Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 469 | Issue 3 | Mar, 2011

Cervical Spine Surgery: An Historical Perspective

Vincenzo Denaro MD, Alberto Di Martino MD, PhD

Continued innovation in surgery requires a knowledge and understanding of historical advances with a recognition of successes and failures.

Increased In-hospital Complications After Primary Posterior versus Primary Anterior Cervical Fusion

Stavros G. Memtsoudis MD, PhD, Alexander Hughes MD, Yan Ma PhD, Ya Lin Chiu MS, Andrew A. Sama MD, Federico P. Girardi MD

Although anterior (ACDF) and posterior cervical fusion (PCDF) are relatively common procedures and both are associated with certain complications, the relative frequency and severity of these complications is unclear. Since for some patients either approach might be reasonable it is important to know the relative perioperative risks for decision-making.

What Is the Incidence and Severity of Dysphagia After Anterior Cervical Surgery?

Jeffrey A. Rihn MD, Justin Kane MD, Todd J. Albert MD, Alexander R. Vaccaro MD, PhD, Alan S. Hilibrand MD

Existing studies suggest a relatively high incidence of dysphagia after anterior cervical decompression and fusion (ACDF). The majority of these studies, however, are retrospective in nature and lack a control group.

A New Zero-profile Implant for Stand-alone Anterior Cervical Interbody Fusion

M. Scholz MD, K. J. Schnake MD, A. Pingel MD, R. Hoffmann MD, F. Kandziora MD

Several studies suggest fusion rates are higher with anterior cervical discectomy and fusion procedures if supplemented with a plate. However, plates may be associated with higher postoperative morbidity and higher rates of dysphagia. This led to the development of a cervical stand-alone cage with integrated fixation for zero-profile segmental stabilization.

Sagittal Segmental Alignment as Predictor of Adjacent-Level Degeneration After a Cloward Procedure

Cesare Faldini MD, Stavroula Pagkrati MD, Danilo Leonetti MD, Maria Teresa Miscione MD, Sandro Giannini MD

The Cloward anterior interbody fusion is commonly performed for cervical disc herniation or spondylosis. In followup studies, various authors have noted clinically relevant adjacent-level degeneration. However, factors associated with adjacent-level degeneration are not well known.

Operated and Adjacent Segment Motions for Fusion versus Cervical Arthroplasty: A Pilot Study

Tomoya Terai MD, PhD, Ahmad Faizan PhD, Koichi Sairyo MD, PhD, Vijay K. Goel PhD

Anterior cervical discectomy and fusion (ACDF) represent the standard treatment for cervical spondylolytic radiculopathy and myelopathy. To achieve solid fusion, appropriate compressive loading of the graft and stability are essential. Fusion may lead to adjacent segment degeneration. Artificial discs have been introduced as motion-preserving devices to reduce the risk of fusion-related complications.

Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy

Barrett I. Woods MD, Justin Hohl MD, Joon Lee MD, William Donaldson MD, James Kang MD

Cervical spondylotic myelopathy is increasingly prevalent in the elderly and is the leading cause of spinal cord dysfunction in this population. Laminectomy with fusion and laminoplasty halt progression of myelopathy in these patients; however, both procedures have well-documented complications and associated morbidity and it is unclear which might be most advantageous.

Does Smoking Influence Fusion Rates in Posterior Cervical Arthrodesis With Lateral Mass Instrumentation?

Jason David Eubanks MD, Steven W. Thorpe MD, Vinay K. Cheruvu MSc, MS, Brett A. Braly MD, James D. Kang MD

Smoking is associated with reduced fusion rates after anterior cervical decompression and arthrodesis procedures. Posterior cervical arthrodesis procedures are believed to have a higher fusion rate than anterior procedures.

An Observational Study of Patient-rated Outcome After Atlantoaxial Fusion in Patients With Rheumatoid Arthritis and Osteoarthritis

Dieter Grob MD, Andrea Luca MD, Anne F. Mannion BSc, PhD

Fusion is used to address several types of abnormality of the atlantoaxial segment. Traditionally, outcome has been assessed by achieving solid bony union. Recently, however, patient-rated outcome instruments have been increasingly used, although these may be influenced by concomitant comorbidity.

Patients With Cervical Metastasis and Neoplastic Pachymeningitis are Less Likely to Improve Neurologically After Surgery

Vincenzo Denaro MD, Alberto Di Martino MD, PhD, Rocco Papalia MD, PhD, Luca Denaro MD, PhD

Although many patients with cervical spine metastases are treated surgically, it is unknown whether certain subsets achieve better pain relief and improvement of neurologic function.

Percutaneous Vertebroplasty Relieves Pain in Metastatic Cervical Fractures

S. Masala MD, G. C. Anselmetti MD, M. Muto MD, M. Mammucari MD, T. Volpi MD, G. Simonetti MD

Percutaneous vertebroplasty is currently an alternative for treating vertebral fractures of the thoracic and lumbar spine, providing both pain control and vertebral stabilization. In the cervical spine, however, percutaneous vertebroplasty is technically challenging because of the complex anatomy of this region.

The Development and Evaluation of the Subaxial Injury Classification Scoring System for Cervical Spine Trauma

Peter G. Whang MD, Alpesh A. Patel MD, Alexander R. Vaccaro MD, PhD

Fractures and dislocations of the subaxial cervical spine may give rise to devastating consequences. Previous algorithms for describing cervical trauma largely depend on retrospective reconstructions of injury mechanism and utilize nonspecific terminology which thus diminish their clinical relevance add to the difficulty of educating doctors and performing prospective research.

Spinal Cord Injury: A Systematic Review of Current Treatment Options

David W. Cadotte MSc, MD, Michael G. Fehlings MD, PhD, FRCSC, FACS

Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary mechanisms of injury, clinicians may be able to offer improved recovery after SCI.

The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

Vincenzo Denaro MD, Rocco Papalia MD, PhD, Alberto Di Martino MD, PhD, Luca Denaro MD, PhD, Nicola Maffulli MD, MS, PhD, FRCS(Orth)

Odontoid fractures are the most common odontoid injury and often cause atlantoaxial instability. Reports on postoperative status of patients who underwent surgery for such injuries are limited to small case series, and it is unclear whether any one technique produces better outcomes than another.

The Epidemiology of Nonaccidental Trauma in Children

Kishore Mulpuri MBBS, MS, MHSc, Bronwyn L. Slobogean PA-C, Stephen J. Tredwell MD, FRCSC

Abuse of children is abhorrent in Western society and, yet, is not uncommon. Nonaccidental trauma (NAT) is the result of a complex sociopathology. Not all of the causative factors of NAT are known, many are incompletely described, not all function in each case, and many are secondary to preexisting pathology in other areas.

Child Abuse and the Legal System: The Orthopaedic Surgeon’s Role in Diagnosis

Christopher M. Sullivan MD, MPH

Orthopaedic surgeons have unique training and experience in diagnosis of fractures, both accidental and nonaccidental. That experience is valuable in identifying physical child abuse and in avoiding false accusations or convictions. Both aspects are important to the welfare of children and their families. The events that follow a report of child abuse are outside the training and experience of most orthopaedic surgeons.

The Radiographic Approach to Child Abuse

Jerry R. Dwek MD

Osseous injuries are a major facet of child abuse and in most patients radiographic imaging plays a major role in diagnosis. While some injuries are typically produced as a result of excessive and inappropriate force other injuries are nonspecific in terms of their causation, but become suspicious when the history provided by the caretakers is inconsistent with the type of injury produced.

Child Abuse: The Role of the Orthopaedic Surgeon in Nonaccidental Trauma

Ernest L. Sink MD, Joshua E. Hyman MD, Travis Matheny MD, Gaia Georgopoulos MD, Paul Kleinman MD

Child abuse presents in many different forms: physical, sexual, psychological, and neglect. The orthopaedic surgeon is involved mostly with physical abuse but should be aware of the other forms. There is limited training regarding child abuse, and the documentation is poor when a patient is at risk for abuse. There is a considerable risk to children when abuse is not recognized.

Femur Fractures in the Pediatric Population: Abuse or Accidental Trauma?

Keith Baldwin MD, MPH, MSPT, Nirav K. Pandya MD, Hayley Wolfgruber BA, Denis S. Drummond MD, Harish S. Hosalkar MD, MBMS (Ortho), FCPS (Ortho), DNB (Ortho)

Child abuse represents a serious threat to the health and well-being of the pediatric population. Orthopaedic specialists will often become involved when child abuse is suspected as a result of the presence of bony injury. Distinguishing abuse from accidental trauma can be difficult and is often based on clinical suspicion.

Unexplained Fractures: Child Abuse or Bone Disease? A Systematic Review

Nirav K. Pandya MD, Keith Baldwin MD, MPH, MSPT, Atul F. Kamath MD, Dennis R. Wenger MD, Harish S. Hosalkar MD, MBMS (Ortho), FCPS (Ortho), DNB (Ortho)

Child abuse and neglect (CAN) is a serious problem that has major implications for the welfare of the child involved. Unexplained fractures are of particular concern to the orthopaedic surgeon, who must often consider alternative diagnoses to CAN.

Does a Positive Neer Impingement Sign Reflect Rotator Cuff Contact with the Acromion?

Xiaofeng Jia MD, PhD, Jong Hun Ji MD, Vinodhkumar Pannirselvam MD, Steve A. Petersen MD, Edward G. McFarland MD

One possible cause of shoulder pain is rotator cuff contact with the superior glenoid (cuff-glenoid contact) with the arm in flexion, as occurs during a Neer impingement sign. It has been assumed that the pain with a Neer impingement sign on physical examination of the shoulder was secondary to the rotator cuff making contact with the anterior and lateral acromion.

CT Angiography for Anterior Lumbar Spine Access: High Radiation Exposure and Low Clinical Relevance

Michaela Gstöttner MD, Bernhard Glodny MD, Johannes Petersen MD, Martin Thaler MD, Christian Michael Bach MD

Some spine surgeons perform CT angiography for detailed planning of anterior access to the lumbar spine. However, the value of this imaging method and its influence on surgeons’ decisions are unclear.

Continued Improved Wear with an Annealed Highly Cross-linked Polyethylene

William N. Capello MD, James A. D’Antonio MD, Rama Ramakrishnan MS, Marybeth Naughton BS

Highly cross-linked polyethylene (HXLPE), created by disrupting the molecular structure of polyethylene, then through the application of heat, encourages creation of new cross-links in the process, resulting in a material with improved wear resistance. The impetuses for this new technology were the unsatisfactory wear properties and subsequent osteolysis of noncross-linked polyethylene. A 72% reduction in wear using highly cross-linked polyethylenes (HXLPE) compared with conventional polyethylene at 5 years was described previously. The longest term followup studies on HXLPE range from 2 to 6 years.

CT Reveals a High Incidence of Osseous Abnormalities in Hips with Labral Tears

Mark M. Dolan MD, Benton E. Heyworth MD, Asheesh Bedi MD, Gavin Duke MD, Bryan T. Kelly MD

Acetabular labral tears are being diagnosed with increasing frequency and there is a growing consensus that these tears rarely occur in the absence of osseous abnormalities.

Modified Hybrid Stem Fixation in Revision TKA is Durable at 2 to 10 Years

Alexander P. Sah MD, Sanjai Shukla MD, Craig J. Della Valle MD, Aaron G. Rosenberg MD, Wayne G. Paprosky MD

Hybrid revision knee component fixation, in which cement is placed in the metaphysis combined with a cementless diaphyseal engaging stem, provides ease of insertion, possibly improved component alignment, and easier removal if required, compared with fully cemented prostheses. The literature suggests the technique has a 2 to 5 year survivorship ranging from 81% to 94%.

A Rotational Scarf Osteotomy Decreases Troughing When Treating Hallux Valgus

Christopher D. Murawski, Christopher J. Egan RPA-C, John G. Kennedy MD FRCS (Orth)

The traditional scarf osteotomy has been associated with complication rates between 1.1% and 45%. We have modified the traditional technique with a rotational osteotomy to reduce these complications.

Outcomes after Scarf Osteotomy for Treatment of Adult Hallux Valgus Deformity

Stephanie P. Adam DO, Steven C. Choung MD, Yang Gu BS, Martin J. O’Malley MD

Many procedures have been developed to correct hallux valgus deformity using distal soft tissue realignment, metatarsal osteotomy, and periodically, a proximal phalanx osteotomy (Akin). The ideal metatarsal osteotomy allows for varying degrees of correction with reliable improvement in deformity and patient satisfaction.

Application of the Ilizarov Technique to the Correction of Neurologic Equinocavovarus Foot Deformity

Dong Yeon Lee MD, In Ho Choi MD, Won Joon Yoo MD, Soong Joon Lee MD, Tae-Joon Cho MD

The treatment of rigid equinocavovarus foot deformities caused by neurologic disorders is often difficult and relapse is common.

Growth Diagrams for Individual Finger Strength in Children Measured with the RIHM

H. M. Molenaar PhD, Ruud W. Selles PhD, Sten P. Willemsen MSc, Steven E. R. Hovius MD, PhD, Henk J. Stam MD, PhD

Although grip and pinch strength provide a more global measure of a large number of digits and muscles, measuring strength of individual fingers or the thumb can provide additional and more detailed information regarding hand strength.

Does Delayed Reexcision Affect Outcome After Unplanned Excision for Soft Tissue Sarcoma?

Ilkyu Han MD, PhD, Hyun Guy Kang MD, PhD, Seung Chul Kang MD, Jay Rim Choi MD, Han-Soo Kim MD, PhD

Unplanned excision of a soft tissue sarcoma generally requires reexcision to achieve an adequate surgical margin. Many surgeons assume delay of definitive surgery adversely affects patient survival and local recurrence. However, no clear evidence of this assumption can be found in the literature.

Comparison of Femoral Morphology and Bone Mineral Density between Femoral Neck Fractures and Trochanteric Fractures

Yuki Maeda MD, Nobuhiko Sugano MD, Masanobu Saito MD, Kazuo Yonenobu MD

Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA).

The Anatomy of the Supraclavicular Nerve During Surgical Approach to the Clavicular Shaft

Tyler Nathe MD, Susan Tseng MD, Brad Yoo MD

Surgery for clavicular shaft fractures is becoming more common but incisional and chest wall numbness reportedly occurs in 10% to 29% of patients. This may be the result of iatrogenic injury to the supraclavicular nerve branches.

Progress Report: The Prevalence of Required Medical School Instruction in Musculoskeletal Medicine at Decade’s End

Joseph Bernstein MD, Grant Hoerig Garcia BA, Jose Luis Guevara BA, Grant W. Mitchell BA

In a 2003 report, required courses in musculoskeletal medicine were found in only 65 of the 122 medical schools in the United States. Since then, national efforts to promote musculoskeletal medicine education were led by the US Bone and Joint Decade, the American Medical Association, the Association of American Medical Colleges, the American Academy of Orthopaedic Surgeons, and the National Board of Medical Examiners, among others. Whether these efforts resulted in any changes in curricula is unclear.

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