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Radiographic measurements of C-2 in patients with atlas assimilation

Clinical article

Tatsuro Aoyama, Muneyoshi Yasuda, Hitoshi Yamahata, Mikinobu Takeuchi, Masahiro Joko, Kazuhiro Hongo, and Masakazu Takayasu

Object

The object of this study was to evaluate the radiographic characteristics of C-2 using multiplanar CT measurements for anchor screw placement in patients with C-1 assimilation (C1A). Insertion of a C-2 pedicle screw in the setting of C1A is relatively difficult and technically demanding, and there has been no report about the optimal sizes of the pedicles and laminae of C-2 for screw placement in C1A.

Methods

An institutional database was searched for all patients who had undergone cervical CT scanning and cervical spine surgery between April 2006 and December 2012. Two neurosurgeons reviewed the CT scans from 462 patients who met these criteria, looking for C1A and other anomalies of the craniocervical junction such as high-riding vertebral artery (VA), basilar invagination, and VA anomaly. The routine axial images were reloaded on a workstation, and reconstruction CT images were used to measure parameters: the minimum width of bilateral pedicles and laminae and the length of bilateral laminae of the atlas.

Results

Seven patients with C1A were identified, and 14 sex-matched patients without C1A were randomly selected from the same database as a control group. The mean minimum pedicle width was 5.21 mm in patients with C1A and 7.17 mm in those without. The mean minimum laminae width was 5.29 mm in patients with C1A and 6.53 mm in controls. The mean minimum pedicle and laminae widths were statistically significantly smaller in the patients with C1A (p < 0.05).

Conclusions

In patients with C1A, the C-2 bony structures are significantly smaller than normal, making C-2 pedicle screw or translaminar screw placement more difficult.

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Novel artificial intelligence algorithm: an accurate and independent measure of spinopelvic parameters

Lindsay D. Orosz, Fenil R. Bhatt, Ehsan Jazini, Marcel Dreischarf, Priyanka Grover, Julia Grigorian, Rita Roy, Thomas C. Schuler, Christopher R. Good, and Colin M. Haines

, Likar B , Castelein RM , Viergever MA , Pernuš F . A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment . Spine J . 2012 ; 12 ( 5 ): 433 – 446 . 22480531 15 Diebo BG , Varghese JJ , Lafage R , Schwab FJ , Lafage V . Sagittal alignment of the spine: what do you need to know? Clin Neurol Neurosurg . 2015 ; 139 : 295 – 301 . 16 Segev E , Hemo Y , Wientroub S , Intra- and interobserver reliability analysis of digital radiographic measurements for pediatric orthopedic parameters using a

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Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases

Clinical article

Vedat Deviren, Justin K. Scheer, and Christopher P. Ames

potential advantages, investigation into the cervicothoracic PSO is infrequently reported in the literature. 12 , 30 , 31 , 40 This study details our cervicothoracic PSO technique and experience in 11 cases, including some refinements of the techniques discussed in the current literature, and correlates clinical kyphosis from the chin-brow to vertical angle 35 , 39 (CBVA) with the radiographic measurements. Methods This retrospective study was approved by the University of California, San Francisco institutional review board. Patient Population Between

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Mid-term and long-term follow-up data after placement of the Graf stabilization system for lumbar degenerative disorders

Akira Onda, Koji Otani, Shinichi Konno, and Shinichi Kikuchi

-term follow-up . Eur Spine J 10 : 234 – 236 , 2001 10.1007/s005860100254 32 Saraste H , Brostrom LA , Aparisi T , Axdorph G : Radiographic measurement of the lumbar spine: A clinical and experimental study in man . Spine 10 : 236 – 241 , 1985 10.1097/00007632-198504000-00008 33 Sato K , Kikuchi S : Clinical analysis of two-level compression of the cauda equina and the nerve roots in lumbar spinal canal stenosis . Spine 22 : 1898 – 1903 , 1997 10.1097/00007632-199708150-00018 34 Strauss PJ , Novotny JE , Wilder DG , Grobler LJ

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Comparison of structural allograft and traditional autograft technique in occipitocervical fusion: radiological and clinical outcomes from a single institution

Jakub Godzik, Vijay M. Ravindra, Wilson Z. Ray, Meic H. Schmidt, Erica F. Bisson, and Andrew T. Dailey

-month intervals. Additional follow-up CT scans were used in the event of an inconclusive radiographs 19 because the combination of CT and dynamic radiography predicts fusion rates with almost 90% accuracy according to experimental studies. 38 Radiographic Measurements Radiographic measurements at preoperative, postoperative, and final follow-up time points were obtained from the lateral standing radiographs with patients in the neutral position. The following spinal parameters were evaluated and are shown in Fig. 4 : 1) C1–2 lordotic angle; 2) C2–7 lordotic

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Impact of lowest instrumented vertebra tilt and rotation on uninstrumented lumbar curve and L4 tilt in thoracic adolescent idiopathic scoliosis

Akira Iwata, Hideki Sudo, Kuniyoshi Abumi, Manabu Ito, Katsuhisa Yamada, and Norimasa Iwasaki

intend to manipulate vertebral rotation at each level separately. 10 , 12 Therefore, the medical device in this study that uses the polyaxial pedicle screw may have significant limitations for the correction of LIV rotation. In this study, the SRS-22 scores showed no significant correlation with uninstrumented lumbar segments. There has been only one report investigating LIV tilt and other radiographic measurements with SRS-22 outcomes. 15 Although there was no significant association between the 10-year composite radiographic score and SRS-22 scores, disc wedging

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Effective lordosis: analysis of sagittal spinal canal alignment in cervical spondylotic myelopathy

Clinical article

David E. Gwinn, Christopher A. Iannotti, Edward C. Benzel, and Michael P. Steinmetz

Object

Analysis of cervical sagittal deformity in patients with cervical spondylotic myelopathy (CSM) requires a thorough clinical and radiographic evaluation to select the most appropriate surgical approach. Angular radiographic measurements, which are commonly used to define sagittal deformity, may not be the most appropriate to use for surgical planning. The authors present a simple straight-line method to measure effective spinal canal lordosis and analyze its reliability. Furthermore, comparisons of this measurement to traditional angular measurements of sagittal cervical alignment are made in regards to surgical planning in patients with CSM.

Methods

Twenty preoperative lateral cervical digital radiographs of patients with CSM were analyzed by 3 independent observers on 3 separate occasions using a software measurement program. Sagittal measurements included C2–7 angles utilizing the Cobb and posterior tangent methods, as well as a straight-line method to measure effective spinal canal lordosis from the dorsal-caudal aspect of the C2–7 vertebral bodies. Analysis of variance for repeated measures or Cohen 3-way (kappa) correlation coefficient analysis was performed as appropriate to calculate the intra- and interobserver reliability for each parameter. Discrepancies in angular and effective lordosis measurements were analyzed.

Results

Intra- and interobserver reliability was excellent (intraclass coefficient > 0.75, kappa > 0.90) utilizing all 3 techniques. Four discrepancies between angular and effective lordotic measurements occurred in which images with a lordotic angular measurement did not have lordosis within the ventral spinal canal. These discrepancies were caused by either spondylolisthesis or dorsally projecting osteophytes in all cases.

Conclusions

Although they are reliable, traditional methods used to make angular measurements of sagittal cervical spine alignment do not take into account ventral obstructions to the spinal cord. The effective lordosis measurement method provides a simple and reliable means of determining clinically significant lordosis because it accounts for both overall alignment of the cervical spine as well as impinging structures ventral to the spinal cord. This method should be considered for use in the treatment of patients with CSM.

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Which lumbar interbody fusion technique is better in terms of level for the treatment of unstable isthmic spondylolisthesis?

Clinical article

Jin-Sung Kim, Kil-Yong Lee, Sang-Ho Lee, and Ho-Yeon Lee

Object

The purpose of this study was to investigate and compare clinical and radiographic outcomes of 2 kinds of lumbar interbody fusion (LIF) for the treatment of adult low-grade isthmic spondylolisthesis at L4–5 and L5–S1 levels.

Methods

The medical records and radiographs of 86 patients who underwent anterior LIF (ALIF) (L4–5, 42 patients; L5–S1, 44 patients) and 42 patients who underwent transforaminal LIF (TLIF) (L4–5, 22 patients; L5–S1, 20 patients) between 2001 and 2004 were retrospectively reviewed. Clinical results were investigated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, and using radiographic measurements, including disc height (DH), degree of spondylolisthesis, segmental lordosis, whole lumbar lordosis (WL), sacral slope (SS), and pelvic tilt; the L-1 axis S-1 distance (LASD) and pelvic incidence were also obtained.

Results

In both groups, VAS and ODI scores had significantly improved at both treatment levels. Statistical analysis showed no significant difference in postoperative VAS scores between groups at the L4–5 level and in postoperative VAS/ODI scores at the L5–S1 level. However, ODI scores were better in the TLIF than in the ALIF group at the L4–5 level. In terms of radiological changes, there were no significant differences between the 2 groups at the L4–5 level; however, at the L5–S1 level, radiographic results indicated that ALIF was superior to TLIF in its capacity to restore DH, WL, SS, and LASD. The radiological evidence of fusion shows no intergroup difference and no interlevel difference.

Conclusions

Considering the clinical and radiological outcomes in both groups, the authors recommend that instrumented mini-TLIF is preferable at the L4–5 level, whereas instrumented mini-ALIF might be preferable at the L5–S1 level for the treatment of unstable isthmic spondylolisthesis.

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Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance

Patrick C. Hsieh, Tyler R. Koski, Brian A. O'Shaughnessy, Patrick Sugrue, Sean Salehi, Stephen Ondra, and John C. Liu

Object

A primary consideration of all spinal fusion procedures is restoration of normal anatomy, including disc height, lumbar lordosis, foraminal decompression, and sagittal balance. To the authors' knowledge, there has been no direct comparison of anterior lumbar interbody fusion (ALIF) with transforaminal lumbar interbody fusion (TLIF) concerning their capacity to alter those parameters. The authors conducted a retrospective radiographic analysis directly comparing ALIF with TLIF in their capacity to alter foraminal height, local disc angle, and lumbar lordosis.

Methods

The medical records and radiographs of 32 patients undergoing ALIF and 25 patients undergoing TLIF from between 2000 and 2004 were retrospectively reviewed. Clinical data and radiographic measurements, including preoperative and postoperative foraminal height, local disc angle, and lumbar lordosis, were obtained. Statistical analyses included mean values, 95% confidence intervals, and intraobserver/interobserver reliability for the measurements that were performed.

Results

Our results indicate that ALIF is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The ALIF procedure increased foraminal height by 18.5%, whereas TLIF decreased it by 0.4%. In addition, ALIF increased the local disc angle by 8.3° and lumbar lordosis by 6.2°, whereas TLIF decreased the local disc angle by 0.1° and lumbar lordosis by 2.1°.

Conclusions

The ALIF procedure is superior to TLIF in its capacity to restore foraminal height, local disc angle, and lumbar lordosis. The improved radiographic outcomes may be an indication of improved sagittal balance correction, which may lead to better long-term outcomes as shown by other studies. Our data, however, demonstrated no difference in clinical outcome between the two groups at the 2-year follow-up.

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Risk factors for closure of lamina after open-door laminoplasty

Clinical article

Morio Matsumoto, Kota Watanabe, Takashi Tsuji, Ken Ishii, Hironari Takaishi, Masaya Nakamura, Yoshiaki Toyama, and Kazuhiro Chiba

Object

This retrospective study was conducted to evaluate the prevalence and clinical consequences of postoperative lamina closure after open-door laminoplasty and to identify the risk factors.

Methods

Eighty-two consecutive patients with cervical myelopathy who underwent open-door laminoplasty without plates or spacers in the open side (Hirabayashi's original method) were included (62 men and 20 women with a mean age of 62 years and a mean follow-up of 1.8 years). In 67 patients the cause of cervical myelopathy was spondylotic myelopathy, and in 15 it was caused by ossification of posterior longitudinal ligament. Radiographic measurements were made of the anteroposterior diameters of the spinal canal and vertebral bodies from C3–6, and the presence of kyphosis were assessed. Lamina closure was defined as ≥ 10% decrease in the canal-to-body ratio at the final follow-up compared with that immediately after surgery at ≥ 1 vertebral level. The impact of lamina closure on neck pain, patient satisfaction, Japanese Orthopaedic Association scores, and recovery rates were also evaluated.

Results

The mean canal-to-body ratio at C3–6 was 0.69–0.72 preoperatively, 1.25–1.28 immediately after surgery, and 1.18–1.24 at the final follow-up examination. Lamina closure was observed in 34% of patients and was not associated with sex, age, or cause of myelopathy, but was significantly associated with the presence of preoperative kyphosis (p = 0.014). Between patients with and without lamina closure, there was no significant difference in preoperative (9.7 ± 3.1 vs 10.6 ± 2.5) and postoperative (13.7 ± 2.4 vs 13.1 ± 2.7) Japanese Orthopaedic Association scores, recovery rates (53.9 ± 29.9% vs 44.3 ± 29.5%), neck pain scores (3.5 ± 0.7 vs 3.3 ± 1.0), or patient satisfaction level (4.0 ± 1.4 vs 4.8 ± 1.0).

Conclusions

Lamina closure at ≥ 1 vertebral level occurred in 34% of patients. Although patients with lamina closure obtained equivalent recovery from myelopathy in a short-term follow-up, they tended to be less satisfied with surgery compared with those who did not have closure. The only significant risk factor identified was the presence of preoperative cervical kyphosis, and preventative methods for lamina closure, therefore, should be considered for patients with preoperative kyphosis.