Clinical Spine Surgery

09/12/2022

Houten et al review degenerative cervical myelopathy (DCM) in December’s Clinical Spine Surgery. DCM is characterized by central canal stenosis caused by spondylosis, flavum hypertrophy and ossification, as well as ossification of the posterior longitudinal ligament. Patients with DCM may present with distal upper extremity numbness and weakness. In its severe form, DCM causes gait incoordination, bowel/bladder dysfunction and quadraparesis. The authors review clinical evaluation tools like the modified Japanese Orthoapedic Association score that groups patients into mild (15-17), moderate (12-14) and severe (

20/09/2022

Moawad et al. review a case series of 36 patients who underwent short-segment fixation of low-lumbar (L3-5) burst fractures in this month's CSS. The authors discuss incidence, surgical management, and outcome for this technique. Their series describes pedicle-screw instrumentation of the levels above, in (when possible), and below the injured segment. They report an 86.1% fusion rate and 11.1% stable pseudoarthrosis rate. At one-year follow-up, 70.6% of patients had no back pain, 14.7% had mild back pain, and 14.7% had moderate back pain. Head to the CSS website (link in bio) for the free article.

04/07/2022

Drs. Vaccaro, Schroeder et al. describe a new AO upper cervical spine classification system in this month's Clinical Spine Surgery in an article entitled "Update on Upper Cervical Injury Classifications: The New AO Upper Cervical Spine Classification System." There are many classification schemes that individually describe various upper cervical spine injuries. These authors attempt to unify and simplify upper cervical spine trauma into a repeatable, reliable AO classification system. Injuries are classified by Type (I, II, or III) with a letter grade (A, B, or C). Type I: occipital condyle and craniocervical junction. Type II: C1 ring and C1-2 joint. Type III: C2 and C2-3 joint. The type is followed by an A (isolated bony), B (ligamentous or tension-band injuries), or C (rotationally/translationally unstable) designation. The authors' initial attempt at validation was performed with 4 senior spine surgeons and 4 senior neurosurgery residents and achieved excellent reliability. Head to CSS (link in bio) for the full article.

23/05/2022

Authors Zavras et al. performed a prospective RCT with 46 patients randomized into 1 and 2-level ACDFs performed with plate supplementation versus stand-alone interbody devices for degenerative cervical conditions. The authors found worse transient dysphagia in both 1 and 2-level ACDFs performed with anterior plating, but these differences were no longer detectable at final follow up. Conversely, patients treated with anterior plating had less initial neck pain and better early neck patient reported outcomes, possibly due to added mechanical stability. Head to this month’s Clinical Spine Surgery for the full article.

Second panel: aseptic screw loosening and subsidence seen in the stand-alone group. No significant differences in complications were seen between groups.

08/02/2022

Authors Donnally et al review cervical myelopathy in this month's Clinical Spine Surgery. Cervical Spondylotic Myelopathy (CSM) is attributed to several static, dynamic, and vascular factors. Osteophyte formation, ligamentous hypertrophy, ossification of the posterior longitudinal ligament, disk herniation, morphological changes to the vertebral body, cervical flexion/extension, and vascular insufficiency have each been associated with CSM. Patients with CSM may present with decreased hand dexterity, gait imbalance, upper/lower extremity numbness, bowel/bladder incontinence, neck pain, and Lhermitte's sign; characteristic physical exam findings are described. Patients with moderate-to-severe myelopathy usually do not fully recover neurologic function post-operatively, leading the authors to conclude that early surgical intervention is warranted. Surgical options including anterior cervical discectomy and fusion, cervical disc arthroplasty, cervical corpectomy, posterior laminectomy and instrumented fusion, as well as laminoplasty all serve a role in treatment of this condition. Head on over to Clinical Spine Surgery (link in bio) for the free article.

08/02/2022

Authors Donnally et al review cervical myelopathy in this month's Clinical Spine Surgery. Cervical Spondylotic Myelopathy (CSM) is attributed to several static, dynamic, and vascular factors. Osteophyte formation, ligamentous hypertrophy, ossification of the posterior longitudinal ligament, disk herniation, morphological changes to the vertebral body, cervical flexion/extension, and vascular insufficiency have each been associated with CSM. Patients with CSM may present with decreased hand dexterity, gait imbalance, upper/lower extremity numbness, bowel/bladder incontinence, neck pain, and Lhermitte's sign; characteristic physical exam findings are described. Patients with moderate-to-severe myelopathy usually do not fully recover neurologic function post-operatively, leading the authors to conclude that early surgical intervention is warranted. Surgical options including anterior cervical discectomy and fusion, cervical disc arthroplasty, cervical corpectomy, posterior laminectomy and instrumented fusion, as well as laminoplasty all serve a role in treatment of this condition. Head over to Clinical Spine Surgery (link in bio) for the free article. 

31/12/2021

Drs. Virk et al. examine the impact of rod configuration on the incidence of rod fracture in patients undergoing three-column osteotomy for adult spinal deformity. Applying principles learned from external fixation of long bones, the authors posit that increased fixation points, rod diameter, number of rod, rod working length between adjacent pedicle screws, and multiaxial rod placement can provide a stronger construct which in turn can reduce hardware failure. For example, in the first image, the patient in figure B with a decreased distance between pedicle screws surrounding the three-column osteotomy site sustained a rod fracture, whereas the patient in figure A did not. Ultimately, the authors conclude that Arbeitsgemeinschaft Osteosynthesefragen (AO) principles can be applied to fixation around a three-column osteotomy site and reduce rod fracture rates. Look for this article in the next issue of Clinical Spine Surgery.

05/05/2021

This months' Controversies in Spine Surgery highlight: "Pros and Cons of Resecting the PLL for Cervical Radiculopathy" from Sawires, Divi, Schroeder, and Lee. The authors in favor of posterior longitudinal ligament (PLL) resection for cervical radiculopathy cite the benefits of directly visualizing that no residual disc fragments remain posterior to the PLL. Those who do not recommend routine resection of PLL for Cervical Radiculopathy cite the potential for increased complications like dural leak or epidural vascular plexus injury plus the benefits of the inherent stability conferred by the PLL. 
Free link in bio. Let us know in the comments below your thoughts on PLL resection for cervical radiculopathy. 

16/04/2021

The role of decompression fusion surgery in patients with cervical spine stenosis who sustain a traumatic cervical spinal cord injury without fracture is unclear. In this retrospective study published in Clinical Spine Surgery (free link in bio), the authors grouped ASIA B/C patients between those who underwent posterior decompression and fusion surgery within 24 hours (54 patients) and those who received methylprednisolone but no surgery (21 patients). They found that 90.9% of patients treated with surgery experienced ≥ 1 grade ASIA improvement compared to 57.1% improvement in those treated with steroids alone. Multivariable regression revealed that only early surgical treatment predicted improved neurologic outcomes and that age, gender, spinal canal diameter, compression, and initial ASIA grade (B/C) did not.

09/03/2021

The authors examined 526 patients with symptomatic lumbar spinal stenosis and degenerative spondylolisthesis. Patients were grouped into two cohorts: those treated within 12 months of pain onset and those at greater than 12 months of pain onset. The authors found no difference in clinical outcomes after eventual lumbar fusion procedure. As spine surgeons work to refine nonoperative and operative protocols, including duration of treatment, this study provides support that a prolonged trial of nonoperative therapy does not portend an inferior surgical result. Link to the article at Clinical Spine Surgery in bio.

22/02/2021

February's Primary Research article features a prospective clinical study examining the true incidence of occult infection after posterior spinal fusion. The others selected 50 consecutive, presumed aseptic patients undergoing revision spinal surgery with removal of instrumentation. Hardware removal was performed at an average 4.55 years after the index operation. Culture swabs were obtained from the screw threads and screw hole, and tissue was removed for histology. 
The authors found a 38% culture-positivity rate of the removed instrumentation; in total, 28% of patients had multiple positive specimens from the same organism. In culture-positive patients, Cutibacterium acnes was the most commonly isolated organism (63% prevalence). This finding is higher than previously reported indolent infection rates, raising the question that common post-operative conditions in presumed-aseptic patients such as pseudoarthrosis, hardware loosening, and persistent pain may often be associated with occult infection. 

14/01/2021

Authors Koakutsu et al describe 10-year follow-up of a prospective cohort study comparing anterior cervical fusion versus laminoplasty for treatment of myelopathy from soft disc herniation in "Anterior Decompression and Fusion Versus Laminoplasty for Cervical Myelopathy Caused by Soft Disk Herniation A Long-term Prospective Multicenter Study," now available at Clinical Spine Surgery for free (link in bio). 
The authors compared 22 patients treated with either single/two-level anterior decompression fusion versus 20 patients treated with C3-C6/C7 laminoplasty. They found myelopathy improved in both groups similarly. Cervical range of motion was reduced significantly in both groups at 10-year follow up. Patients who received a laminoplasty were more likely to report neck pain at 10 year follow-up. The authors argue that both surgical strategies are successful and feature a unique risk/benefit profile. 

02/01/2021

Niu et al performed a retrospective review of 484 patients with confirmed cervical myelopathy evaluated and treated at a single academic center. The authors found upper extremity sensory changes to be the most common single chief complaint for patients with confirmed myelopathy; yet this was present in less than 50% of patients. The presence of upper extremity pain positively correlated with more distal compression.

Head over to Clinical Spine Surgery for the free text (link in bio) and to view the latest in spine surgery research.

16/11/2020

We’re reaching into the archive to show off a new look to our clinical abstracts. This format underlines the practice-changing research we are proud to highlight in our journal. Head over to Clinical Spine Surgery for more evidence-based spine surgery content.

28/10/2020

The timing of nonoperative and operative management in patients with herniated nucleus pulposus in the lumbar spine is an active debate. Even in patients with dense nerve palsy. Head to Clinical Spine Surgery (link in bio) for the full, free Controversies in Spine Surgery article. And let us know in the comments below your thoughts on initial management of these patients.

25/09/2020

A prospective cohort study comparing in-person versus telemedicine neurological examination was performed by researchers at the Rothman Institute at Thomas Jefferson University Hospital. A control group of healthy patients was compared against a cohort of patients with known cervical or lumbar spinal disease. All patients received both in-person and telemedicine evaluation. During the telemedicine visit, patients self-performed a recorded neurological examination under guidance with standardized resistance bands, Semmes-Weinstein monofilaments, and grip-strength rings. Telemedicine visits revealed no differences in the evaluated motor and special exam tests compared to in-person exams, and the telemedicine examination was more sensitive than in-person examination for decreased sensation to light touch. Comment below if telehealth is used in your clinic. Full, free version of the manuscript available at the link in bio. -19

17/08/2020

Do you perform ? Generally endoscopic surgery is easier to perform from L1-L5. A high riding iliac crest can make it difficult to perform this procedure at L5-S1.

For this week's we highlight a study by Shim et al that used newer instrument designs that can be used at all levels. The instruments are generally used for L5-S1, but the authors adapted them to be used for other levels as well.

Aug 2020

Link to article:
https://bit.ly/2Q2ZDFa

Link to videos:
https://lnkd.in/dNMC3Ff

https://lnkd.in/d8wf_xq

04/08/2020

A few years ago I visited Prof Harms in Germany where I observed him perform a C2 spondylectomy for a chordoma

In this week's we highlight a study by Yang et al looking at a novel implant to reconstruct C2 after tumor resection.

Aug 2020

Link to article:
https://bit.ly/2EPlgqp

22/07/2020

What's the best imaging technology to place pedicle screws: O-arm navigation or fluoroscopy?

In this week's we highlight a study that looks at this issue.

July 2020

Link to article:
https://bit.ly/2E28vIw

07/07/2020

When the Covid pandemic ends there will be a lot of discussion about how healthcare will be fundamentally transformed.

Virtual visits have taken off. The use of remote patient monitoring is still beginning to gain traction.

For remote patient monitoring to be effective there has to be an objective data point to follow that correlates to a meaningful outcome. In we have not been able to come to a consensus on that data point.

For this week's we highlight a study that reviews the data on in care.

Link to article:
https://bit.ly/3gyDz0K

15/06/2020

What's the best way to treat a syrinx?

As an I'll be honest and admit that I do not think about this problem much.

This week we share a from Hussain et al that describes a novel approach using a shunt placed with ultrasound to treat this very challenging problem.

June 2020

Link to article:
https://bit.ly/3fsLHPs

Link to surgical technique video:
https://lnkd.in/dJPsJer

14/06/2020

08/06/2020

**Controversy Alert**

As we start to resume elective surgery it is clear that patients would like to minimize the time spent in a hospital. ERAS protocols(begun in the GI field) have clearly helped enhance and shorten the recovery process.

and protocols are an adaptation of ERAS for .

In this week's we highlight a paper that discusses the pros/cons of ERAS in spine surgery.

Clinical Spine Surgery June 2020

Link to article:

https://bit.ly/2BKhPzNSS

27/05/2020

Statistics are the tool that converts clinical knowledge and expertise into hard science. A solid foundation in core statistical principles allows spine surgeons to generate valid, generalizable observations that help patients in and beyond their direct practice. Head to Clinical Spine Surgery (free link in bio) for a refresher on essential statistical tools needed for quality spine surgery research.

26/05/2020

26/05/2020

Which type of cage is better, Titanium or PEEK?

Find out in this week's

Link to article:

https://bit.ly/3elyE20

https://make.headliner.app/download/36ee9fdd-0acc-42e7-9d7c-f921619de239

18/05/2020

Many patients ask when they can return to recreational sports after a .

For this week's we chose to highlight a study that looked at this question.

Clinical Spine Surgery May 2020

Link to article:
https://bit.ly/3dZqts1



When do you allow your patients to return to sports after a ?

05/05/2020

Listen to Dr Alok Sharan discuss the advantages/disadvantages of Cortical Screws vs Percutaneous Pedicle Screws

Link to article:
https://bit.ly/2W7yzc2

Clinical Spine Surgery May 2020

27/04/2020

As we resume elective surgery there will be a lot of discussion about pain management protocols after spine surgery.

In this week's we highlight a study by Rajpal et al that looks at a unique preventative multimodal approach to lumbar fusion.

Link to article:
https://bit.ly/3aGnkvd

Mike Selby Nitin Khanna Brian R. Gantwerker, MD, FAANS, FACS

27/04/2020

As we resume elective surgery there will be a lot of discussion about pain management protocols after spine surgery.

In this week's we highlight a study by Rajpal et al that looks at a unique preventative multimodal approach to lumbar fusion.