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Study Design: Prospective observational cohort study.Objective: To compare the outcomes of our new technique, distraction arthrodesis of C1-C2 facet joint with C2 root preservation (Study group), to those of conventional C1-C2 fusion with C2 root transection (Control group) for the management of intractable occipital neuralgia caused by C2 root compression.Summary Of Background Data: We are not aware of any report concerning C2 root decompression during C1-C2 fusion.Materials and Methods: Inclusion criteria were visual analogue scale (VAS) score for occipital neuralgia 7 or more; C2 root compression at the collapsed C1-C2 neural foramen; and follow-up 12 months or more. The Study group underwent surgery with our new technique including (1) C1-C2 facet joint distraction and bone block insertion while preserving the C2 root; and (2) use of C1 posterior arch screws instead of conventional lateral mass screws during C1-C2 segmental screw fixation. The Control group underwent C2 root transection with C1-C2 segmental screw fixation and fusion. We compared the prospectively collected outcomes data.Results: There were 15 patients in the Study group and 8 in the Control group. Although there was no significant difference in the VAS score for the occipital neuralgia between the 2 groups preoperatively (8.2 ± 0.9 vs. 7.9 ± 0.6, P = 0.39), it was significantly lower in the Study group at 1, 3, and 6 months postoperatively (P < 0.01, respectively). At 12 months, it was 0.4 ± 0.6 versus 2.5 ± 2.6 (P = 0.01). There was no significant difference in improvement in the VAS score for neck pain and neck disability index and Japanese Orthopedic Association recovery rate, which are minimally influenced by occipital neuralgia.Conclusion: Our novel technique of distraction arthrodesis with C2 root preservation can be an effective option for the management of intractable occipital neuralgia caused by C2 root compression. [ABSTRACT FROM AUTHOR]

Study Design: Evaluation using 3-dimensional screw trajectory software and computed tomographic scans. Objective: To investigate the anatomic feasibility of laminar screw placement in the upper thoracic spine compared with pedicle screw placement. Summary Of Background Data: Although laminar screws have been suggested as an alternative to pedicle screws in the upper thoracic spine, previous anatomic feasibility studies have some limitations. Methods: Four types of screws were simulated from T1 to T6: unilaminar screw (US), superior bilaminar screw (SBS), inferior bilaminar screw (IBS), and pedicle screw (PS). Maximum allowable screw dimensions and the success rates of 4.5-mm screw placement were compared for each level. Laminar screw dimensions with more than 90% success rate at each level were determined for reference. Results: Computed tomographic scans of 132 patients were analyzed. Laminar screw diameters gradually increased from T1 (4.4-5.4 mm, for each type) to T6 (4.8-6.7 mm), whereas PS diameter steeply declined from T1 (5.9 mm) to T4 (3.4 mm) and then leveled off. At T1, PS had greater success rate of 4.5-mm screw placement than laminar screws (US > IBS > SBS); at T2, US had greater success rate than IBS, followed by PS and SBS; and at T3 to T6, laminar screws (US > IBS > SBS) had greater success rate than PS in all comparisons. Except for SBS at T1, laminar screw diameters with more than 90% success rates were between 3.5 and 5.0 mm. Conclusion: In view of their anatomic feasibility, laminar screws can be a viable alternative to PSs in the upper thoracic spine. Particularly at T3 to T6 where the pedicle width is inherently small, the success rates of laminar screw placement were significantly and consistently higher than those of PS placement. The comparable success rates of laminar screws using commercially available screw sizes further emphasize their potential clinical use. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the optimal entry point and trajectory of atlantooccipital transarticular screws. The study examined four entry points of screw placement in 126 patients using computed tomography (CT). It concluded that although no significant difference in success rates were found between anterolateral (AL) and posteriolateral (PL), PL can still be considered as the best entry point.

Study Design: A retrospective case-control analysis of prospectively collected data. Objective: First, to evaluate spinal intervertebral mobility in patients with joint hypermobility (JHM) and matched controls without JHM, and second, to investigate the influence of JHM on back pain, disability, and general health status in young males. Summary Of Background Data: Despite the significance of benign JHM in the musculoskeletal feature, there have been no studies regarding low back pain and segmental motion in subjects with JHM. Furthermore, the clinical significance of the excessive segmental motion in young males with JHM remains unknown. Methods: The JHM group included 32 subjects who had Beighton scale score of 4 or more according to 9° Beighton scale. The age-matched 32 young males without JHM were selectively included in the control group. In both groups, Oswestry Disability Index (ODI), visual analogue pain scale (VAS) for back pain, and Short-Form 36 was assessed. Radiological sagittal plane motions for each segment and whole lumbar spine were calculated as the difference between the Cobb angle measurements in the flexion and extension plain radiographs. In the lateral radiograph with neutral standing position, the intervertebral disc heights were also measured at each segment. Results: The JHM group showed significantly larger range of motion and higher intervertebral disc height at each matched segment than the control group. The JHM group had significant increased VAS for back pain and ODI score, compared with control group. The Short-Form 36 physical function, role physical, role emotional, and physical component summary in the JHM group were significantly lower than in the control group. Conclusion: This study shows that young males with JHM were found to have excessive lumbar segmental motion that was associated with increased low back pain, disability, and limited physical activity. [ABSTRACT FROM AUTHOR]

STUDY DESIGN.: A retrospective review of clinical and radiological parameters. OBJECTIVE.: The purpose of this study was to investigate the therapeutic efficacy of transpedicular intracorporeal bone graft (IBG) in osteonecrosis of vertebral body (ONV) for 5-years follow-up period. SUMMARY OF BACKGROUND DATA.: Although a broad spectrum of surgical options has been described for the treatment of ONV without neurological deficits, no effective treatment has been definitely established. Limited previous work has reported favorable outcomes with IBG; however, these studies were limited by short-term follow-up and small sample sizes. This study is the first to report the clinical and radiological results of IBG with short-segmental posterior instrumentation in ONV with a 5-year follow-up period. METHODS.: Thirty-six patients were followed for at least 5 years after transpedicular IBG with short-segmental posterior instrumentation. We retrospectively reviewed outcomes, including visual analogue scale score, the Oswestry Disability Index score, compression ratio, and kyphotic angle. RESULTS.: There were 11 complications, including pneumonia in 4 patients, screw loosening in 5 patients, mild hematoma at the subcutaneous tissue in 1 case, and pseudarthrosis in 1 case. The mean visual analogue scale score was exhibiting V-shaped upward trend after postoperative 6 months that ended with the almost similar score obtained with preoperative status. The mean Oswestry Disability Index score was also shown with similar trend. In functional score, there was a statistical significant improvement until only 6 months after surgery. In radiological evaluation, the mean kyphotic angle and compression ratio was significantly corrected after surgery (P < 0.05). However, these improved radiological parameters were maximal at the immediate postoperative time with gradual loss over time. CONCLUSION.: Transpedicular IBG with short-segmental posterior instrumentation may lead to complications such as prolonged back pain and recurrence of kyphotic deformity in the 5 years after the procedure. Therefore, we do not recommend short-segmental posterior instrumentation concurrently with transpedicular IBG for treating ONV.Level of Evidence: 4. [ABSTRACT FROM AUTHOR]