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1. Sizes of the transverse foramina correlate with blood flow and dominance of vertebral arteries.

Author

Kotil K and Kilincer C

Subjects
Adult, Blood Flow Velocity, Female, Humans, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Spondylosis diagnostic imaging, Vertebral Artery diagnostic imaging, Cervical Vertebrae diagnostic imaging, Spondylosis physiopathology, Tomography, X-Ray Computed methods, Ultrasonography, Doppler methods, Vertebral Artery physiology
Abstract

Background Context: Knowing the side of the dominant vertebral artery (VA) may be of utmost importance if the VAs are at risk during spine surgery. Determination of the size of VAs is obtained by using Doppler ultrasonography or angiography. Because VA is the main anatomic structure occupying the transverse foramina (TF), it may be assumed that size of TF and blood flow of VAs should be proportional., Purpose: To investigate if there is a correlation between the sizes of TF and the flow of VAs and determine the diagnostic accuracy of measuring TF to predict dominant side of VA. The specific hypothesis was that the larger side of TF corresponds to the side of the dominant VA., Study Design: This is a morphologically based, prospectively designed, single-center study. Thirty patients (14 male, 16 female) who were treated for degenerative spinal pathologies were included. Patients with cervical fractures, occluded VA, prominent degenerative changes affecting TF, deformity, or previous cervical instrumentation were excluded from the study., Outcome Measures: In all patients, computed tomography of the cervical spine and Doppler ultrasonography of VAs were obtained for morphometric analysis., Methods: Axial computed tomography cuts at the C6 vertebral level were taken. Two measurements were performed for each foramen: its right to left width and its anteroposterior depth. Blood flow volumes of bilateral VAs were measured using color Doppler., Results: Diameters of TF ranged between 2.2 and 7 mm, and its width was generally slightly larger than the depth. Transverse foramina were always asymmetric, with no right or left side preference. There was a strong correlation between TF diameters and blood flow of VAs. Between TF width and VA blood flow, the Pearson correlation coefficient was 0.59 (p=.001) for right side and 0.72 for left side (p<.0001). The side of the larger TF matched with the side of dominant VA in 28 of 30 cases (93.3%) (p<.0001). The agreement between the dominant VA and the larger side of TF was almost perfect (Kappa=0.087, p<.0001)., Conclusions: There was strong correlation between TF diameters and VA blood volume. Our results suggest that TF diameter of C6 level can be used to predict the side of the dominant VA reliably., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Published
2014
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2. Establishing the Injury Severity of Subaxial Cervical Spine Trauma: Validating the Hierarchical Nature of the AO Spine Subaxial Cervical Spine Injury Classification System

Author

Schroeder, G. D., Canseco, J. A., Patel, P. D., Divi, S. N., Karamian, B. A., Kandziora, F., Vialle, E. N., Oner, F. C., Schnake, K. J., Dvorak, M. F., Chapman, J. R., Benneker, L. M., Rajasekaran, S., Kepler, C. K., Vaccaro, A. R., Abdelgawaad, A. S., Abdul, W., Abdulsalam, A., Abeid, M., Ackshota, N., Acosta, O., Akman, Y., Aldahamsheh, O., Alhammoud, A., Aleixo, H., Alexander, H., Alkharsawi, M., Alsammak, W., Amadou, H., Amin, M., Arbatin, J., Atan, A., Athanasiou, A., Bas, P., Bazan, P., Benzakour, T., Benzarti, S., Bernucci, C., Bosco, A., Butler, J., Castillo, A., Cawley, D., Chek, W., Chen, J., Cheng, C., Cheung, J., Chong, C., Corluka, S., Corredor, J., Costa, B., Curri, C., Dawoud, A., Delgado-Fernandez, J., Demiroz, S., Desai, A., Diez-Ulloa, M., Dimas, N., Diniz, S., Direito-Santos, B., Duerinck, J., El-Hewala, T., El-Shamly, M., El-Sharkawi, M., Espinosa, G., Estefan, M., Fang, T., Fernandes, M., Fernandez, N., Ferreira, M., Figueiredo, A., Fiorenza, V., Francis, J., Franz, S., Freedman, B., Fu, L., Fuego, S., Gahlot, N., Ganau, M., Garcia-Pallero, M., Garg, B., Gidvani, S., Giera, B., Godinho, A., Goni, M., Gonzalez, M., Gonzalez, R., Gopalakrishnan, D., Grin, A., Grozman, S., Gruenberg, M., Grundshtein, A., Guasque, J., Guerra, O., Guiroy, A., Hackla, S., Harris, C., Harrop, J., Hassan, W., Henine, A., Hickman, Z., Igualada, C., James, A., Jetjumnong, C., Kaen, A., Karmacharya, B., Kilincer, C., Klezl, Z., Koerner, J., Konrads, C., Krappel, F., Kruyt, M., Krywinski, F., Kundangar, R., Landriel, F., Lindtner, R., Linhares, D., Llombart-Blanco, R., Lopez, W., Lotan, R., Lourido, J., Luna, L., Magashi, T., Majer, C., Mandizvidza, V., Manilha, R., Mannara, F., Margetis, K., Medina, F., Milano, J., Miyakoshi, N., Moisa, H., Montemurro, N., Montoya, J., Morais, J., Morande, S., Msuya, S., Mubarak, M., Mulbah, R., Murugan, Y., Nacer, M., Neves, N., Nicassio, N., Niemeier, T., Olorunsogo, M., Orosco, D., Ozdener, K., Paez, R., Panchal, R., Paterakis, K., Pemovska, E., Pereira, P., Perovic, D., Perozo, J., Pershin, A., Phedy, P., Picazo, D., Pitti, F., Platz, U., Pluderi, M., Ponnusamy, G., Popescu, E., Ramakrishnan, S., Ramieri, A., Rebholz, B., Ricciardi, G., Ricciardi, D., Robinson, Y., Rodriguez, L., Rodrigues-Pinto, R., Romero, I., Rosas, R., Russo, S., Rutges, J., Sartor, F., Shariati, B., Sharma, J., Shoaib, M., Smith, S., Sorimachi, Y., Sribastav, S., Steiner, C., Subbiah, J., Subramanian, P., Suri, T., Tannoury, C., Tokala, D., Toluse, A., Ungurean, V., Vahl, J., Valacco, M., Valdez, C., Vernengo-Lezica, A., Veroni, A., Vieira, R., Viswanadha, A., Wagner, S., Wamae, D., Weening, A., Weidert, S., W. -T., Wu, M. -H., Wu, Yuan, H., Yuh, S. -J., Yurac, R., Zarate-Kalfopulos, B., Ziabrov, A., Zubairi, A., Surgical clinical sciences, Neuroprotection & Neuromodulation, and Neurosurgery

Subjects
Adult, Male, Facet (geometry), medicine.medical_specialty, Cross-sectional study, Clinical Neurology, 610 Medicine & health, Cervical spine injury, cervical spine, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Injury Severity Score, Surveys and Questionnaires, Severity of illness, Validation, medicine, Humans, Orthopedics and Sports Medicine, Spinal cord injury, Spinal Cord Injuries, 030222 orthopedics, business.industry, Reproducibility of Results, AO spine subaxial cervical spine injury, Cervical spine, Classification system, Injury severity score, Trauma, Cervical Vertebrae, Cross-Sectional Studies, Female, medicine.disease, medicine.anatomical_structure, trauma, Neurology (clinical), Radiology, business, 030217 neurology & neurosurgery, Cervical vertebrae
Abstract

STUDY DESIGN Global cross-sectional survey. OBJECTIVE To validate the AO Spine Subaxial Cervical Spine Injury Classification by examining the perceived injury severity by surgeon across AO geographical regions and practice experience. SUMMARY OF BACKGROUND DATA Previous subaxial cervical spine injury classifications have been limited by subpar interobserver reliability and clinical applicability. In an attempt to create a universally validated scheme with prognostic value, AO Spine established a subaxial cervical spine injury classification involving four elements: (1) injury morphology, (2) facet injury involvement, (3) neurologic status, and (4) case-specific modifiers. METHODS A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. Respondents graded the severity of each variable of the classification system on a scale from zero (low severity) to 100 (high severity). Primary outcome was to assess differences in perceived injury severity for each injury type over geographic regions and level of practice experience. RESULTS A total of 189 responses were received. Overall, the classification system exhibited a hierarchical progression in subtype injury severity scores. Only three subtypes showed a significant difference in injury severity score among geographic regions: F3 (floating lateral mass fracture, p:0.04), N3 (incomplete spinal cord injury, p:0.03), and M2 (critical disk herniation, p:0.04). When stratified by surgeon experience, pairwise comparison showed only 2 morphological subtypes, B1 (bony posterior tension band injury, p:0.02) and F2 (unstable facet fracture, p:0.03), and one neurologic subtype (N3, p:0.02) exhibited a significant difference in injury severity score. CONCLUSIONS The AO Spine Subaxial Cervical Spine Injury Classification System has shown to be reliable and suitable for proper patient management. The study shows this classification is substantially generalizable by geographic region and surgeon experience; and provides a consistent method of communication among physicians while covering the majority of subaxial cervical spine traumatic injuries.Level of Evidence: 4.

Published
2021
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3. Regional and experiential differences in surgeon preference for the treatment of cervical facet injuries: a case study survey with the AO Spine Cervical Classification Validation Group

Author

Canseco, Jose A, Schroeder, Gregory D, Patel, Parthik D, Grasso, Giovanni, Chang, Michael, Kandziora, Frank, Vialle, Emiliano N, Oner, F Cumhur, Schnake, Klaus J, Dvorak, Marcel F, Chapman, Jens R, Benneker, Lorin M, Rajasekaran, Shanmuganathan, Kepler, Christopher K, Vaccaro, Alexander R, Abdelgawaad, Ahmed, Abdul, Waheed, Abdulsalam, Asmatullah, Abeid, Mbarak, Ackshota, Nissim, Acosta, Olga, Akman, Yunus, Aldahamsheh, Osama, Alhammoud, Abduljabbar, Aleixo, Hugo, Alexander, Hamish, Alkharsawi, Mahmoud, Alsammak, Wael, Amadou, Hassame, Amin, Mohamad, Arbatin, Jose, Atan, Ahmad, Athanasiou, Alkinoos, Bas, Paloma, Bazan, Pedro, Benzakour, Thami, Benzarti, Sofien, Bernucci, Claudiio, Bosco, Aju, Butler, Joseph, Castillo, Alejandro, Cawley, Derek, Chek, Wong, Chen, John, Cheng, Christina, Cheung, Jason, Chong, Chun, Corluka, Stipe, Corredor, Jose, Costa, Bruno, Curri, Cloe, Dawoud, Ahmed, Delgado- Fernandez, Juan, Demiroz, Serdar, Desai, Ankit, Diez-Ulloa, Maximo, Dimas, Noe, Diniz, Sara, Direito-Santos, Bruno, Duerinck, Johnny, El- Hewala, Tarek, El-Shamly, Mahmoud, El-Sharkawi, Mohammed, Espinosa, Guillermo, Estefan, Martin, Fang, Taolin, Fernandes, Mauro, Fernandez, Norbert, Ferreira, Marcus, Figueiredo, Alfredo, Fiorenza, Vito, Francis, Jibin, Franz, Seibert, Freedman, Brett, Fu, Lingjie, Fuego, Segundo, Gahlot, Nitesh, Ganau, Mario, Garcia-Pallero, Maria, Garg, Bhavuk, Gidvani, Sandeep, Giera, Bjoern, Godinho, Amauri, Goni, Morshed, Gonzalez, Maria, Gopalakrishnan, Dilip, Grin, Andrey, Grozman, Samuel, Gruenberg, Marcel, Grundshtein, Alon, Guasque, Joana, Guerra, Oscar, Guiroy, Alfredo, Hackla, Shafiq, Harris, Colin, Harrop, James, Hassan, Waqar, Henine, Amin, Hickman, Zachary, Igualada, Cristina, James, Andrew, Jetjumnong, Chumpon, Kaen, Ariel, Karmacharya, Balgopal, Kilincer, Cumur, Klezl, Zdenek, Koerner, John, Konrads, Christian, Krappel, Ferdinand, Kruyt, Moyo, Krywinski, Fernando, Kundangar, Raghuraj, Landriel, Federico, Lindtner, Richard, Linhares, Daniela, Llombart-Blanco, Rafael, Lopez, William, Lotan, Raphael, Lourido, Juan, Luna, Luis, Magashi, Tijjani, Majer, Catalin, Mandizvidza, Valentine, Manilha, Rui, Mannara, Francisco, Margetis, Konstantinos, Medina, Fabrico, Milano, Jeronimo, Miyakoshi, Naohisa, Moisa, Horatiu, Montemurro, Nicola, Montoya, Juan, Morais, Joao, Morande, Sebastian, Msuya, Salim, Mubarak, Mohamed, Mulbah, Robert, Murugan, Yuvaraja, Nacer, Mansouri, Neves, Nuno, Nicassio, Nicola, Niemeier, Thomas, Olorunsogo, Mejabi, Oner, F. C., Orosco, David, Ozdener, Kubilay, Paez, Rodolfo, Panchal, Ripul, Paterakis, Konstantinos, Pemovska, Emilija, Pereira, Paulo, Perovic, Darko, Perozo, Jose, Pershin, Andrey, Phedy, Phedy, Picazo, David, Pitti, Fernando, Platz, Uwe, Pluderi, Mauro, Ponnusamy, Gunasaeelan, Popescu, Eugen, Ramakrishnan, Selvaraj, Ramieri, Alessandro, Rebholz, Brandon, Ricciadri, Guillermo, Ricciardi, Daniel, Robinson, Yohan, Rodriguez, Luis, Rogrigues-Pinto, Ricardo, Romero, Itati, Rosas, Ronald, Russo, Salvatore, Rutges, Joost, Sartor, Federico, Schroeder, Gregory, Shariati, Babak, Sharma, Jeevan, Shoaib, Mahmoud, Smith, Sean, Sorimachi, Yasunori, Sribastav, Shilanant, Steiner, Craig, Subbiah, Jayakumar, Suramanian, Panchu, Suri, Tarun, Tannoury, Chadi, Tokala, Devi, Toluse, Adetunji, Ungurean, Victor, Vaccaro, Alexander, Vahl, Joachim, Valacco, Marcelo, Valdez, Cristian, Vernengo-Lezica, Alejo, Veroni, Andrea, Vieira, Rian, Viswanadha, Arun, Wagner, Scott, Wamae, David, Weening, Alexander, Weidert, Simon, Wu, Wen-Tien, Wu, Meng-Huang, Yuan, Haifeng, Yuh, Sung-Joo, Yurac, Ratko, Zarate- Kalfopulos, Baron, Ziabrov, Alesksei, Zubairi, Akbar, AO Spine Cervical Classification Validation Group, Canseco, Jose A, Schroeder, Gregory D, Patel, Parthik D, Grasso, Giovanni, Chang, Michael, Kandziora, Frank, Vialle, Emiliano N, Oner, F Cumhur, Schnake, Klaus J, Dvorak, Marcel F, Chapman, Jens R, Benneker, Lorin M, Rajasekaran, Shanmuganathan, Kepler, Christopher K, Vaccaro, Alexander R, Canseco J.A., Schroeder G.D., Patel P.D., Grasso G., Chang M., Kandziora F., Vialle E.N., Oner F.C., Schnake K.J., Dvorak M.F., Chapman J.R., Benneker L.M., Rajasekaran S., Kepler C.K., Vaccaro A.R., Abdelgawaad A., Abdul W., Abdulsalam A., Abeid M., Ackshota N., Acosta O., Akman Y., Aldahamsheh O., Alhammoud A., Aleixo H., Alexander H., Alkharsawi M., Alsammak W., Amadou H., Amin M., Arbatin J., Atan A., Athanasiou A., Bas P., Bazan P., Benzakour T., Benzarti S., Bernucci C., Bosco A., Butler J., Castillo A., Cawley D., Chek W., Chen J., Cheng C., Cheung J., Chong C., Corluka S., Corredor J., Costa B., Curri C., Dawoud A., Delgado-Fernandez J., Demiroz S., Desai A., Diez-Ulloa M., Dimas N., Diniz S., Direito-Santos B., Duerinck J., El-Hewala T., El-Shamly M., El-Sharkawi M., Espinosa G., Estefan M., Fang T., Fernandes M., Fernandez N., Ferreira M., Figueiredo A., Fiorenza V., Francis J., Franz S., Freedman B., Fu L., Fuego S., Gahlot N., Ganau M., Garcia-Pallero M., Garg B., Gidvani S., Giera B., Godinho A., Goni M., Gonzalez M., Gopalakrishnan D., Grin A., Grozman S., Gruenberg M., Grundshtein A., Guasque J., Guerra O., Guiroy A., Hackla S., Harris C., Harrop J., Hassan W., Henine A., Hickman Z., Igualada C., James A., Jetjumnong C., Kaen A., Karmacharya B., Kilincer C., Klezl Z., Koerner J., Konrads C., Krappel F., Kruyt M., Krywinski F., Kundangar R., Landriel F., Lindtner R., Linhares D., Llombart-Blanco R., Lopez W., Lotan R., Lourido J., Luna L., Magashi T., Majer C., Mandizvidza V., Manilha R., Mannara F., Margetis K., Medina F., Milano J., Miyakoshi N., Moisa H., Montemurro N., Montoya J., Morais J., Morande S., Msuya S., Mubarak M., Mulbah R., Murugan Y., Nacer M., Neves N., Nicassio N., Niemeier T., Olorunsogo M., Orosco D., Ozdener K., Paez R., Panchal R., Paterakis K., Pemovska E., Pereira P., Perovic D., Perozo J., Pershin A., Phedy P., Picazo D., Pitti F., Platz U., Pluderi M., Ponnusamy G., Popescu E., Ramakrishnan S., Ramieri A., Rebholz B., Ricciadri G., Ricciardi D., Robinson Y., Rodriguez L., Rogrigues-Pinto R., Romero I., Rosas R., Russo S., Rutges J., Sartor F., Schroeder G., Shariati B., Sharma J., Shoaib M., Smith S., Sorimachi Y., Sribastav S., Steiner C., Subbiah J., Suramanian P., Suri T., Tannoury C., Tokala D., Toluse A., Ungurean V., Vaccaro A., Vahl J., Valacco M., Valdez C., Vernengo-Lezica A., Veroni A., Vieira R., Viswanadha A., Wagner S., Wamae D., Weening A., Weidert S., Wu W.-T., Wu M.-H., Yuan H., Yuh S.-J., Yurac R., Zarate-Kalfopulos B., Ziabrov A., Zubairi A., Surgical clinical sciences, Neuroprotection & Neuromodulation, and Neurosurgery

Subjects
Cervical spine, Joint dislocations, Neck injuries, Spinal diseases, Spinal injuries, Trauma, medicine.medical_specialty, Facet (geometry), Neck injurie, Neuroscience(all), 610 Medicine & health, Experiential learning, Joint dislocation, 03 medical and health sciences, 0302 clinical medicine, Spinal disease, medicine, Humans, Orthopedics and Sports Medicine, 030212 general & internal medicine, Surgeons, Validation group, Spinal injurie, business.industry, Spine.cervical, medicine.disease, Preference, Spinal Fusion, Cervical Vertebrae, Physical therapy, Surgery, Neurosurgery, Anterior approach, business, 030217 neurology & neurosurgery
Abstract

Purpose The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon’s geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries. Methods A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options. Results A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected to initiate management of cervical facet dislocation injuries with an MRI, with 6 case exceptions. Overall, there was considerable agreement between American and European responders regarding management of these injuries, with only 3 cases exhibiting a significant difference. Additionally, results also exhibited considerable management agreement between those with ≤ 10 and > 10 years of practice experience, with only 2 case exceptions noted. Conclusion More than half of responders, regardless of geographical location or practice experience, identified MRI as a screening imaging modality when managing cervical facet dislocation injuries, regardless of the status of the spinal cord and prior to any additional intervention. Additionally, a majority of surgeons would elect an anterior approach for the surgical management of these injuries. The study found overall agreement in management preferences of cervical facet dislocation injuries around the globe.

Published
2020
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