The spine journal : official journal of the North American Spine Society
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Postoperative malalignment of the cervical spine may alter cervical spine mechanics and put patients at risk for clinical adjacent segment pathology requiring surgery. ⋯ Our results suggest that malalignment of the cervical spine following an ACF at C5-C6 has an effect on the development of clinical adjacent segment pathology requiring surgery.
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Several methods for C1-C2 stabilization have been described in the literature. These include C1-C2 transarticular and C1 lateral mass screws. In patients with aberrant anatomy such as a high-riding vertebral artery (VA) or the presence of an arcuate foramen at C1, there exists a higher risk of VA injury. This may lead to excessive bleeding, stroke, and possibly death. There have been several studies determining the incidence of arcuate foramen and high-riding VA occurring individually in the general population, but none have determined their occurrence simultaneously. ⋯ The arcuate foramen and high-riding VA are common anomalies that are often not recognized. Although ipsilateral high-riding VA and arcuate foramen rarely occur in the general population, proper identification of these anomalies on preoperative CT scan facilitates planning the safest technique for C1-C2 instrumentation.
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Review Case Reports
Thoracic disc herniation leads to anterior spinal artery syndrome demonstrated by diffusion-weighted magnetic resonance imaging (DWI): a case report and literature review.
Thoracic disc herniation rarely causes acute ischemic events involving the spinal cord. Few reports have suggested this as a mechanism leading to anterior spinal artery syndrome, and none with illustration through diffusion-weighted magnetic resonance imaging (DWI). ⋯ Acute thoracic disc herniation with cord contact but without canal stenosis is able to disrupt blood flow to the cord leading to anterior spinal artery distribution ischemia. This case represents the first demonstrated use of DWI in diagnosing this rare cause of anterior spinal artery ischemia.
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Denosumab (XGeva) is a receptor activator of nuclear factor-κB ligand (RANKL)-antibody that was approved by the Food and Drug Administration (FDA) in 2010 for the prevention of skeletal fractures in patients with bone metastases from solid tumors. Although there is a widespread use of such drug in patients under risk of pathological fractures, the compatibility of denosumab therapy with percutaneous vertebroplasty (an interventional procedure commonly used for pain control in such population) has not yet been established. ⋯ This is the first report of the technical peculiarities of percutaneous vertebroplasty in patients under medical treatment with denosumab. According to our experience, because of its RANKL-mediated effects on osteoclasts activity, denosumab has been shown to induce a fast and marked sclerotic response on vertebral bodies that may not be accompanied by a satisfactory improvement in pain control (especially in patients with mechanical type of pain) and which may actually prevent the successful performance of percutaneous vertebroplasty. Therefore, it is of paramount importance that future studies evaluating patients with vertebral fractures under treatment with denosumab include long-term pain outcome measures. Additionally, further investigation is warranted to determine the optimal order of treatment and the best timeframe for combining percutaneous vertebroplasty and denosumab therapy in patients presenting with acute vertebral compression fractures and refractory axial pain.
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Adolescent idiopathic scoliosis (AIS) affects 2% to 4% of the population and predominantly affects female individuals. The scoliosis researchers and clinical communities use the "Cobb angle" obtained from anterior-posterior radiographs as the standard assessment tool for scoliosis. However, excessive radiation exposure over consecutive visits during the growing years increases the risk of cancer in young patients with AIS. Surface topography (ST) is a noninvasive method that is being investigated as an alternative tool for scoliosis assessment. The necessity of applying markers by skilled operators, which is time consuming and a potential area for errors, is one of the main limitations of these methods. ⋯ A novel method to examine torso asymmetry in patients with AIS is presented, using noninvasive ST scans and a visually intuitive asymmetry map. Distinct patterns of asymmetry were identified allowing patients to be classified into three groups, with six subgroups based on their asymmetry map with very good to excellent reliability. The presented technique shows promise to provide a noninvasive tool for assessment and monitoring of AIS.