Pub Date : 2016-06-01DOI: 10.1097/01.CSS.0000484104.14290.32
Yu-po Lee, R. Allen
CAUSES AND RISK FACTORS PJK may develop secondary to one or more of the following conditions: progressive deformity; disruption of the posterior ligament complex; vertebral compression fracture(s); instrumentation failure; degenerative disc disease, and/or facet violation.12-17 Several risk factors for development of PJK have been identified. These include advanced age (>55 years); fusion to the sacrum; combined anterior/posterior surgery; thoracoplasty; and upper instrumented vertebra at T1-T3. In addition, postoperative hypokyphosis or hyperkyphosis has been associated with increased risk of PJK.12-17 Studies have demonstrated that the risk of developing PJK is greatest within 2 years after surgery and that the risk decreases significantly after the 2-year period.12 The literature regarding the association between the length of the fusion, the location of the uppermost instrumented vertebrae, and the risk of PJK is less clear. Both greater and lower number of levels of fusion have been reported to be associated with an elevated risk for developing PJK.12-17 Similarly, termination of the construct at either the upper or lower thoracic levels have been reported as separate risk factors for PJK.12-17 The rates of and the risk factors for development of PJK are similar between instrumented fusion for adolescent versus and patients may be asymptomatic.1-4 However, severe cases may warrant surgical management. The primary indications for surgery in adults with degenerative scoliosis include: (1) progressive deformity; (2) development of poor spinal balance causing functional difficulties; (3) a large deformity threatening cardiopulmonary compromise; and (4) evidence of neurologic manifestations.5-7 In addition, the presence of persistent pain that fails to respond to standard nonoperative treatment and an unsatisfactory cosmetic appearance also may be considered indications for surgery.8-11 Proximal junctional kyphosis (PJK) has been increasingly recognized as a complication after long-segment instrumentation for the correction of kyphosis and scoliosis (Figures 1 and 2).12-17 PJK most commonly occurs at the site immediately above the uppermost instrumented vertebrae. PJK has been defined as a final proximal junctional sagittal Cobb angle greater than 10 degrees and a postoperative angle at least 10 degrees greater than the preoperative value (as measured between the lower endplate of the uppermost instrumented vertebra and the upper endplate of 2 vertebrae supra-adjacent).15 The incidence of PJK has been demonstrated to range between 17.0% to 39.0%, and the majority of cases seem to occur within 2 years after surgery.12-17 LEARNING OBJECTIVES: After participating in this CME activity, the spine surgeon should be better able to: 1. Describe the incidence, prevalence, and risk factors for proximal junctional kyphosis. 2. Identify the appropriate modality for management of proximal junctional kyphosis as a function of patient characteristics. 3. Explai
{"title":"Proximal Junctional Kyphosis","authors":"Yu-po Lee, R. Allen","doi":"10.1097/01.CSS.0000484104.14290.32","DOIUrl":"https://doi.org/10.1097/01.CSS.0000484104.14290.32","url":null,"abstract":"CAUSES AND RISK FACTORS PJK may develop secondary to one or more of the following conditions: progressive deformity; disruption of the posterior ligament complex; vertebral compression fracture(s); instrumentation failure; degenerative disc disease, and/or facet violation.12-17 Several risk factors for development of PJK have been identified. These include advanced age (>55 years); fusion to the sacrum; combined anterior/posterior surgery; thoracoplasty; and upper instrumented vertebra at T1-T3. In addition, postoperative hypokyphosis or hyperkyphosis has been associated with increased risk of PJK.12-17 Studies have demonstrated that the risk of developing PJK is greatest within 2 years after surgery and that the risk decreases significantly after the 2-year period.12 The literature regarding the association between the length of the fusion, the location of the uppermost instrumented vertebrae, and the risk of PJK is less clear. Both greater and lower number of levels of fusion have been reported to be associated with an elevated risk for developing PJK.12-17 Similarly, termination of the construct at either the upper or lower thoracic levels have been reported as separate risk factors for PJK.12-17 The rates of and the risk factors for development of PJK are similar between instrumented fusion for adolescent versus and patients may be asymptomatic.1-4 However, severe cases may warrant surgical management. The primary indications for surgery in adults with degenerative scoliosis include: (1) progressive deformity; (2) development of poor spinal balance causing functional difficulties; (3) a large deformity threatening cardiopulmonary compromise; and (4) evidence of neurologic manifestations.5-7 In addition, the presence of persistent pain that fails to respond to standard nonoperative treatment and an unsatisfactory cosmetic appearance also may be considered indications for surgery.8-11 Proximal junctional kyphosis (PJK) has been increasingly recognized as a complication after long-segment instrumentation for the correction of kyphosis and scoliosis (Figures 1 and 2).12-17 PJK most commonly occurs at the site immediately above the uppermost instrumented vertebrae. PJK has been defined as a final proximal junctional sagittal Cobb angle greater than 10 degrees and a postoperative angle at least 10 degrees greater than the preoperative value (as measured between the lower endplate of the uppermost instrumented vertebra and the upper endplate of 2 vertebrae supra-adjacent).15 The incidence of PJK has been demonstrated to range between 17.0% to 39.0%, and the majority of cases seem to occur within 2 years after surgery.12-17 LEARNING OBJECTIVES: After participating in this CME activity, the spine surgeon should be better able to: 1. Describe the incidence, prevalence, and risk factors for proximal junctional kyphosis. 2. Identify the appropriate modality for management of proximal junctional kyphosis as a function of patient characteristics. 3. Explai","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134594770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.1097/01.CSS.0000482815.94528.67
Matthew F. Gary, Michael Y. Wang
{"title":"Spinal Surgery Without General Anesthesia","authors":"Matthew F. Gary, Michael Y. Wang","doi":"10.1097/01.CSS.0000482815.94528.67","DOIUrl":"https://doi.org/10.1097/01.CSS.0000482815.94528.67","url":null,"abstract":"","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125017861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-01DOI: 10.1097/01.CSS.0000482088.43696.19
Junyoung J Ahn, M. Colman
{"title":"En Bloc Spondylectomy for Primary Tumors and Metastatic Disease: A Review of Reported Outcomes","authors":"Junyoung J Ahn, M. Colman","doi":"10.1097/01.CSS.0000482088.43696.19","DOIUrl":"https://doi.org/10.1097/01.CSS.0000482088.43696.19","url":null,"abstract":"","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127935239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1097/01.CSS.0000481177.24608.48
S. Hashmi, Shah-Nawaz M. Dodwad, Alpesh A. Patel
wake-up test is rarely performed unless suspicion for significant neurologic injury is high, and intraoperative evaluation is deemed to be absolutely necessary.4 IONM began in the 1970s as direct evaluation of the dorsal column through SSEP assessment.6 Nuwer et al7 established the clinical efficacy of intraoperative SSEP monitoring during scoliosis surgery in a multicenter survey of 51,263 spine surgeries. The authors concluded that SSEP detection of postoperative neurologic deficits had an overall sensitivity of 92.0% and specificity of 98.9%.7 In addition, neuromonitoring was associated with a decreased rate of neurologic deficits. However, no definitive data supported this assertion. Merton and Morton8 were the first to excite cortical neurons with high-voltage transcranial electrical stimulation to activate contralateral motor activity. Establishing TcMEPs facilitated direct intraoperative monitoring of anterior column motor activity.8 The development of TcMEPs enabled evaluation of the corticospinal tract, spinal cord interneurons, anterior horn cells, and peripheral nerves. IONM modalities allow spine surgeons to monitor the integrity of the central and peripheral nervous systems continuously in real time to prevent, minimize, or reverse neurologic injury. The aim of this article is to provide an overview of current IONM modalities and their applications in cervical, thoracic, and lumbar spine surgery. potentials (SSEPs), and transcranial motorevoked potentials (TcMEPs) to assess the integrity of the central and peripheral nervous systems.1 IONM has a variety of applications in other surgical subspecialties such as urology, otolaryngology, endocrinology, intracranial neurosurgery, interventional neuroradiology, vascular surgery, and orthopedic surgery, including pelvic fracture internal fixation.1 The Stagnara wake-up test was one of the earliest IONM tests to be used in spine surgery.2 This intraoperative test requires a gradual reduction of anesthesia until the patient is able to move both the upper and lower extremities voluntarily. Assessment of the primary motor cortex, anterior motor pathways of the spinal cord, nerve roots, and peripheral nerves through the wake-up test allows detection of gross intraoperative motor changes.3 However, fine motor changes or abnormalities are not readily identified using this test. Furthermore, proper assessment requires optimal patient and anesthesiologist participation and evaluation by a physician who is not participating in the procedure.4 Repeated wake-up tests have been associated with decreased interperformance reliability, increased risk of air embolism, self-extubation, patient recall of events, sterile field contamination, and patient positional changes that may lead to neural compression.5 The limitations of the Stagnara wake-up test led to the development of other modalities. Currently, the LEARNING OBJECTIVES: After participating in this activity, the spine surgeon should be better able t
{"title":"Intraoperative Neuromonitoring for Spinal Surgery","authors":"S. Hashmi, Shah-Nawaz M. Dodwad, Alpesh A. Patel","doi":"10.1097/01.CSS.0000481177.24608.48","DOIUrl":"https://doi.org/10.1097/01.CSS.0000481177.24608.48","url":null,"abstract":"wake-up test is rarely performed unless suspicion for significant neurologic injury is high, and intraoperative evaluation is deemed to be absolutely necessary.4 IONM began in the 1970s as direct evaluation of the dorsal column through SSEP assessment.6 Nuwer et al7 established the clinical efficacy of intraoperative SSEP monitoring during scoliosis surgery in a multicenter survey of 51,263 spine surgeries. The authors concluded that SSEP detection of postoperative neurologic deficits had an overall sensitivity of 92.0% and specificity of 98.9%.7 In addition, neuromonitoring was associated with a decreased rate of neurologic deficits. However, no definitive data supported this assertion. Merton and Morton8 were the first to excite cortical neurons with high-voltage transcranial electrical stimulation to activate contralateral motor activity. Establishing TcMEPs facilitated direct intraoperative monitoring of anterior column motor activity.8 The development of TcMEPs enabled evaluation of the corticospinal tract, spinal cord interneurons, anterior horn cells, and peripheral nerves. IONM modalities allow spine surgeons to monitor the integrity of the central and peripheral nervous systems continuously in real time to prevent, minimize, or reverse neurologic injury. The aim of this article is to provide an overview of current IONM modalities and their applications in cervical, thoracic, and lumbar spine surgery. potentials (SSEPs), and transcranial motorevoked potentials (TcMEPs) to assess the integrity of the central and peripheral nervous systems.1 IONM has a variety of applications in other surgical subspecialties such as urology, otolaryngology, endocrinology, intracranial neurosurgery, interventional neuroradiology, vascular surgery, and orthopedic surgery, including pelvic fracture internal fixation.1 The Stagnara wake-up test was one of the earliest IONM tests to be used in spine surgery.2 This intraoperative test requires a gradual reduction of anesthesia until the patient is able to move both the upper and lower extremities voluntarily. Assessment of the primary motor cortex, anterior motor pathways of the spinal cord, nerve roots, and peripheral nerves through the wake-up test allows detection of gross intraoperative motor changes.3 However, fine motor changes or abnormalities are not readily identified using this test. Furthermore, proper assessment requires optimal patient and anesthesiologist participation and evaluation by a physician who is not participating in the procedure.4 Repeated wake-up tests have been associated with decreased interperformance reliability, increased risk of air embolism, self-extubation, patient recall of events, sterile field contamination, and patient positional changes that may lead to neural compression.5 The limitations of the Stagnara wake-up test led to the development of other modalities. Currently, the LEARNING OBJECTIVES: After participating in this activity, the spine surgeon should be better able t","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133746092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-01-01DOI: 10.1097/01.CSS.0000475963.80233.cb
Sean M. Mitchell, W. Hsu
{"title":"Lumbar Pedicle Cortical Bone Trajectory Screw: Indications and Surgical Technique","authors":"Sean M. Mitchell, W. Hsu","doi":"10.1097/01.CSS.0000475963.80233.cb","DOIUrl":"https://doi.org/10.1097/01.CSS.0000475963.80233.cb","url":null,"abstract":"","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123023590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-12-01DOI: 10.1097/01.CSS.0000473820.53583.74
Jonathan J Rasouli, B. Skovrlj, S. Qureshi
{"title":"Hemostasis During Spine Surgery: A Critical Review","authors":"Jonathan J Rasouli, B. Skovrlj, S. Qureshi","doi":"10.1097/01.CSS.0000473820.53583.74","DOIUrl":"https://doi.org/10.1097/01.CSS.0000473820.53583.74","url":null,"abstract":"","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114229251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-01DOI: 10.1097/01.CSS.0000473036.55682.94
Gregory D. Schroeder, A. Vaccaro
{"title":"Variations in the Treatment of Thoracolumbar Burst Fractures","authors":"Gregory D. Schroeder, A. Vaccaro","doi":"10.1097/01.CSS.0000473036.55682.94","DOIUrl":"https://doi.org/10.1097/01.CSS.0000473036.55682.94","url":null,"abstract":"","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116889094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-10-01DOI: 10.1097/01.CSS.0000471827.86645.d6
J. Murar, M. Chioffe, A. Marquez-Lara, Alpesh A. Patel
{"title":"Anterior Cervical Pseudarthrosis","authors":"J. Murar, M. Chioffe, A. Marquez-Lara, Alpesh A. Patel","doi":"10.1097/01.CSS.0000471827.86645.d6","DOIUrl":"https://doi.org/10.1097/01.CSS.0000471827.86645.d6","url":null,"abstract":"","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123886997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.1097/01.CSS.0000471189.39145.d1
D. Bateman, M. McDonnell, C. Kepler
{"title":"Value and Cost Effectiveness of Common Spinal Surgical Procedures","authors":"D. Bateman, M. McDonnell, C. Kepler","doi":"10.1097/01.CSS.0000471189.39145.d1","DOIUrl":"https://doi.org/10.1097/01.CSS.0000471189.39145.d1","url":null,"abstract":"","PeriodicalId":209002,"journal":{"name":"Contemporary Spine Surgery","volume":"308 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134019774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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