Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy.

Study Design: A prospective cohort study.

Objective: To investigate whether the immediate and short-term effects of preoperative electrical peripheral nerve stimulation (ePNS) on performance of the 10-second test could predict the early postoperative outcomes of patients with cervical spondylotic myelopathy (CSM).

Summary Of Background Data: Previous studies have shown that early clinical improvement in CSM patients may be because of reversal of spinal cord ischemia after spinal cord compression.

Defining Cervical Sagittal Plane Deformity - When Are Sagittal Realignment Procedures Necessary in Patients Presenting Primarily With Radiculopathy or Myelopathy?

Objective: It remains unclear whether cervical sagittal deformity (CSD) should be defined by radiographic parameters alone versus both clinical and radiographic factors, and whether radiographic malalignment by itself warrants a CSD corrective surgery in patients who present primarily with neurologic symptoms.

Methods: We administered a survey to a group of expert surgeons to evaluate whether radiographic parameters alone were sufficient to diagnose CSD, and in which scenarios surgeons recommend a CSD realignment procedure versus addressing the neurologic symptoms alone.

Results: No single radiographic criteria reached a 50% threshold as being sufficient to establish the diagnosis of CSD.

Off-label usage of RhBMP-2 in posterior cervical fusion is not associated with early increased complication rate and has similar clinical outcomes.

Background Context: Arthrodesis is important for the success of posterior cervical fusion (PCF), however, there exists limited data regarding the safety and efficacy of bone morphogenic protein (BMP) in PCF.

Purpose: The primary objective was to evaluate early postoperative complications associated with BMP in PCF and determine whether BMP leads to adverse early clinical outcomes. A secondary objective was to determine the optimal location for BMP sponge placement, within the facet joint (IF) or elsewhere, and the optimal dosage/level.

Cervical laminoplasty: indication, technique, complications.

Cervical laminoplasty is a non-fusion, decompression procedure for cervical spondylotic myelopathy (CSM). It is most commonly indicated for patients with multilevel stenosis who have preserved sagittal alignment and minimal to no axial neck pain related to spondylosis. Expansion of the laminar arch can allow for direct and indirect decompression of the spinal canal.

Facet injection trends in the Medicare population and the impact of bundling codes.

Background Context: Interventional spine procedures have seen a steady increase in utilization over the last 10 to 20 years. In 2010, the Current Procedural Terminology (CPT) codes for facet injections were bundled with image guidance (fluoroscopic or computed tomography) and limited billing to a maximum of three levels. This was done in part because of increased utilization and to ensure that procedures were done appropriately with image guidance.

The effect of capacitively coupled (CC) electrical stimulation on human disc nucleus pulposus cells and the relationship between CC and BMP-7.

Purpose: An in vitro study using human intervertebral disc nucleus pulposus cells to evaluate the effects of CC stimulation on disc-matrix macromolecule production.

Methods: Nucleus pulposus cells were cultured in alginate beads and treated with CC stimulation. The effect of BMP on CC stimulation of the cells was evaluated by applying a BMP blocker (noggin) or by applying additional BMP-7 to the culture.

Posterolateral Lumbar Arthrodesis With and Without Interbody Arthrodesis for L4-L5 Degenerative Spondylolisthesis: A Comparative Value Analysis.

Study Design: Independent retrospective review of prospectively collected data, comparative cohort study.

Objective: The objective of this study was to compare the clinical, radiographical, and cost/value of the addition of an interbody arthrodesis (IBA) to a posterolateral arthrodesis (PLA) in the surgical treatment of L4-L5 degenerative spondylolisthesis (DS). The authors hypothesized that the addition of IBA to PLA would produce added value while incurring minimal additional costs.

Octyl-cyanoacrylate skin adhesive is effective for wound closure in posterior spinal surgery without increased risk of wound complications.

Objective: Few published studies have examined the complication profile after posterior spinal surgery wherein absorbable, subcuticular suture and cyanoacrylate skin adhesives (CSA) were used for incision closure. The purpose of this report is to compare the rate and profile of wound complications in a large number of patients who underwent posterior spinal surgery with CSA skin closure to rates of similar complications with standard nylon closure techniques.

Methods: The prospective database of all surgical cases maintained by the senior author was retrospectively reviewed.

Anomalous location of the vertebral artery in relation to the neural foramen. Implications for cervical transforaminal epidural steroid injections.

Objectives: Evaluate the prevalence of an anomalous posterior vertebral artery (VA) in the neural foramen and to see if any factors might correlate with proximity of the VA to needle location in a cervical transforaminal epidural steroid injection (CTFESI).

Methods: A radiologist with subspecialty training in neuroradiology documented VA location in relation to the neural foramen on axial views of 198 consecutive computed tomography angiograms done for various reasons, 11 were excluded because of poor imaging or occluded VA. The levels of C2-3 through C6-7 were evaluated, where the VA courses within the foramen.

Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial.

Study Design: A prospective, randomized, multicenter study of surgical treatment of cervical disc disease.

Objective: To assess the safety and efficacy of cervical disc arthroplasty using a new arthroplasty device at 24-months follow-up.

Summary Of Background Data: Cervical disc arthroplasty preserves motion in the cervical spine.

Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations.

Background: Epidural steroid injections are commonly used for the treatment of radicular symptoms associated with symptomatic lumbar intervertebral disc herniations. Transforaminal epidural injections are believed to produce better clinical outcomes than interlaminar epidural injections.

Objective: To determine a difference in short-term pain improvement and longterm surgical rates between interlaminar and transforaminal injection techniques.

Spine fusion by gene therapy.

Over 250 000 patients each year undergo a spine fusion procedure in the US. This constitutes 50% of all bone graft procedures. Despite best efforts, a large percentage of spine fusions (up to 35%) fail to form a solid bony arthrodesis.

Cervical transfacet versus lateral mass screws: a biomechanical comparison.

The authors directly the compared biomechanical pullout strength of screws placed in the cervical lateral masses to that of screws placed across the facet joints. Posterior cervical fixation with lateral mass plates is an accepted adjunctive technique for cervical spine fusions. Altered anatomy resulting from congenital malformation, tumor, trauma, infection, or failed lateral mass fixation may limit traditional screw placement options.