Cervical Lordosis Actually Increases With Aging and Progressive Degeneration in Spinal Deformity Patients.

Study Design: Retrospective.

Objectives: The authors hypothesized that cervical lordosis (CL) would decrease with aging and increasing degeneration.

Summary Of Background Data: It is theorized that with age and degeneration, the cervical spine loses lordosis and becomes progressively more kyphotic; however, no studies support these conclusions in patients with various spinal deformities.

Age-related changes in cervical sagittal range of motion and alignment.

Study Design Retrospective cohort study. Objective To compare sagittal cervical range of motion (ROM) and alignment in young versus middle-aged adults. Methods One hundred four asymptomatic adults were selected randomly out of 791 subjects who underwent lateral cervical radiographs in neutral, flexion, and extension positions.

Defining hyoplasia of the atlas: a cadaveric study.

Study Design: Cadaveric study.

Objective: To define congenital hypoplasia of the atlas.

Summary Of Background Data: Little has been written about hypoplasia of the atlas and it is usually described in the setting of other skeletal dysplasias or syndromes.

Vertebral artery variations and osseous anomaly at the C1-2 level diagnosed by 3D CT angiography in normal subjects.

Introduction: The craniovertebral junction is anatomically complicated. Representative vertebral artery (VA) variations include the persistent first intersegmental artery (FIA), fenestration of the VA above and below C1 (FEN), posterior inferior cerebellar artery (PICA) from C1/2, and high-riding VA (HRVA). The ponticulus posticus (PP) is a well-known osseous anomaly at C1.

Cervical spondylotic myelopathy surgical trial: randomized, controlled trial design and rationale.

Background: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the world. There are significant practice variation and uncertainty as to the optimal surgical approach for treating CSM.

Objective: To determine whether ventral surgery is associated with superior Short Form-36 Physical Component Summary outcome at the 1-year follow-up compared with dorsal (laminectomy/fusion or laminoplasty) surgery for the treatment of CSM, to investigate whether postoperative sagittal balance is an independent predictor of overall outcome, and to compare health resource use for ventral and dorsal procedures.

Anterior cervical osteotomy for fixed cervical deformities.

Study Design: Description of surgical technique with case series.

Objective: To describe the surgical management of fixed cervical deformities using an anterior osteotomy of the cervical spine.

Summary Of Background Data: Although posteriorly based osteotomies of the cervical spine have been described in the past, there are no reports of the surgical technique for performing an anterior osteotomy of the cervical spine for fixed cervical deformities.

Risk factors for dural tears in the cervical spine.

Study Design: Retrospective review of prospective database.

Objective: To investigate the incidence of cervical dural tears (DTs), risk factors for occurrence and failure of treatment, and the effect on clinical outcomes.

Summary Of Background Data: Only 1 study has specifically investigated the impact of cervical DTs.

Facet joint degeneration of the cervical spine: a computed tomographic analysis of 320 patients.

Study Design: Retrospective study.

Objective: To determine the frequency of facet arthrosis according to age, sex, and cervical level. In addition, we propose and evaluate a new grading system for cervical facet degeneration.

Dynamic radiographic criteria for detecting pseudarthrosis following anterior cervical arthrodesis.

Background: While interspinous motion analysis is commonly used to determine the status of an anterior cervical fusion, the accuracy of this technique is unclear. We believed that three questions needed to be answered. What degree of image magnification is ideal? How much motion should be considered "adequate" for making dynamic radiographs? What is the optimal amount of interspinous motion for detecting pseudarthrosis?

Methods: We performed a retrospective study of 125 patients (109 fused segments and 153 pseudarthrotic segments) who had undergone reexploration with confirmation of fusion status.

Indirect decompression for a prior severe C1-2 dislocation causing progressive quadriparesis.

Combined anterior and posterior surgery is frequently chosen for the treatment of prior, severe C1-2 dislocations that occurred during early childhood because of the difficulty in achieving reduction and satisfactory decompression. The authors treated a prior, severe C1-2 dislocation that was causing progressive quadriparesis. The patient was a 14-year-old boy who had suffered a C1-2 fracture-dislocation at 3 years of age and had been treated with a Minerva body jacket cast.

Neurologic recovery after anterior cervical discectomy and fusion.

Study Design Retrospective review. Objective The objective of this study is to describe the natural history of neurologic recovery after anterior cervical discectomy and fusion (ACDF). Methods Patients between 18 and 80 years of age, diagnosed with cervical radiculopathy, who underwent single-level ACDF and were followed for a minimum of 2 years were identified from a single-center database.

Fluoroscopically guided extraforaminal cervical nerve root blocks: analysis of epidural flow of the injectate with respect to needle tip position.

Study Design Retrospective evaluation of consecutively performed fluoroscopically guided cervical nerve root blocks. Objective To describe the incidence of injectate central epidural flow with respect to needle tip position during fluoroscopically guided extraforaminal cervical nerve root blocks (ECNRBs). Methods Between February 19, 2003 and June 11, 2003, 132 consecutive fluoroscopically guided ECNRBs performed with contrast media in the final injected material (injectate) were reviewed on 95 patients with average of 1.

Differentiating c8-t1 radiculopathy from ulnar neuropathy: a survey of 24 spine surgeons.

Study Design Questionnaire. Objective To evaluate the ability of spine surgeons to distinguish C8-T1 radiculopathies from ulnar neuropathy. Methods Twenty-four self-rated "experienced" cervical spine surgeons completed a questionnaire with the following items.

Single-level degenerative cervical disc disease and driving disability: results from a prospective, randomized trial.

Study Design Post hoc analysis of prospective, randomized trial. Objective To investigate the disability associated with driving and single-level degenerative, cervical disc disease and to investigate the effect of surgery on driving disability. Methods Post hoc analysis of data obtained from three sites participating in a multicenter, randomized, controlled trial comparing cervical disc arthroplasty (TDA) with anterior cervical discectomy and fusion (ACDF).

Hypovitaminosis D and Cervical Disk Herniation among Adults Undergoing Spine Surgery.

Study Design Single-center, retrospective study. Objective Suboptimal concentrations of vitamin D have been linked to hip and knee osteoarthritis in large, population-based cohort studies. We sought to examine the association of vitamin D levels with intervertebral disk disease.

Why Are Spine Surgery Patients Lost to Follow-up?

Long-term outcome studies are frequently hindered by a decreasing frequency of patient follow-up with the treating surgeon over time. Whether this attrition represents a "loss of faith" in their index surgeon or the realities of a geographically mobile society has never been assessed in a population of patients undergoing spinal surgery. The purpose of this article is to determine the frequency with which patients who have undergone prior surgery and develop new problems attempt to follow-up with their index spine surgeon.

Comparative effectiveness of different types of cervical laminoplasty.

Study Design Systematic review. Study Rationale Numerous cervical laminoplasty techniques have been described but there are few studies that have compared these to determine the superiority of one over another. Clinical Questions The clinical questions include key question (KQ)1: In adults with cervical myelopathy from ossification of the posterior longitudinal ligament (OPLL) or spondylosis, what is the comparative effectiveness of open door cervical laminoplasty versus French door cervical laminoplasty? KQ2: In adults with cervical myelopathy from OPLL or spondylosis, are postoperative complications, including pain and infection, different for the use of miniplates versus the use of no plates following laminoplasty? KQ3: Do these results vary based on early active postoperative cervical motion? Materials and Methods A systematic review of the English-language literature was undertaken for articles published between 1970 and March 11, 2013.

Neck Pain Following Cervical Laminoplasty: Does Preservation of the C2 Muscle Attachments and/or C7 Matter?

Study Design Systematic review. Objective In patients aged 18 years or older, with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament (OPLL), does sparing the C2 muscle attachments and/or C7-preserving cervical laminoplasty lead to reduced postoperative axial pain compared with conventional C3 to C7 laminoplasty? Do these results vary based on early active postoperative cervical motion? Methods A systematic review of the English-language literature was undertaken for articles published between 1970 and August 17, 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating C2/C3- or C7-preserving cervical laminoplasty for the treatment of cervical spondylotic myelopathy (CSM) or OPLL in adults.

Intrawound vancomycin powder eradicates surgical wound contamination: an in vivo rabbit study.

Background: Surgical site infection remains a complication of spine surgery despite routine use of prophylactic antibiotics. Retrospective clinical studies of intrawound vancomycin use have documented a decreased prevalence of surgical site infection after spine surgery. The purpose of the present study was to assess the efficacy of intrawound vancomycin powder in terms of eradicating a known bacterial surgical site contamination in a rabbit spine surgery model.

Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis.

Background Context: Postoperative malalignment of the cervical spine may alter cervical spine mechanics and put patients at risk for clinical adjacent segment pathology requiring surgery.

Purpose: To investigate whether a relationship exists between cervical spine sagittal alignment and clinical adjacent segment pathology requiring surgery (CASP-S) following anterior cervical fusion (ACF).

Study Design: Retrospective matched study.

Do Anterior Cervical Osteophytes Prevent Dynamization of Cervical Dynamic Plates?

Study Design: A retrospective study.

Objective: To evaluate radiographic changes of patients with osteophytes at the anterior border of the caudal vertebral body who were treated with anterior cervical discectomy and fusion using dynamic rotational plates.

Summary Of Background Data: Dynamic cervical plates are widely used in surgeries of the anterior cervical spine.

Risk factors for postoperative retropharyngeal hematoma after anterior cervical spine surgery.

Study Design: Retrospective review of prospective database.

Objective: To investigate risk factors involved in the development of anterior cervical hematomas and determine any impact on patient outcomes.

Summary Of Background Data: Postoperative (PO) hematomas after anterior cervical spine surgery require urgent recognition and treatment to avoid catastrophic patient morbidity or death.

Anterior cervical fusion assessment using reconstructed computed tomographic scans: surgical confirmation of 254 segments.

Study Design: Retrospective study developing diagnostic criteria.

Objective: To validate 2 computed tomography-based findings, extragraft bone bridging (ExGBB) and intragraft bone bridging (InGBB), as diagnostic criteria for anterior cervical fusion using subsequent surgical confirmation and to demonstrate the different diagnostic accuracy on the basis of the graft material used.

Summary Of Background Data: The accuracy and the methodology for evaluating bone bridging on computed tomographic scans to determine anterior cervical fusion status have not been validated or standardized.

Sagittal range of motion after extensive cervical fusion.

Background Context: Complicated cervical spine revision and deformity correction surgeries are becoming increasingly common. These challenging operations often necessitate fusion of the entire cervical spine. Patients frequently express concern over the likely loss of range of motion (ROM) of the neck postoperatively.