Jorge E. Alvernia, Emile Simon, Krishnakant Khandelwal, Cara D. Ramos, Eddie Perkins, Patrick Kim, Patrick Mertens, Raffaella Messina, Gustavo Luzardo, and Orlando Diaz
In this anatomical study of the artery of Adamkiewicz (AKA) and the supporting thoracolumbar radiculomedullary arteries (RMAs), the authors showed that a significant percentage (32%) of their cadaveric specimens had additional RMAs other than the AKA and, in some cases, an extra radiculomedullary vessel of the same caliber as the AKA. New evidence, including these findings, demonstrates the robust capabilities of the spinal cord collateral circulation to withstand the sacrifice of several levels of radicular arteries, including the AKA. A paradigm shift from a single RMA (i.e., the AKA) belief toward a collateral network concept has emerged.
Dong-Ho Lee, Suk-Kyu Lee, Jae Hwan Cho, Chang Ju Hwang, Choon Sung Lee, Jae Jun Yang, Kook Jong Kim, Jae Hong Park, and Sehan Park
Researchers evaluated the efficacy and safety of oblique posterior endplate resection for wider decompression. This trumpet-shaped decompression (TSD) widened the workspace during anterior cervical discectomy and fusion (ACDF), and 26% of the region posterior to the vertebral body could be accessed using this technique. The construct stability was not adversely affected by TSD as demonstrated by the similar fusion and subsidence rates among patients who underwent TSD and those who did not. TSD can be safely applied during ACDF when compressive lesions extend behind the vertebral body and are not limited to the disc space, enabling adequate decompression without disrupting construct stability.
Alicia M. Trbovich, Anne Mucha, Shawn Eagle, Bindal Makwana Mehmel, Nathan Kegel, Vanessa Fazio Sumrok, Michael W. Collins, and Anthony P. Kontos
The objective of this study was to adapt the current Vestibular/Ocular Motor Screening (VOMS) tool for pediatric patients aged 5-9 years and establish the clinical utility of this tool in concussion patients. The adapted tool, the VOMC-Child (VOMS-C), accurately classified concussion patients and control participants with good accuracy in a model that also included concussion risk factors and had an acceptable false-positive rate consistent with that for adolescent samples. These findings provide the first step to validating an age-appropriate vestibular/ocular motor assessment as part of a comprehensive multidomain assessment for young children with a suspected concussion.
Gloria Kim, Sally El Sammak, Giorgos D. Michalopoulos, William Mualem, Zachariah W. Pinter, Brett A. Freedman, and Mohamad Bydon
Several growth-preserving surgical techniques are employed in the management of early-onset scoliosis (EOS). The authors’ objective was to compare the use of traditional growing rods (TGRs), magnetically controlled growing rods (MCGRs), Shilla growth guidance techniques, and vertically expanding prosthetic titanium ribs (VEPTRs) for the management of EOS.
A systematic review of electronic databases, including Ovid MEDLINE and Cochrane, was performed. Outcomes of interest included correction of Cobb angle, T1–S1 distance, and complication rate, including alignment, hardware failure and infection, and planned and unplanned reoperation rates. The percent changes and 95% CIs were pooled across studies using random-effects meta-analysis.
A total of 67 studies were identified, which included 2021 patients. Of these, 1169 (57.8%) patients underwent operations with TGR, 178 (8.8%) Shilla growth guidance system, 448 (22.2%) MCGR, and 226 (11.1%) VEPTR system. The mean ± SD age of the cohort was 6.9 ± 1.2 years. The authors found that the Shilla technique provided the most significant improvement in coronal Cobb angle immediately after surgery (mean [95% CI] 64.2° [61.4°–67.2°]), whereas VEPTR (27.6% [22.7%–33.6%]) and TGR (45% [42.5%–48.5%]) performed significantly worse. VEPTR also performed significantly worse than the other techniques at final follow-up. The techniques also provided comparable gains in T1–S1 height immediately postoperatively (mean [95% CI] 10.5% [9.0%–12.0%]); however, TGR performed better at final follow-up (21.3% [18.6%–24.1%]). Complications were not significantly different among the patients who underwent the Shilla, TGR, MCGR, and VEPTR techniques, except for the rate of infections. The TGR technique had the lowest rate of unplanned reoperations (mean [95% CI] 15% [10%–23%] vs 24% [19%–29%]) but the highest number of planned reoperations per patient (5.31 [4.83–5.82]). The overall certainty was also low, with a high risk of bias across studies.
This analysis suggested that the Shilla technique was associated with a greater early coronal Cobb angle correction, whereas use of VEPTR was associated with a lower correction rate at any time point. TGR offered the most significant height gain at final follow-up. The complication rates were comparable across all surgical techniques. The optimal surgical approach should be tailored to individual patients, taking into consideration the strengths and limitations of each option.