bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple myeloma of the cervical spine: treatment strategies for pain and spinal instability
Authors: Rao Ganesh , Ha Chul S. , Chakrabarti Indro , Feiz-Erfan Iman , Mendel Ehud , Rhines Laurence D.
Published: January 2008

Object

Metastases of multiple myeloma often occur in the cervical spine. These metastases may cause pain and associated spinal instability. The authors report the results of radiotherapy and surgical treatment for myeloma involving the cervical spine. The results of radiation therapy for multiple myeloma metastases to the cervical spine that cause clinical or radiographically documented instability have not been reported previously.

Methods

A retrospective chart review of patients with multiple myeloma metastases to the cervical spine was undertaken. Between 1993 and 2005, 35 patients were treated with external-beam radiation and/or surgical stabilization at the University of Texas M. D. Anderson Cancer Center in Houston, Texas. Nineteen of 20 patients with sufficient follow-up data experienced resolution of their pain when treated with radiation without surgical intervention. Twenty-three patients had evidence of spinal instability on radiographic images; 15 of these were treated with radiation alone. Of these, 10 had sufficient follow-up data, and none showed any clinical progression of instability. Radiographic follow-up images demonstrated an arrest of further progression of instability and, in some cases, healing of pathological fractures by means of radiation alone.

Conclusions

The results of this series suggest that, in selected cases, external-beam radiation for multiple myeloma metastases to the cervical spine is an effective palliative treatment, even in cases involving clinical or radiographically documented instability.
Development and psychometric properties of the Vertebral Compression Fracture Pain and Functional Disability Questionnaire
Authors: Evans Avery J. , Kip Kevin E. , Boutin Selene M.
Published: January 2008

Object

Vertebral compression fractures (VCFs) result in severe and disabling pain, diminished quality of life, and substantial medical costs. There exists no standard instrument with which to measure pain and functional status before and after treatment of VCFs.

Methods

A questionnaire was specifically developed to assess pain and disability in patients with VCFs before and after undergoing percutaneous polymethylmethacrylate–augmented vertebroplasty. The first section of the baseline questionnaire (before treatment) contains 11 items that address the patient’s previous and current levels of back pain and distress. The second section of the baseline questionnaire lists 24 activities of daily living (ADLs), each measured on a four-point scale ranging from “able to do without pain” to “cannot do because of pain.” The follow-up questionnaire (after treatment) is similar in format.

Among 72 vertebroplasty-treated patients, the internal consistency reliability of the 24 ADLs ranged from 0.87 to 0.98, with similar results observed before and after treatment. Correlations of 0.29 to 0.72 were observed among the 24 ADLs and the internal measures of pain and distress measured on both visual analog and adjectival scales. Similar correlations (range 0.35–0.63) were observed between the questionnaire and 10 dimensions of the Oswestry Disability Index’s low-back pain questionnaire, an external instrument used to assess criterion-referenced validity. Evidence in support of the validity of the questionnaire was present before and after treatment.

Conclusions

The Vertebral Compression Fracture Pain and Functional Disability Questionnaire appears to be a reliable and valid instrument for assessing back pain and functional ability in patients before and after treatment for VCFs.
Spinal cord–fragment interactions following burst fracture: an in vitro model
Authors: Hall Richard M. , Oakland Robert J. , Wilcox Ruth K. , Barton David C.
Published: January 2008

Object

The purpose of the study was to develop an in vitro model of the bone fragment and spinal cord interactions that occur during a burst fracture and further the understanding of how the velocity of the bone fragment and the status of the posterior longitudinal ligament (PLL) affect the deformation of the cord.

Methods

An in vitro model was developed such that high-speed video and pressure measurements recorded the impact of a simulated bone fragment on sections of explanted bovine spinal cord. The model simulated the PLL and the posterior elements.

The status of the PLL had a significant effect on both the maximum occlusion of the spinal cord and the time for occlusion to occur. Raising the fragment velocity led to an overall increase in the spinal cord deformation. Interestingly the dura mater appeared to have little or no effect on the extent of occlusion.

Conclusions

These findings may indicate the importance of the dura’s interaction with the cerebrospinal fluid in protecting the cord during this type of impact.
Metastatic disease from spinal chordoma: a 10-year experience
Authors: McPherson Christopher M. , Suki Dima , McCutcheon Ian E. , Gokaslan Ziya L. , Rhines Laurence D. , Mendel Ehud
Published: January 2008

Object.

Metastastic lesions have been reported in 5 to 40% of patients with spinal and sacrococcygeal chordoma, but few contemporary series of chordoma metastastic disease exist in the literature. Additionally, the outcome in patients with chordoma-induced metastastic neoplasms remains unclear. The authors performed a retrospective review of the neurosurgery database at the University of Texas M. D. Anderson Cancer Center in Houston to determine the incidence of metastatic disease in a contemporary series of spinal and sacrococcygeal chordoma as well as to determine the outcomes.

Methods.

Thirty-seven patients underwent surgery for spinal and sacrococcygeal chordoma between June 1, 1993, and March 31, 2004. All records were reviewed, and appropriate statistical analyses were used to compare patient data for preoperative characteristics, treatments, and outcomes.

The authors identified seven patients (19%) in whom metastatic disease developed; in three the disease had metastasized to the lungs only, in two to the lungs and liver, and in two to distant locations in the spine. There were no significant differences in age, sex, tumor location, or history of radiation treatments between patients with and those without metastases. In cases with local recurrent tumors, metastastic disease was more likely to develop than in those without recurrence (28 compared with 0%, respectively; p = 0.07). In two (12%) of 17 patients who underwent en bloc resection, metastatic disease developed, whereas it developed in five (25%) of 20 patients treated by curettage (p = 0.42). The median time from first surgery to the appearance of metastatic disease, as calculated using the Kaplan–Meier method, was 143.4 months (95% confidence interval [CI] 66.8–219.9). The median survival duration of patients with metastatic disease after the first surgery was 106 months (95% CI 55.7–155.7), and this did not differ significantly from that in patients in whom no metastases developed (p = 0.93).

Conclusions.

Spinal chordoma metastasized to other locations in 19% of the patients in this series. In patients with local disease recurrence, metastatic lesions are more likely to develop. Metastatic lesions were shown to be aggressive in some cases. Surgery and chemotherapy can play a role in controlling metastatic disease.
Hollow cylindrical polymethylmethacrylate strut for spinal reconstruction after single-level cervical corpectomy
Authors: Chen Jyi-Feng , Wu Chieh-Tsai , Lee Sai-Cheung , Lee Shih-Tseng
Published: January 2008

Object

This prospective study was conducted to assess the safety of using a cylindrical polymethylmethacrylate (PMMA) strut for fusion and reconstruction of the cervical spine after single-level cervical corpectomy. The authors describe the clinical results obtained in patients after surgery.

Methods

Fifty-four patients underwent single-level cervical corpectomy, fusion, and spinal reconstruction that involved the placement of hollow cylindrical PMMA struts. In each patient, the spine was reinforced with anterior cervical plates. The PMMA struts were filled with autologous bone obtained from the resected vertebral body. Follow-up radiographic evaluation involved plain lateral dynamic radiographs and computed tomography (CT) scans. Neurological status was assessed pre- and postoperatively using the Nurick Scale. A total of 46 patients (85.1%) attended follow-up visits for a minimum of 2 years. Spinal stability was documented in all patients on 12-month plain dynamic lateral radiographs; in 37 patients (80.4%), complete osseous fusion was demonstrated on the 12-month CT reconstructions. In the remaining nine patients, complete fusion had been achieved by 24 months. The overall mean preoperative Nurick grade was 2.94 ± 0.97, and this improved significantly to 1.71 ± 0.77 (p < 0.05) by 24 months. There were no complications related to the hollow cylindrical PMMA strut.

Conclusions

The findings of this preliminary study indicate that hollow cylindrical PMMA struts can be safely used in cervical fusion after single-level corpectomy and that the clinical results are satisfactory. The hollow cylindrical PMMA strut is a good substitute for spinal reconstruction and fusion when combined with plate fixation in patients who have undergone anterior cervical single-level corpectomy.
Diagnosis and treatment of spinal cord herniation: a combined experience
Authors: Barrenechea Ignacio J. , Lesser Jonathan B. , Gidekel Alberto L. , Turjanski Leon , Perin Noel I.
Published: January 2008

Object

Idiopathic spinal cord herniation (ISCH) is an uncommon clinical entity typically presenting with lower-extremity myelopathy. Despite the existence of 85 ISCH cases in the literature, misdiagnosis and delayed diagnosis remain a major concern.

Methods

The authors conducted a retrospective review of patients who underwent surgery for ISCH at their institutions between 1993 and 2004. Seven patients were treated for ISCH, five in New York and two in Buenos Aires. The patients’ ages ranged from 32 to 72 years. There were three men and four women. The interval between the onset of symptoms and surgery ranged from 12 to 84 months (mean 42.1 months).

Preoperatively, spinal cord function in four patients was categorized as American Spinal Injury Association (ASIA) Grade D, and that in the other three patients was ASIA Grade C. In all patients a diagnosis of posterior intradural arachnoid cyst had been rendered at other institutions, and three had undergone surgery for the treatment of this entity. In all cases, the herniation was reduced and the defect repaired with a dural patch. The follow-up period ranged from 10 to 147 months (mean 49.2 months). Clinical recovery following surgery varied; however, there was no functional deterioration compared with baseline status. Syringomyelia, accompanied by neurological deterioration, developed postoperatively in two patients at 2 and 10 years, respectively.

Conclusions

Patients presenting with a diagnosis of posterior intradural arachnoid cyst should be evaluated carefully for the presence of an anterior spinal cord herniation. Based on the authors’ literature review and their own experience, they recommend offering surgery to patients even when neurological compromise is advanced.
Advanced glycation end-products downregulating intervertebral disc cell production of proteoglycans in vitro
Authors: Yokosuka Kimiaki , Park Jin Soo , Jimbo Kotaro , Yamada Kei , Sato Kimiaki , Tsuru Michiyo , Takeuchi Masayoshi , Yamagishi Sho-Ichi , Nagata Kensei
Published: January 2008

Object

The authors sought to clarify the role, if any, of advanced glycation end-products (AGEs) in disc degeneration.

Methods

Intervertebral discs were analyzed for the presence of AGEs and of their receptor (RAGE) by immunohistochemical analysis. Reverse transcriptase polymerase chain reaction (RT-PCR) was performed to detect any RAGE gene expression, and real-time PCR was used to quantify messenger RNA (mRNA) levels of aggrecan and collagen types I and II in nucleus pulposus cells treated with AGEs. Aggrecan protein concentration was determined by enzyme-linked immunosorbent assay.

Immunohistochemical analysis revealed that AGEs and RAGE were localized in the nucleus pulposus of the intervertebral disc. Advanced glycation end-products were found to significantly suppress the expression of aggrecan at both mRNA and protein levels in a dose- and time-dependent manner. The levels of collagen types I and II remained unchanged after treatments with AGEs.

Conclusions

These results suggest that the accumulation of AGEs and their interaction with their receptor in the nucleus pulposus might result in the downregulation of aggrecan production responsible for disc degeneration.
Biomechanical comparison of two new atlantoaxial fixation techniques with C1–2 transarticular screw–graft fixation
Authors: Härtl Roger , Chamberlain Robert H. , Fifield Mary S. , Chou Dean , Sonntag Volker K. H. , Crawford Neil R.
Published: January 2008

Object

Two new techniques for atlantoaxial fixation have been recently described. In one technique, C-2 intra-laminar screws are connected with C-1 lateral mass screws; in the second, C-1 and C-3 lateral mass screws are interconnected and C-2 is wired sublaminarly. Both techniques include a C1–2 interspinous graft. The authors compared these techniques with the gold-standard, interspinous graft–augmented C1–2 transarticular screw fixation and with a control C1–2 interspinous graft fixation procedure alone.

Methods

In six human cadaveric occiput–C4 specimens, nonconstraining 1.5-Nm pure moments were applied to induce flexion, extension, lateral bending, and axial rotation during which three-dimensional angular motion was measured optoelectronically. Each specimen was tested in the normal state, with graft alone (after odontoidectomy), and then in varying order after applying each construct with a rewired graft. All three constructs allowed significantly less angular motion at the C1–2 junction than the wired interspinous graft alone during lateral bending and axial rotation (p < 0.01, paired Student t-test) but not during flexion or extension. Transarticular screw fixation with an interspinous graft allowed less motion at the atlantoaxial junction than the two new constructs in several conditions. Differences were greater between the transarticular screw construct and the intralaminar screw construct than between the transarticular screw construct and the C1–3 lateral mass screw construct. During lateral bending and axial rotation, the C1–3 construct allowed less motion at the atlantoaxial junction than the intralaminar screw construct.

Conclusions

Biomechanically, the gold-standard C1–2 transarticular screw fixation outperformed the two new techniques during lateral bending and axial rotation. Wiring C-2 to C1–3 rods provided greater stability than C1–2 laminar screws, but it sacrificed C2–3 mobility. It is unknown whether the small differences observed biomechanically would lead to clinically relevant differences in fusion rates.
A therapeutic time window for anti-CD11d monoclonal antibody treatment yielding reduced secondary tissue damage and enhanced behavioral recovery following severe spinal cord injury
Authors: Ditor David S. , Bao Feng , Chen Yuhua , Dekaban Gregory A. , Weaver Lynne C.
Published: January 2008

Object

The purpose of this study was to investigate the therapeutic time window for antiinflammatory treatment within the first 24 hours of spinal cord injury (SCI). The authors have shown that an anti-CD11d antibody treatment attenuates leukocyte infiltration and improves neurological function when administered beginning 2 hours after SCI. A more clinically relevant time for the initiation of treatment after SCI, however, is 6 or more hours postinjury.

Methods

In Study 1, the T-4 vertebrae in four groups of rats were injured by a 50-g clip-induced compression method, and the anti-CD11d antibody (1 mg/kg) was intravenously administered starting 2, 6, 12, or 24 hours postinjury. All groups received subsequent doses at 24 and 48 hours, and animals were killed at 72 hours. The anti-CD11d antibody treatment starting at 6 hours postinjury caused significant attenuation of leukocyte infiltration, reactive oxygen species–associated enzymes, and secondary tissue damage. Based on these findings, Study 2 included two groups of rats receiving the aforementioned injury and treatment beginning at 6 hours postinjury (with subsequent treatments at 24 and 48 hours) with the anti-CD11d or a control antibody (1B7); these rats were then observed for 5 weeks. Basso-Beattie-Bresnahan (BBB) scores were significantly higher in anti-CD11d–treated rats (mean BBB score 8.9 ± 0.1) than controls (mean BBB score 7.7 ± 0.1) 5 weeks postinjury. Increases in mean arterial pressure during colon distension were smaller in anti-CD11d–treated rats (19.5 ± 3.7 mm Hg) than in controls (37.4 ± 4.7 mm Hg).

Conclusions

These findings suggest that antiinflammatory treatments that reduce secondary tissue damage after SCI may be delayed until 6 hours postinjury and still be effective.
Anterior transvertebral transposition of the spinal cord for the relief of paraplegia associated with congenital cervicothoracic kyphoscoliosis
Authors: Shenouda Emad F. , Nelson Ian W. , Nelson Richard J.
Published: January 2008

✓The authors describe a technique for the relief of spinal cord compression associated with congenital kyphoscoliosis. A 13-year-old girl with congenital cervicothoracic kyphoscoliosis had undergone in situ fusion; spastic paraparesis and bladder disturbance developed postoperatively. Spinal cord detethering and posterolateral decompression temporarily arrested the neurological deterioration; however, the patient’s condition then progressed to paraplegia with a partial sensory level at L-1. Imaging demonstrated persisting cord compression at the apex of the kyphotic curve. Transvertebral transposition of the spinal cord was performed using sagittal vertebrotomies, preserving the lateral aspects of the vertebral bodies, pedicles, and fusion mass. By 2 years postoperatively she had recovered normal sensation and good bladder function and was walking unaided.

Transposition of the spinal cord may be used to relieve spinal cord compression associated with complex spinal deformities.
Pathognomonic radiological signs for predicting prognosis in patients with chronic atlantoaxial rotatory fixation
Authors: Ishii Ken , Chiba Kazuhiro , Maruiwa Hirofumi , Nakamura Masaya , Matsumoto Morio , Toyama Yoshiaki
Published: January 2008

Object

The authors conducted a study to assess the correlation between radiological features and clinical courses in patients with chronic atlantoaxial rotatory fixation (AARF) and to determine diagnostic imaging signs for predicting prognosis.

Methods

There were 24 patients (eight boys and 16 girls) whose mean age was 7.8 years (range 4–14 years) and in whom AARF was diagnosed. The mean follow-up duration was 3.7 years (range 5 weeks–12 years). There were two groups of patients: 15 patients who visited the hospital less than 8 weeks after symptom (torticollis) onset comprised the acute group, and nine patients in whom the diagnosis of AARF was established later than 3 months after symptom onset comprised the chronic group. The chronic group was divided into two subgroups: those in whom the closed reduction could be achieved and those in whom it could not. Clinical data and radiographic studies, including plain radiographs and plain and three-dimensional (3D) computed tomography (CT) reconstructions, were reviewed retrospectively.

A deformity of the superior C-2 facet joint was frequently observed in the group of patients with chronic AARF (p < 0.0001). This sign represented a risk factor for recurrent dislocation (p = 0.0003, Fisher exact test). Prominent lateral inclination of C-1 was an impeding factor for reduction of chronic AARF (p < 0.0001, analysis of variance with Fisher post hoc test). Greater than 20° of lateral inclination of the atlas indicated an irreducible subluxation (p = 0.0023, Fisher exact test).

Conclusions

Both facet joint deformity and lateral inclination observed on 3D CT reconstructions can be useful signs to predict the prognosis and the treatment of choice in patients with chronic AARFs.
Cervical spine epidural abscess: experience with microsurgical treatment in eight cases
Authors: Muzii Vitaliano Francesco , Mariottini Aldo , Zalaffi Alessandro , Carangelo Biagio Roberto , Palma Lucio
Published: January 2008

Object

The authors report a series of eight consecutive cases in which epidural abscesses in the cervical spine were treated by microsurgery without arthrodesis, including two cases of concomitant pyogenic and tubercular infection.

Methods

The authors used a minimally invasive surgical approach consisting of single-level anterior microsurgical discectomy and drainage of the epidural abscess via a silicone catheter, and then initiated antibiotic therapy. At follow-up examination (mean duration 39 months), six patients exhibited complete recovery and two suffered from minor residual deficits. In all cases, spontaneous vertebral fusion occurred. Sagittal alignment was maintained in seven patients, and in one there was slight asymptomatic kyphosis. In two patients, tubercular and pyogenic infections were found. Prior intervention for dental infection was recorded in four cases.

Conclusions

In the absence of preoperative spinal instability, microsurgical drainage of the abscess followed by specific antibiotic therapy resulted in spinal cord decompression and neurological recovery, thereby facilitating spontaneous fusion and vertebral stability. The presence of combined tubercular and pyogenic infections of the cervical spine should be considered, especially in patients whose immune systems are depressed.
Evaluation of postoperative spinal epidural hematoma after microendoscopic posterior decompression for lumbar spinal stenosis: a clinical and magnetic resonance imaging study
Authors: Ikuta Ko , Tono Osamu , Tanaka Takayuki , Arima Junichi , Nakano Soichiro , Sasaki Kosuke , Oga Masayoshi
Published: January 2008

Object

The incidence of postoperative spinal epidural hematoma (SEH) is low, and to the best of the authors’ knowledge, no researchers have evaluated its actual incidence and clinical features. The purpose of this study was to investigate the clinical consequences of SEH after microendoscopic posterior decompression (MEPD) in patients with lumbar spinal stenosis.

Methods

Data obtained in 30 patients undergoing MEPD for lumbar spinal stenosis were reviewed. At 1 week after surgery, magnetic resonance (MR) imaging documented SEHs in 10 patients (33% [Group 1]) and no evidence of SEHs in 20 patients (67% [Group 2]). The authors compared MR imaging findings, postoperative morbidities, and clinical outcomes between the groups.

Three Group 1 patients had symptomatic SEHs. All symptoms were mild without associated neurological deterioration and spontaneously subsided within 3 weeks of surgery. Magnetic resonance imaging demonstrated spontaneous regression of the SEH in all patients at 3 months after surgery. In Group 1 patients, however, the authors observed less expansion of the dural sac after 1 year despite sufficient widening of the osseous spinal canal. Low-back pain within 1 week of surgery was moderate in Group 1 and mild in Group 2. Improvements at the final follow up were greater in Group 2 patients.

Conclusions

The incidence of postoperative SEHs may be greater than reported. Postoperative SEHs caused poor expansion of the dural sac despite its spontaneous regression. In addition, postoperative SEHs caused a delay in the patient’s recovery and led to a poor clinical improvement. The prevention of postoperative SEHs might be required to prevent not only neurological deterioration but also a delay in the patient’s recovery.
Anatomical relationships between the V2 segment of the vertebral artery and the cervical nerve roots
Authors: Paolini Sergio , Lanzino Giuseppe
Published: January 2008

Object

During surgical procedures focused on the cervical nerve roots, the surgeon works in proximity to the V2 segment of the vertebral artery (VA). Depending on the specific surgical approach, it may be necessary to identify, expose, or mobilize the artery. In most cases, the artery may be left undisturbed. To reduce the risk of iatrogenic injury to the V2 segment during anterior and anterolateral approaches to the cervical spine, the authors analyzed the relationship between the V2 segment and the proximal segment of the C3–6 nerve roots.

Methods

Six cadaveric cervical spines (12 sides) were fixed with formalin, injected with red and blue latex, and investigated intraoperatively using different magnifications (× 3–40).

The VA rested on the anteromedial surface of the cervical nerve roots at the level of each intertransverse space. The exiting nerve roots intersected the VA at a distance ranging from 4.5 to 8.1 mm (mean 6.3 ± 1.06 mm) from the dural sac. The distance was slightly shorter at cephalad levels, suggesting that the artery is more posteriorly and medially situated at those levels. Arterial pedicles anchored the VA to the cervical nerve roots at various levels. These arteries gave rise to purely radicular, ligamentous, and medullary branches without a predictable pattern. After reaching the nerve roots on their lower margin, the nonligamentous branches pierced the radicular dural sheath within the neural foramen at a distance of 2 to 4 mm from the VA.

Conclusions

Proximal-to-distal dissection of a cervical nerve root may proceed with relative safety for at least 4 mm. The V2 segment of the VA gives rise to at least one radicular arterial pedicle between C-4 and C-6. These trunks give rise to purely radicular, ligamentous, and medullary branches in an unpredictable pattern.
Tumoral calcinosis in bilateral facet joints of the lumbar spine in scleroderma
Authors: Shibuya Sei , Kawaguchi Yoji , Arima Nobuo , Yamamoto Tetsuji , Dobashi Hiroaki , Tokuda Michiaki
Published: January 2008

✓Tumoral calcinosis commonly occurs in the articular soft tissues of the extremities but rarely in the spine. The authors performed surgery to treat lumbar tumoral calcinosis in a patient with scleroderma, in whom symptoms of neurological dysfunction had manifested.

This 49-year-old woman presented with low-back pain and gait disturbance. Seven years before presentation, scleroderma had been diagnosed, and the patient had received medical treatment ever since. Imaging revealed tumoral calcinosis centered at the bilateral facet joints between L-3 and L-4, marked stenosis of the spinal canal, L-3 spondylolisthesis, and intervertebral instability. Surgery was performed to excise the lesion en bloc. After neural decompression, posterolateral fusion and pedicle screw fixation were undertaken. Symptoms improved after surgery.

In this case, the underlying scleroderma that predisposes to calcinosis and facet joint degeneration due to lumbar spondylolisthesis were probably factors leading to the development of tumoral calcinosis in the lumbar spine.
Endoscopic vertebroplasty for the treatment of chronic vertebral compression fracture
Authors: Hoshino Masatoshi , Nakamura Hiroaki , Konishi Sadahiko , Nagayama Ryuichi , Terai Hidetomi , Tsujio Tadao , Namikawa Takashi , Kato Minori , Takaoka Kunio
Published: January 2008

✓ The authors describe a new vertebroplasty technique for the treatment of chronic painful vertebral compression fractures (VCFs).

A urinary balloon catheter is introduced into the vertebral body (VB) via a bilateral transpedicular approach and inflated with contrast medium to obtain sufficient space for endoscopic observation. The granulation tissue occupying the VB is then removed using a punch or curette inserted through one pedicle, with the guidance of an endoscope introduced through the contralateral pedicle. After endoscopic resection of granulation tissue in the fractured VB, vertebroplasty is performed by injecting calcium phosphate cement (CPC) into the VB.

Fourteen patients in whom chronic painful VCFs were diagnosed underwent surgery involving the aforementioned technique. In all cases, intractable pain and ambulatory function improved after surgery, and there were no significant systemic complications. On radiological evaluation in eight cases in which the follow-up period exceeded 1 year, the mean height of the fractured VB improved from 38% of that of adjacent intact VBs to 85%. Although a slight loss of correction was routinely observed at 1 month postoperatively, an additional loss of VB height was not noted up to 1 year later. Bone formation was commonly seen along the anterior wall of the involved vertebrae in all cases.

Vertebroplasty involving the endoscopic removal of granulation tissue proved to be an efficacious procedure for the treatment of chronic painful VCFs. The osteoconductive capacity of CPC facilitated callus formation and ultimately restoration of vertebral bone structure.
Dynamic retraction of the psoas muscle to expose the lumbar spine using the retroperitoneal approach
Authors: Rao Ganesh , Bohinski Robert , Feiz-Erfan Iman , Rhines Laurence D.
Published: January 2008

✓The retroperitoneal surgical approach has gained acceptance as a way to access the ventral aspect of the lumbar spine. Visualization is often limited, however, by the psoas muscle, which lies along the posterolateral aspect of the spine. Improved visualization is often attempted by retracting the muscle from the wound, which generally pulls the muscle laterally from the spine but not posteriorly, which is desirable for a better exposure of the spine, particularly the neural elements. In this paper, the authors describe a simple, atraumatic technique for retraction of the psoas muscle that allows excellent visualization of the spine.
Postoperative factors affecting neurological recovery after surgery for cervical spondylotic myelopathy
Authors: Ogawa Yuto , Chiba Kazuhiro , Matsumoto Morio , Nakamura Masaya , Takaishi Hironari , Toyama Yoshiaki
Published: January 2008

Object

Many prognostic factors associated with surgery for cervical spondylotic myelopathy (CSM) have been detailed in the literature. All of these factors, however, are defined preoperatively. If it is possible to clarify factors influencing surgical results that can be modulated after surgery, then the overall results of surgery may improve. The purpose of this study was to elucidate such postoperative factors affecting neurological recovery.

Methods

The authors assessed the surgical outcomes obtained in 183 patients with CSM who underwent expansive open-door laminoplasty between 1993 and 2004 and who underwent follow up for a minimum of 1 year. They classified the cases into two groups according to the degree of neurological recovery: an excellent recovery group, comprising patients in whom the recovery rates were greater than 75%, and a poor recovery group, composed of patients in whom the recovery rates were lower than 30%. Comparisons of various clinical and imaging parameters revealed that the mean age at surgery was significantly lower in patients in the excellent recovery group than that in the poor recovery group. Therefore, the authors repeated the same analyses after adjustment for age. Postoperative cervical range of motion (ROM) was significantly more reduced in the excellent recovery group than in the poor recovery group. There was a significant positive correlation between reduced cervical ROM and recovery rate in the poor recovery group.

Conclusions

Dynamic stress may ameliorate functional recovery of the degenerated spinal cord even after sufficient decompression. Postoperative preservation of cervical ROM may not always be beneficial for neurological recovery in patients with CSM.
Quality of life of lumbar stenosis–treated patients in whom the X STOP interspinous device was implanted
Authors: Hsu Ken Y. , Zucherman James F. , Hartjen Charles A. , Mehalic Thomas F. , Implicito Dante A. , Martin Michael J. , Johnson Donald R. , Skidmore Grant A. , Vessa Paul P. , Dwyer James W. , Cauthen Joseph C. , Ozuna Richard M.
Published: January 2008

Object

This study was conducted to compare the quality of life (QOL) in patients with neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis (LSS). Using the 36-Item Short Form (SF-36) questionnaire, the authors compared the results obtained in patients treated with the X STOP Interspinous Process Decompression (IPD) System with those obtained in patients who underwent nonoperative therapies.

Methods

Patients with LSS were enrolled in a prospective 2-year multicenter study and randomized either to the X STOP or nonoperative group. The SF-36 survey was used to assess the QOL before treatment and at 6 weeks, 6 months, 1 year, and 2 years posttreatment. An analysis of variance was used to compare individual pre- and posttreatment mean SF-36 domain scores between the two groups and within each treatment group.

At all posttreatment time points, the authors observed the following: 1) mean domain scores in X STOP–treated patients were significantly greater than those in patients treated nonoperatively, with the exception of the mean General Health (GH), Role Emotional, and Mental Component Summary scores at 2 years; and 2) mean posttreatment domain scores documented in X STOP–treated patients were significantly greater than mean pretreatment scores, with the exception of mean GH scores at 6, 12, and 24 months.

Conclusions

The results of this study demonstrate that the X STOP device is significantly more effective than non-operative therapy in improving the QOL in patients with LSS. The results are comparable with those reported in other studies involving traditional decompressive techniques for LSS and suggest that the X STOP implant can provide an effective treatment compared with nonoperative and conventional surgical therapies.
Approach to the cervical portion of the vagus nerve via the posterior cervical triangle: a cadaveric feasibility study with potential use in vagus nerve stimulation procedures
Authors: Tubbs R. Shane , Loukas Marios , Shoja Mohammadali M. , Salter E. George , Oakes W. Jerry , Blount Jeffrey P.
Published: January 2008

Object

The authors describe a technique in which the cervical portion of the vagus nerve is exposed during procedures such as neuroma resection or, more commonly, during the placement of a vagus nerve stimulator.

Methods

To test their hypothesis that a posterolateral approach to the vagus nerve may be feasible and efficacious, the authors performed dissection of the left-sided vagus nerve in 13 adult cadavers. The carotid sheath was exposed via the posterior cervical triangle, and the vagus nerve was identified posterolaterally. Measurements were made of the length of available nerve, and the anatomical approach was documented. As part of a comparison study regarding the available length of nerve, the authors exposed the left vagus nerve in five additional adult cadavers via a standard anterior approach to the carotid sheath, and compared the results obtained with each technique.

A mean length of 12 cm of the vagus nerve was isolated when using the posterior approach to the carotid sheath, whereas a mean length of 11 cm of the nerve was documented when using the anterior approach. With the aforementioned posterior approach, no obvious injury occurred to the vagus nerve or other local neurovascular structures such as the spinal accessory nerve.

Conclusions

Evaluation of the findings obtained in the present cadaveric study showed that a posterior approach to the vagus nerve is feasible. The technique for posterior exposure of the carotid sheath may prove useful in surgical exposures of the vagus nerve when a standard anterior method is not possible.
Charité lumbar artificial disc retrieval: use of a lateral minimally invasive technique
Authors: Pimenta Luiz , Díaz Roberto Carlos , Guerrero Luis Guerrero
Published: January 2008

✓Indications for total disc replacement (TDR) may include implant loosening, malposition, displacement, early wear, and infection. Each indication is likely to require different preoperative planning, testing, and strategies. Preoperative planning is the first and most important step in performing a TDR revision. An organized approach reduces operative time, minimizes risks, decreases stress, and increases the success rate. Primary revision of a failed total disc arthroplasty can be planned as a posterior fusion, leaving the TDR device in place, but an unstable anterior column may require retrieval and revision of the interbody device. An anterior revision approach is associated with significant risk due to scarring and adhesions resulting from the primary procedure, making mobilization of the vessels very difficult, especially at the L4–5 bifurcation.

The authors describe a new alternative for retrieval and revision of a TDR device. They present the details of two cases of TDR device revision in which they performed a minimally invasive extreme-lateral interbody fusion to effect a safer access route that avoids vascular structures and the creation of scar tissue.
Discal cysts of the lumbar spine
Authors: Nabeta Masaharu , Yoshimoto Hisashi , Sato Shigenobu , Hyakumachi Takahiko , Yanagibashi Yasushi , Masuda Takeshi
Published: January 2008

✓Discal cysts are rare lesions that can result in refractory sciatica. Because they are so rare, their exact origin and details of the clinical manifestations are still unknown. The authors report on five men treated for discal cysts. The mean age of the patients at the time of the surgery was 32 years (range 25–38 years). All patients suffered from lower-extremity pain and the results of the straight leg–raising test were positive in all cases. Three patients reported motor weakness and four had sensory disturbance—symptoms similar to those found in patients with lumbar disc herniation. Magnetic resonance imaging demonstrated spherically shaped extradural lesions of various sizes with low and high signal intensities on T1- and T2-weighted images, respectively. Discography revealed obvious communication between the cyst and the intervertebral disc with reproducible leg pain in all patients. All patients underwent posterior decompression and excision of the cysts either with or without additional discectomy. The radicular symptoms were remarkably improved in all patients immediately after surgery, and no recurrent lesions were noted during follow up.
Corpectomy followed by the placement of instrumentation with titanium cages and recombinant human bone morphogenetic protein–2 for vertebral osteomyelitis
Authors: Aryan Henry E. , Lu Daniel C. , Acosta Frank L. , Ames Christopher P.
Published: January 2008

Object

The treatment of vertebral osteomyelitis includes antibiotics with or without surgical intervention. The decision to place instrumentation into an infected spinal column remains controversial. The use of recombinant human bone morphogenetic protein–2 (rhBMP-2) in patients with osteomyelitis is also extremely controversial. The authors review their experience in performing corpectomy and fusion with titanium cages and rhBMP-2 in patients with vertebral instability and/or neurological compromise due to vertebral osteomyelitis.

Methods

Data obtained in 15 patients treated between 2001 and 2005 were included in this analysis. Nine patients presented primarily with axial pain and six with radiculopathy or myelopathy. Seven patients had an associated epidural abscess. The cervical spine was affected in six patients, the thoracic spine in five, and the lumbar spine in four. All patients underwent corpectomy of the involved vertebral bodies; the authors then performed spinal reconstruction, placing a titanium cage–plate system with morcellized allograft/autograft and rhBMP-2. In 10 patients, supplemental posterolateral screw–rod fixation was conducted.

A one-level corpectomy was performed in one patient, a two-level corpectomy in 13, and a six-level corpectomy in one. A morcellized allograft and rhBMP-2–filled titanium cage was used in 10 patients, and an autograft and rhBMP-2–filled cage in five patients. The most common pathogen wasStaphylococcus aureus. All patients received intravenous antibiotics for at least 6 weeks postoperatively, and life-long antibiotic therapy was required in three patients with coccidiomycoses, candida, and tuberculosis osteomyelitis, respectively. There were no recurrent infections. Radiography demonstrated evidence of fusion in all patients at the last follow-up examination. The mean follow-up period was 20 months.

Conclusions

Corpectomy followed by titanium cage–plate reconstruction and the placement of rhBMP-2 may be a safe and effective treatment for selected patients with vertebral osteomyelitis. This surgical therapy does not appear, at least based on preliminary results, to lead to recurrent hardware infections. Based on the results obtained in this limited series, the authors found that rhBMP-2 can be used in the setting of active infection with excellent fusion rates and without complication. The morbidity associated with the autograft donor site is avoided when using cages. Antibiotic therapy tailored to the specific organism should be continued for at least 6 weeks after surgery, and life-long therapy is required in cases of fungal or tuberculosis infections.
Expansile, enhancing cervical cord lesion with an associated syrinx secondary to demyelination
Authors: Waziri Allen , Vonsattel Jean-Paul , Kaiser Michael G. , Anderson Richard C. E.
Published: January 2008

✓The authors describe the case of a patient with an enhancing, intramedullary cervical spinal cord lesion and associated syrinx. Biopsy sampling of the cervical lesion was performed, and the histological findings were consistent with a demyelinating process supporting the diagnosis of multiple sclerosis (MS). Syrinx formation associated with demyelinating disease has only been described in isolated cases, almost exclusively in Japanese patients with MS.

A 22-year-old woman of Caribbean descent presented with a subacute, progressive myelopathy including symptoms of pain and weakness in all extremities, bladder incontinence, and the inability to ambulate. Magnetic resonance imaging of the brain and spinal cord demonstrated an enlarged cervical cord with enhancement and central cavitation consistent with a syrinx.

The patient underwent a C3–7 laminoplasty and placement of a dural graft for cord decompression as well as fenestration of the central syrinx. Biopsy sampling of the lesion was performed, and the histopathological analysis, in conjunction with subsequent laboratory and diagnostic testing, supported the diagnosis of demyelinating disease. After treatment with a course of high-dose dexamethasone and inpatient rehabilitation therapy, the patient demonstrated significant clinical improvement.

Spinal cord involvement is not uncommon in patients with demyelinating disease; however, enhancing lesions associated with extensive tissue loss and syrinx formation have rarely been reported. For the consulting neurological surgeon, demyelinating disease should be included in the differential diagnosis of such lesions given the level of complexity and risk to the patient associated with open biopsy of the spinal cord.
Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures
Authors: Gerszten Peter C. , Welch William C.
Published: January 2008

✓Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation.

The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case.

A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.
Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature
Authors: Kuntz Charles , Levin Linda S. , Ondra Stephen L. , Shaffrey Christopher I. , Morgan Chad J.
Published: January 2008

Object

An increasing emphasis is being placed on the preservation or restoration of neutral upright sagittal spinal alignment in both deformity surgery and routine spinal operations. Sagittal spinal alignment is becoming recognized as an important predictor of a patient’s outcome after spinal surgery. In this literature review, the authors analyze data obtained from previously published studies conducted to evaluate neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults.

Methods

A review of the English-language literature was conducted to identify studies conducted to evaluate neutral upright sagittal spinal (occiput–pelvis) alignment in asymptomatic adult volunteers with no spinal disease. The authors identified 12 articles that met the strict primary inclusion criteria of the current study. From these articles, 23 angles and displacements were selected to depict neutral upright sagittal occiput–pelvis alignment. Pooled estimates of the mean and variance were calculated for angles and displacements that met secondary inclusion criteria. The greatest variation in the regional spinal curves occurred in the cervical spine from C-2 to C-7, whereas the greatest focal angulation in the spine occurred from L-4 to S-1. Sagittal spinal balance was maintained in a narrow range for alignment of the spine over the pelvis and femoral heads.

Conclusions

Neutral upright sagittal occiput–pelvis alignment in asymptomatic adults has been well studied regionally. Despite a wide variation in the undulating lordotic and kyphotic regional curves from the occiput to the pelvis, sagittal spinal balance is maintained in a narrower range for alignment of the spine over the pelvis and femoral heads.
Lumbar nerve root compression due to extramedullary hemopoiesis in a patient with thalassemia: complete clinical regression with radiation therapy
Authors: Tsitsopoulos Philippos , Zevgaridis Dimitris , Tsitsopoulos Parmenion , Tsonidis Christos , Anagnostopoulos Ioannis , Marinopoulos Dimitris
Published: January 2008

✓The authors describe the case of a 24-year-old woman who had a history of β-thalassemia and presented with severe symptoms of lumbar nerve root compression due to extramedullary hemopoiesis in the intervertebral foramen. Radiation therapy (2000 cGy in six fractions) was delivered to the mass. The patient’s neurological symptoms completely resolved following treatment. Follow-up images showed a reduction in lesion size. The results of this unique case supported by a review of the literature suggest that radiation therapy alone is an effective modality in the treatment of patients with compression of neural structures due to extramedullary hemopoietic tissue.