• Symptomatic Lumbar Spinal Stenosis Increases the Risk of Spondylotic Cervical Spinal Cord Compression and Cervical Spondylotic Myelopathy

    Introduction: Spondylosis frequently affects not just one segment of the spine; it is generally more widespread. The most commonly affected regions are the lumbar and cervical spine.   Concurrent cervical and lumbar stenosis is usually recorded as “tandem stenosis.” The aim of this prospective cross-sectional observational comparative study was to determine the prevalence of spondylotic cervical cord compression (SCCC) and symptomatic cervical spondylotic myelopathy (CSM) in patients with symptomatic lumbar spinal stenosis (LSS) in comparison with a general population sample and to seek to identify predictors for the development of CSM.
  • Outcome of Correction Surgery using Pedicle Screw for Cervical Kyphosis Exclusive of Ankylosing Spondylitis

    Introduction: Severe cervical kyphosis exclusive of ankylosing spondylitis (AS) is rare.  Decompensation of the alignment due to multilevel disc degeneration, loss of disc height, anterior slip of the vertebra, and/or denervation of paravertebral muscles can cause severe kyphotic deformity, and canal stenosis, osteoarthritis of the facet, and/or foraminal stenosis may coexist. Correction surgery for those has a risk to cause neural complications such as spinal cord injury and C5 nerve palsy.
  • Factors Associated with Morbidity and Mortality in Adults Undergoing Cervical Corpectomy

    Introduction: Cervical corpectomy is a common surgical technique and several studies have shown favorable outcomes for patient being treated for cervical myelopathy, radiculopathy, and other forms of spinal cord or nerve root compression. However, postoperative complications are reportedly high and few studies have identified consistent risk factors for morbidity and mortality in this patient cohort using a large database. Our study objective was to analyze predictors of morality and morbidity in adults following cervical corpectomy. Materials/Methods: Adult patients (> 18 years) who underwent cervical corpectomy (CPT code: 6301 ad 63082) between 2005 and 2012 were identified in the NSQIP database.  
  • Where do True Cost Savings Exist following Elective Surgery for Degenerative Spine Disease?

    Background: Value-base purchasing and pay-for-performance model are driving the development of the bundle payment systems for reimbursement. In an effort to have a sustainable bundling system, it is important to identify the contributions of each component of the total cost of index surgery and to determine the domain where the targeted savings should occur. We determine the percent contribution of health-care resource utilization, hospital fee, surgeons’ fee and readmission to the total cost of index surgery following elective spine surgery. Methods: A total of 1694 consecutive patients undergoing elective spine surgery for degenerative cervical and lumbar pathologies, that were enrolled in a prospective longitudinal registry were included in the study.
  • The Effect of Local Intraoperative Steroid Administration on the Rate of Post-Operative Dysphagia following ACDF: A National Database Study of 245,754 Patients

    Introduction: Literature on the effectiveness of intraoperative local steroid administration following ACDF has been limited to small institutional studies describing conflicting results. The PearlDiver database was utilized to compare rates of postoperative dysphagia following short and long ACDF in patients who received intraoperative local steroids and those who did not. We hypothesized that intraoperative local administration of steroids was associated with decreased rates of postoperative dysphagia in patients undergoing ACDF, without any increase in infection. Methods: The PearlDiver database was utilized to characterize and compare rates of dysphagia within 90 days postoperatively in patients who received intraoperative local steroid during short...
  • Incidence of and Risk Factors for Incorrect Level Needle Localization during Anterior Cervical Discectomy and Fusion Surgery (ACDF)

    Introduction: Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for patients with axial neck pain and upper extremity radiculopathy. During the surgery for ACDF, radiographic confirmation of the operative level before beginning the discectomy is often performed by placing a needle into the disc space. Studies have shown that a needle puncture could potentially lead to degenerative changes in an incorrectly marked disc level.
  • Accurate and Simple Screw Insertion Procedure with Patient-Specific Screw Guide Templates for Posterior C1-C2 Fixation

    Background: Posterior C1 lateral mass screw (LMS) and C2 pedicle screw (PS) fixation, also known as the Goel-Harms method can provide immediate rigid fixation, but the screw insertion carries a potential risk for injury to neuronal and vascular structures. It is also sometimes problematic to dissect venous plexus and C2 nerve root to confirm the insertion point of C1 LMS. To solve these problems, we developed an intraoperative screw guiding method using patient-specific laminar templates. Methods: Preoperative bone images of the computed tomography (CT) scans were analyzed using three-dimensional (3D)/multiplanar imaging software and the trajectories of the screws were planned.
  • What Happens to the Disc Bulge after Posterior Laminectomy and Fusion in Patients with Cervical Myelopathy?

    Introduction: Cervical myelopathy is a disabling condition that often presents with a loss of fine motor skills in the hand with lower limb ataxia. The most common cause of myelopathy is degeneration of the cervical discs with resulting compression of the spinal cord. Treatment often consists of surgical decompression and fixation, performed through ugh an anterior, posterior, or combined approach. Posterior laminectomy and fusion is recommended for patients with multilevel compression with preserved cervical lordosis.  This approach affords an indirect decompression of the spinal cord by allowing it to drift away posteriorly from the anteriorly bulging discs. Although this approach effectively decompresses the spinal cord there has been no study that critically analyzes the degree of remaining stenosis due to the anterior bulging discs.