placement in the thoracic spine or the use of pedicle hooks should be considered. 45 Underlying cord diseases such as syringomyelia, tethered cord, or an associated Chiari malformation must be recognized prior to deformity correction. On clinical examination of apparent idiopathic scoliosis patients with neurological signs, patients younger than 11 years of age, with a left thoracic scoliosis, or significant neck or back pain should be further investigated with MR imaging. 46 Syringomyelia is a risk factor for neurological complications during correction of scoliosis
Henry Ahn and Michael G. Fehlings
W. Bradley Jacobs and Michael G. Fehlings
patients with AS have significantly impaired mobility directly related to their rigid, kyphotic spinal deformity as well as a variable degree of peripheral joint arthritis. These factors exacerbate gait unsteadiness and thus increase susceptibility to falls. This finding has been supported in numerous case series of AS-related vertebral fractures, when falls are almost invariably the most common mechanism of fracture. 1 , 14 , 31 , 34 Authors of numerous studies have evaluated the risk factors associated with vertebral fractures in the population with AS (reviewed by
Julio C. Furlan and Michael G. Fehlings
have not been completely clarified, the 3 major reasons for development of VTE (stasis, hypercoagulability, and intimal injury) can occur in patients with acute SCI. 1 , 77 , 78 , 109 Immobility is a major risk factor for VTE, particularly in tetraplegic patients. Given that the susceptibility to VTE after SCI declines with time, other underlying mechanisms for the development of VTE have been suggested, such as altered fibrinolytic activity, abnormal platelet function, and impaired circadian variations of hemostatic and fibrinolytic parameters. 34 , 50 , 106 Of
Preneshlin V. Govender, Yoga R. Rampersaud, Lynda Rickards and Michael G. Fehlings
The safety and effectiveness of osteogenic protein (OP)–1 putty (recombinant human bone morphogenetic protein–7) in promoting fusion in complex spinal cases was studied in nine cases.
The authors prospectively evaluated nine patients requiring spinal fusion in whom there were medical risk factors that would inhibit osseous fusion. Intraoperatively the OP-1 putty mixed with autologous bone was placed at the fusion site. Outcome measurement instruments were used to provide information on patient demographics, comorbidities, and pain. The Short Form (SF)–36 questionnaire and Oswestry Disability Index (ODI) were administered pre- and postoperatively. All patients underwent routine radiography of the surgery site during follow-up examination.
The age of the five women and four men ranged from 21 to 74 years (mean height 1.6 m, mean weight 76.7 kg). Risk factors included mucopolysaccharide syndrome, adrenal insufficiency, rheumatoid arthritis with chronic corticosteroid use, morbid obesity, and heavy smoking. Surgery, which consisted of five cervical and four lumbar procedures, including intradural surgery in three patients, was uneventful in all cases without perioperative complication. The follow-up period ranged from 1 to 15 months (mean 5.22 months). The ODI score changed from severe disability (mean 46.89) pre-operatively to minimal and moderate disability (mean 34.56) postoperatively. The SF-36 survey showed overall improved mental and physical health scores. Fusion was present in all patients with greater than 3 months follow up.
The OP-1 putty appears to be safe and effective in promoting spinal arthrodesis in patients in whom adverse medical risk factors exist.
Michael G. Fehlings and H. Francis Farhadi
cervical stenosis. They concluded that a ratio of less than 0.8 indicated significant stenosis and constituted a risk factor for neurological injury in contact sports (with a sensitivity >90%). In a case series of elite football players, Herzog et al., 2 however, found that approximately 33% of asymptomatic and 49% of all players have abnormally low Torg ratios (< 0.8). As such, very low positive predictive values (PPVs) have been identified for this measure in professional football players for either 1) determining future neurapraxic injuries (PPV 0.2%) or even for 2
Michael O. Kelleher, Gamaliel Tan, Roger Sarjeant and Michael G. Fehlings
. Undetected Cord Injuries Each of the 9 patients (0.85% of the total series) whose perioperative neurological worsening was undetected by SSEPs had significant risk factors that either made monitoring a challenge or rendered the patients susceptible to increased deficits. Two patients had absent SSEP baseline recordings, and therefore it was not possible to monitor them. One of the 2 patients had severe myelopathy from cervical spondylosis, and the other had cord impairment due to an intramedullary tumor. Of the remaining 7 patients, 4 were myelopathic from spondylosis, 1
Jefferson R. Wilson, David W. Cadotte and Michael G. Fehlings
, 1999 29 Krause JS , Carter RE , Pickelsimer EE , Wilson D : A prospective study of health and risk of mortality after spinal cord injury . Arch Phys Med Rehabil 89 : 1482 – 1491 , 2008 30 Krause JS , Devivo MJ , Jackson AB : Health status, community integration, and economic risk factors for mortality after spinal cord injury . Arch Phys Med Rehabil 85 : 1764 – 1773 , 2004 31 Lazar RB , Yarkony GM , Ortolano D , Heinemann AW , Perlow E , Lovell L , : Prediction of functional outcome by motor capability after
Aria Nouri, Allan R. Martin, David Mikulis and Michael G. Fehlings
TP , Phan K , : Risk factors for missed dynamic canal stenosis in the cervical spine . Spine (Phila Pa 1976) 39 : 812 – 819 , 2014 35 Holly LT , Freitas B , McArthur DL , Salamon N : Proton magnetic resonance spectroscopy to evaluate spinal cord axonal injury in cervical spondylotic myelopathy . J Neurosurg Spine 10 : 194 – 200 , 2009 36 Hori M , Fukunaga I , Masutani Y , Taoka T , Kamagata K , Suzuki Y , : Visualizing non-Gaussian diffusion: clinical application of q-space imaging and diffusional kurtosis imaging of
Lindsay Tetreault, Ahmed Ibrahim, Pierre Côté, Anoushka Singh and Michael G. Fehlings
of myelopathy. ** Included cervical alignment, number of compressed segments, position of the superior articular process, cord inclination, and high-intensity area on T2-weighted image. Upper Extremity or C-5 Palsy Hasegawa et al., Kaneyama et al., and Kimura et al. explored various clinical and imaging risk factors of upper extremity palsy following surgical decompression. 26 , 34 , 41 The sample used in the studies by Hasegawa et al. and Kaneyama et al. consisted of surgical patients with various forms of degenerative cervical myelopathy, including CSM
Spinal cord tumor research
Michael G. Fehlings and Soo Yong Chua
collaborative research efforts. As they pointed out, “Extension of a collaborative network to include the laboratories of neurobiologists, stem cell biologists, and cancer biologists would similarly accelerate the pace of basic science research and the discovery of effective new treatments for spinal cord tumors.” It would be natural that with such an open and collaborative approach, the domino effect will open many new doors. From the epidemiological standpoint, a better understanding of the risk factors associated with spinal cord tumors based on larger scale studies will