve anterior intradiscal fusion in pigs with use of minimally invasive techniques.