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2. Safety and outcomes analysis: transcatheter implantation of autologous angiogenic cell precursors for the treatment of cardiomyopathy

Author

Jane R. Schubart, Amirhossein Zare, Roberto M. Fernandez-de-Castro, Hector Rosario Figueroa, Ina Sarel, Kelly Tuchman, Kaitlyn Esposito, Fraser C. Henderson, and Ernst von Schwarz

Subjects
Autologous hematopoietic stem cell, VEGF, Angiogenin, Cytokine IL-8, NF-kB, Anti-apoptosis, Medicine (General), R5-920, Biochemistry, QD415-436
Abstract

Abstract Background Stem cell transplantation is an emerging therapy for severe cardiomyopathy, proffering stem cell recruitment, anti-apoptosis, and proangiogenic capabilities. Angiogenic cell precursors (ACP-01) are autologous, lineage-specific, cells derived from a multipotent progenitor cell population, with strong potential to effectively engraft, form blood vessels, and support tissue survival and regeneration. Methods This IRB approved outcome analysis reports upon 74 consecutive patients who failed medical management for severe cardiomyopathy, and were selected to undergo transcatheter intramyocardial or intracoronary implantation of ACP-01. Serious adverse events (SAEs) were reported. Cell analysis was conducted for each treatment. The left ventricular ejection fraction (LVEF) was measured by multi-gated acquisition scan (MUGA) or echocardiogram at 4 months ± 1.9 months and 12 months ± 5.5 months. Patients reported quality of life statements at 6 months (± 5.6 months). Results Fifty-four of 74 patients met requirements for inclusion (48 males and five females; age 68.1 ± 11.3 years). The mean treatment cell number of 57 × 106 ACP-01 included 7.7 × 106 CD34 + and 21 × 106 CD31 + cells with 97.6% viability. SAEs included one death (previously unrecognized silent MI), ventricular tachycardia (n = 2) requiring cardioversion, and respiratory infection (n = 2). LVEF in the ischemic subgroup (n = 41) improved by 4.7% ± 9.7 from pre-procedure to the first follow-up (4 months ± 1.9 months) (p

Published
2023
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3. Chemokine CXCL16 Expression Suppresses Migration and Invasiveness and Induces Apoptosis in Breast Cancer Cells

Author

Yeying Fang, Fraser C. Henderson, Qiong Yi, Qianqian Lei, Yan Li, and Nianyong Chen

Subjects
Pathology, RB1-214
Abstract

Background. Increasing evidence argues that soluble CXCL16 promotes proliferation, migration, and invasion of cancer cells in vitro. However, the role of transmembrane or cellular CXCL16 in cancer remains relatively unknown. In this study, we determine the function of cellular CXCL16 as tumor suppressor in breast cancer cells. Methods. Expression of cellular CXCL16 in breast cancer cell lines was determined at both RNA and protein levels. In vitro and in vivo studies that overexpressed or downregulated CXCL16 were conducted in breast cancer cells. Results. We report differential expression of cellular CXCL16 in breast cancer cell lines that was negatively correlated with cell invasiveness and migration. Overexpression of CXCL16 in MDA-MB-231 cells led to a decrease in cell invasion and migration and induced apoptosis of the cells; downregulation of CXCL16 in MCF-7 cells increased cell migration and invasiveness. Consistent with the in vitro data, CXCL16 overexpression inhibited tumorigenesis in vivo. Conclusions. Cellular CXCL16 suppresses invasion and metastasis of breast cancer cells in vitro and inhibits tumorigenesis in vivo. Targeting of cellular CXCL16 expression is a potential therapeutic strategy for breast cancer.

Published
2014
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4. Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization

Author

Kelly Tuchman, Malini Narayanan, Fraser C. Henderson, Peter C. Rowe, Robert Rosenbaum, Clair Francomano, and Myles Koby

Subjects
Adult, Joint Instability, Male, medicine.medical_specialty, Lightheadedness, Adolescent, Atlanto-axial, Bone Screws, Joint Dislocations, Rotary subluxation, Syncope, 030218 nuclear medicine & medical imaging, Cohort Studies, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Vertigo, Dynamic imaging, medicine, Humans, C1-C2 fusion, Retrospective Studies, Subluxation, Neck pain, biology, business.industry, Alar ligament, General Medicine, Middle Aged, biology.organism_classification, medicine.disease, Surgery, medicine.anatomical_structure, Spinal Fusion, Treatment Outcome, Atlanto-Axial Joint, Joint pain, Rheumatoid arthritis, Original Article, Female, Neurology (clinical), Headaches, medicine.symptom, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

Atlanto-axial instability (AAI) is common in the connective tissue disorders, such as rheumatoid arthritis, and increasingly recognized in the heritable disorders of Stickler, Loeys-Dietz, Marfan, Morquio, and Ehlers-Danlos (EDS) syndromes, where it typically presents as a rotary subluxation due to incompetence of the alar ligament. This retrospective, IRB-approved study examines 20 subjects with Fielding type 1 rotary subluxation, characterized by anterior subluxation of the facet on one side, with anormal atlanto-dental interval. Subjects diagnosed with a heritable connective tissue disorder, and AAI had failed non-operative treatment and presented with severe headache, neck pain, and characteristic neurological findings. Subjects underwent a modified Goel-Harms posterior C1-C2 screw fixation and fusion without complication. At 15 months, two subjects underwent reoperation following a fall (one) and occipito-atlantal instability (one). Patients reported improvement in the frequency or severity of neck pain (P P = 0.001), headaches, pre-syncope, and lightheadedness (allP P = 0.01), and syncope, nausea, joint pain, and exercise tolerance (allP

Published
2020

5. Symptomatic : The Symptom-Based Handbook for Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders

Author

Clair A. Francomano, Alan J. Hakim, Lansdale G.S. Henderson, Fraser C. Henderson Sr, Clair A. Francomano, Alan J. Hakim, Lansdale G.S. Henderson, and Fraser C. Henderson Sr

Subjects
Joints--Hypermobility, Ehlers-Danlos syndrome
Abstract

Symptomatic: The Symptom-Based Handbook for Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders offers a novel approach structured around the panoply of 75 symptoms with which a person with Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorders (HSD) may present to a clinician. The content is arranged intuitively from head to feet, with each chapter integrating clinical case studies with a concise discussion and two important diagnostic tools: a simplified algorithm for diagnosing and treating each symptom and differential diagnoses and alternative explanations for their symptoms. This is a handbook that combines the expertise of some 70 leading clinicians, representing more than 30 specialties. This book is suited for clinicians who need a concise and straight-forward presentation of the various and complex symptoms they confront in their clinical practice. It brings forth a field of knowledge emerging from interdisciplinary collaboration despite the pressures of specialization that bridges gaps in understanding between the several dozen disciplines implicated in EDS and HSD. - A comprehensive compendium of the symptoms of EDS and HSD to aid clinicians and patients - Symptom-based chapters for ease of making a diagnosis - A case report, differential diagnosis, discussion, and diagnostic and treatment algorithm for each symptom

Published
2024

6. Refractory Syncope and Presyncope Associated with Atlantoaxial Instability: Preliminary Evidence of Improvement Following Surgical Stabilization

Author

Malini Narayanan, Kelly Tuchmann, Fraser C. Henderson, Clair A. Francomano, Robert Rosenbaum, Myles Koby, and Peter C. Rowe

Subjects
Adult, Joint Instability, Male, Down syndrome, Lightheadedness, Adolescent, Syncope, 03 medical and health sciences, Young Adult, 0302 clinical medicine, medicine, Humans, Retrospective Studies, Presyncope, biology, business.industry, Incidence, Syncope (genus), Dysautonomia, Retrospective cohort study, Middle Aged, medicine.disease, biology.organism_classification, Atlanto-Axial Joint, Atlantoaxial instability, 030220 oncology & carcinogenesis, Rheumatoid arthritis, Anesthesia, Surgery, Female, Spinal Diseases, Neurology (clinical), medicine.symptom, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery
Abstract

The proclivity to atlantoaxial instability (AAI) has been widely reported for conditions such as rheumatoid arthritis and Down syndrome. Similarly, we have found a higher than expected incidence of AAI in hereditary connective tissue disorders. We demonstrate a strong association of AAI with manifestations of dysautonomia, in particular syncope and lightheadedness, and make preliminary observations as to the salutary effect of surgical stabilization of the atlantoaxial motion segment.In an institutional review board-approved retrospective study, 20 subjects (16 women, 4 men) with hereditary connective tissue disorders had AAI diagnosed by computed tomography. Subjects underwent realignment (reduction), stabilization, and fusion of the C1-C2 motion segment. All subjects completed preoperative and postoperative questionnaires in which they were asked about performance, function, and autonomic symptoms, including lightheadedness, presyncope, and syncope.All patients with AAI reported lightheadedness, and 15 had refractory syncope or presyncope despite maximal medical management and physical therapy. Postoperatively, subjects reported a statistically significant improvement in lightheadedness (P = 0.003), presyncope (P = 0.006), and syncope (P = 0.03), and in the frequency (P0.05) of other symptoms related to autonomic function, such as nausea, exercise intolerance, palpitations, tremors, heat intolerance, gastroesophageal reflux, and sleep apnea.This study draws attention to the potential for AAI to present with syncope or presyncope that is refractory to medical management, and for surgical stabilization of AAI to lead to improvement of these and other autonomic symptoms.

Published
2020

7. Letter to the editor regarding 'Atlantoaxial dislocation due to os odontoideum in patients with Down's syndrome: literature review and case reports'

Author

Peter C. Rowe, Fraser C. Henderson, and Clair A. Francomano

Subjects
medicine.medical_specialty, Letter to the editor, S syndrome, Atlantoaxial dislocation, business.industry, General surgery, MEDLINE, Joint Dislocations, General Medicine, Os Odontoideum, Pediatrics, Perinatology and Child Health, medicine, Humans, In patient, Neurology (clinical), Neurosurgery, Down Syndrome, business, Axis, Cervical Vertebra
Published
2020

8. The Neurosurgical Intraoperative Checklist for Surgery of the Craniocervical Junction and Spine

Author

Fraser C. Henderson, Robert Rosenbaum, Malini Narayanan, John Mackall, and Clayton Korson

Subjects
medicine.medical_specialty, business.industry, General Engineering, Neurosurgery, Craniocervical junction, iatrogenic complication, 030204 cardiovascular system & hematology, Quality Improvement, spine, Checklist, Surgery, 03 medical and health sciences, 0302 clinical medicine, Spine surgery, Operating theater, Health care, medicine, craniocervical junction, Historical control, Surgical errors, quality control, business, checklist, 030217 neurology & neurosurgery
Abstract

Many sectors within healthcare have adapted checklists to improve quality control. Notwithstanding the reported successful implementation of surgical checklists in the operating theater, a dearth of literature addresses the specific challenges posed by complex surgery in the craniocervical junction and spine. The authors devised an intraoperative checklist to address the common errors and verify the completion of objectives unique to these surgeries. The data over six years is presented retrospectively; no historical control for comparison is available, as those omissions and surgical errors addressed by the checklist are not generally registered in any morbidity and mortality reports. Through six years and approximately 1200 surgeries, the checklist was implemented with 98% compliance. The checklist eliminated the occurrences of mundane surgical errors, minimized iatrogenic complications, and ensured completion of specific objectives. We discuss that preoperative checklists, now in general use in all hospitals, have not addressed the most common, intraoperative omissions. These technical omissions result in part from the complexity of spine surgery and directly impact the surgical outcome. The Neurosurgical Intraoperative Checklist is a practical, rapid, and comprehensive means to prevent common, avoidable errors and iatrogenic complications inherent to spine surgery.

Published
2020

9. Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization

Author

Sunil J. Patel, K. Tuchman, Clair A. Francomano, J. Adcock, Fraser C. Henderson, and Myles Koby

Subjects
Adult, Joint Instability, Male, medicine.medical_specialty, Adolescent, Clivo-axial angle, Medullary cavity, Visual analogue scale, Craniocervical instability, 030218 nuclear medicine & medical imaging, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Vertigo, Deformity, Humans, Medicine, Kyphosis, Child, Connective Tissue Diseases, Chiari malformation, biology, business.industry, Occiput, Syndrome, General Medicine, Middle Aged, Cervical medullary syndrome, biology.organism_classification, medicine.disease, Magnetic Resonance Imaging, Arnold-Chiari Malformation, Surgery, Spinal Fusion, Treatment Outcome, medicine.anatomical_structure, Ehlers–Danlos syndrome, Female, Original Article, Neurology (clinical), Neurosurgery, medicine.symptom, Tomography, X-Ray Computed, Ehlers-Danlos syndrome, business, 030217 neurology & neurosurgery, Brain Stem, Follow-Up Studies
Abstract

A great deal of literature has drawn attention to the “complex Chiari,” wherein the presence of instability or ventral brainstem compression prompts consideration for addressing both concerns at the time of surgery. This report addresses the clinical and radiological features and surgical outcomes in a consecutive series of subjects with hereditary connective tissue disorders (HCTD) and Chiari malformation. In 2011 and 2012, 22 consecutive patients with cervical medullary syndrome and geneticist-confirmed hereditary connective tissue disorder (HCTD), with Chiari malformation (type 1 or 0) and kyphotic clivo-axial angle (CXA) enrolled in the IRB-approved study (IRB# 10-036-06: GBMC). Two subjects were excluded on the basis of previous cranio-spinal fusion or unrelated medical issues. Symptoms, patient satisfaction, and work status were assessed by a third-party questionnaire, pain by visual analog scale (0–10/10), neurologic exams by neurosurgeon, function by Karnofsky performance scale (KPS). Pre- and post-operative radiological measurements of clivo-axial angle (CXA), the Grabb-Mapstone-Oakes measurement, and Harris measurements were made independently by neuroradiologist, with pre- and post-operative imaging (MRI and CT), 10/20 with weight-bearing, flexion, and extension MRI. All subjects underwent open reduction, stabilization occiput to C2, and fusion with rib autograft. There was 100% follow-up (20/20) at 2 and 5 years. Patients were satisfied with the surgery and would do it again given the same circumstances (100%). Statistically significant improvement was seen with headache (8.2/10 pre-op to 4.5/10 post-op, p

Published
2019
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10. Optimizing Alignment Parameters During Craniocervical Stabilization and Fusion: A Technical Note

Author

Malini Narayanan, Myles Koby, Fraser C. Henderson, Robert Rosenbaum, and John Mackall

Subjects
gaze angle, medicine.medical_specialty, Medullary cavity, Dynamic imaging, Radiography, medicine.medical_treatment, Neurosurgery, craniocervical reduction, harris measurement, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, craniocervical fusion, grabb-oakes measurement, Medicine, Reduction (orthopedic surgery), Foramen magnum, clival-axial angle, mandible-axial angle, business.industry, dynamic imaging, craniocervical alignment, General Engineering, orbital-axial angle, Technical note, Dysphagia, Gaze, medicine.anatomical_structure, Neurology, Radiology, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Proper craniocervical alignment during craniocervical reduction, stabilization, and fusion optimizes cerebrospinal fluid (CSF) flow through the foramen magnum, establishes the appropriate "gaze angle", avoids dysphagia and dyspnea, and, most importantly, normalizes the clival-axial angle (CXA) to reduce ventral brainstem compression. To illustrate the metrics of reduction that include CXA, posterior occipital cervical angle, orbital-axial or "gaze angle", and mandible-axial angle, we present a video illustration of a patient presenting with signs and symptoms of the cervical medullary syndrome along with concordant radiographic findings of craniocervical instability as identified on dynamic imaging and through assessment of the CXA, Harris, and Grabb-Oakes measurements.

Published
2020
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12. Comment on 'Quantitative measures of tissue mechanics to detect hypermobile Ehlers-Danlos syndrome and hypermobility syndrome disorders: a systematic review'

Author

Irfan Malik, Fraser C. Henderson, Alan Hakim, Rodney Grahame, and Myles Koby

Subjects
medicine.medical_specialty, business.industry, MEDLINE, Hypermobility syndrome, Joint instability, General Medicine, medicine.disease, Dermatology, Rheumatology, Ehlers–Danlos syndrome, Internal medicine, medicine, Tissue mechanics, business
Published
2020
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16. Contributors

Author

Khalid M. Abbed, Kalil G. Abdullah, Paul D. Ackerman, Yunus Alapan, Vincent J. Alentado, Matthew D. Alvin, Christopher P. Ames, Neel Anand, Paul A. Anderson, Lilyana Angelov, Alireza K. Anissipour, John A. Anson, Ronald I. Apfelbaum, Michael Archdeacon, Paul M. Arnold, Mike W.J. Arun, Harel Arzi, Ahmed J. Awad, Basem I. Awad, Biji Bahuleyan, Mark D. Bain, Lissa C. Baird, Jamie Baisden, Nevan G. Baldwin, Perry A. Ball, Karl E. Balsara, Eli M. Baron, H. Hunt Batjer, Andrew M. Bauer, Thomas W. Bauer, Joshua M. Beckman, Gordon R. Bell, Carlo Bellabarba, E. Emily Bennett, Edward C. Benzel, Darren L. Bergey, Tarun Bhalla, Karin S. Bierbrauer, Mark Bilsky, Harjus Birk, Erica F. Bisson, Christopher Bono, Richard J. Bransford, Darrel S. Brodke, Nathaniel Brooks, Cristian Brotea, Jared R. Brougham, Samuel R. Browd, Robert T. Buckley, Shane Burch, John Butler, Mohamad Bydon, Steven Casha, Jeroen Ceuppens, Andrew K. Chan, Thomas C. Chen, Joseph Cheng, Dean Chou, Tanvir Choudhri, Aaron J. Clark, Adam M. Conley, Paul R. Cooper, Domagoj Coric, Mark Corriveau, Ian P. Côté, Jean-Valery C.E. Coumans, Charles H. Crawford, William T. Curry, Scott D. Daffner, Sedat Dalbayrak, Russell C. DeMicco, Harel Deutsch, Sanjay S. Dhall, Denis J. DiAngelo, Curtis A. Dickman, Shah-Nawaz M. Dodwad, Siena M. Duarte, Zeyd Ebrahim, Gerald W. Eckardt, Bruce L. Ehni, Kurt M. Eichholz, Marc Eichler, Samer K. Elbabaa, Benjamin D. Elder, James B. Elder, Richard G. Ellenbogen, Nancy Epstein, Thomas J. Errico, Yoshua Esquenazi, Daniel K. Fahim, Ehab Farag, Chad W. Farley, Michael G. Fehlings, Frank Feigenbaum, Eoin Fenton, Lisa A. Ferrara, R. David Fessler, Richard G. Fessler, Michael A. Finn, Ryan Finnan, Jeffrey S. Fischgrund, Kevin T. Foley, Ricardo B.V. Fontes, Todd B. Francis, Brett A. Freedman, Frederick Frost, John George, John W. German, Peter C. Gerszten, George M. Ghobrial, Zoher Ghogawala, Justin L. Gibson, Christopher C. Gillis, Vijay K. Goel, Jan Goffin, Ziya L. Gokaslan, Sohrab Gollogly, C. Rory Goodwin, Carlos R. Goulart, Vadim Goz, Yair M. Gozal, Randall B. Graham, Gerald A. Grant, Jian Guan, Ilker Gulec, Yazeed M. Gussous, Richard D. Guyer, David Gwinn, Sung Ha, Eldad Hadar, Clayton L. Haldeman, Alexander Y. Halim, Kimberly M. Hamilton, Christine L. Hammer, Fadi Hanbali, Shannon W. Hann, Jurgen Harms, James S. Harrop, Blaine L. Hart, David J. Hart, Daniel Harwell, Reyaad A. Hayek, Robert F. Heary, Fraser C. Henderson, Patrick W. Hitchon, Daniel J. Hoh, Paul J. Holman, Noboru Hosono, Clifford Houseman, John K. Houten, Joseph C. Hsieh, Wellington K. Hsu, Meng Huang, R. John Hurlbert, Lee Hwang, Steven Hwang, Serkan İnceoğlu, Libby Kosnik Infinger, Tatiana von Hertwig Fernandes de Oliveira, Devesh Jalan, Neilank Jha, J. Patrick Johnson, Charles I. Jones, G. Alexander Jones, Michael Jones, Rupa G. Juthani, Christopher D. Kager, Maziyar A. Kalani, M. Yashar S. Kalani, Iain H. Kalfas, Ricky R. Kalra, Reza J. Karimi, Osama Kashlan, Manish K. Kasliwal, Vikas Kaul, Mayank Kaushal, Tyler J. Kenning, Saad Khairi, Tagreed Khalaf, Jad G. Khalil, Larry T. Khoo, Ali Kiapour, Daniel H. Kim, David H. Kim, Kristopher T. Kimmell, Steven Kirshblum, Sameer A. Kitab, Paul Klimo, Eric O. Klineberg, Tyler R. Koski, Thomas A. Kosztowski, Robert J. Kowalski, Ajit A. Krishnaney, Kelly Krupa, Kristin Krupa, Varun R. Kshettry, Sunil Kukreja, Charles Kuntz, Shekar N. Kurpad, Srinivasu Kusuma, Michael LaBagnara, Frank La Marca, Ilya Laufer, Elizabeth Demers Lavelle, William F. Lavelle, W. Thomas Lawrence, Darren R. Lebl, Bryan S. Lee, Sun-Ho Lee, Lawrence G. Lenke, Steven P. Leon, Amy Li, Yiping Li, Isador H. Lieberman, James K.C. Liu, Victor P. Lo, S. Scott Lollis, Miguel Lopez-Gonzalez, Daniel Lubelski, Mark G. Luciano, Andre G. Machado, Raghu Maddela, Ravichandra A. Madineni, Casey Madura, Dennis J. Maiman, David G. Malone, Antonios Mammis, Satyajit Marawar, Nicolas Marcotte, Joseph C. Maroon, Michael D. Martin, Eduardo Martinez-del-Campo, Eric M. Massicotte, Tobias A. Mattei, Paul K. Maurer, Eric A.K. Mayer, Miguel Mayol del Valle, Daniel J. Mazanec, Paul C. McCormick, William McCormick, Zachary A. Medress, Ehud Mendel, Umesh S. Metkar, Vincent J. Miele, Ahmed Mohyeldin, Jad Bou Monsef, Timothy A. Moore, Hikaru Morisue, Peter Morone, Thomas E. Mroz, Jeffrey P. Mullin, F. Reed Murtagh, Ryan D. Murtagh, Sait Naderi, Usha D. Nagaraj, Charles C. Nalley, Anil Nanda, Richard J. Nasca, Anick Nater, Matthew T. Neal, Russ P. Nockels, John A. Norwig, Solomon M. Ondoma, Akinwunmi Oni-Orisan, Jonathan H. Oren, Jennifer Orning, R. Douglas Orr, Katie Orrico, Joseph A. Osorio, Ernesto Otero-Lopez, John O'Toole, Paul Park, Vikas Parmar, Robert S. Pashman, Rakesh D. Patel, Smruti K. Patel, Mick J. Perez-Cruet, Noel I. Perin, David B. Pettigrew, H. Westley Phillips, Rick Placide, Paul Porensky, Joshua P. Prager, Srinivas Prasad, Mark L. Prasarn, Rakesh Ramakrishnan, Ashwin G. Ramayya, Y. Raja Rampersaud, Peter A. Rasmussen, John K. Ratliff, Wolfgang Rauschning, Glenn R. Rechtine, Pablo F. Recinos, Daniel K. Resnick, Jay Rhee, Laurence D. Rhines, Alexander R. Riccio, Marlin Dustin Richardson, Bertram Richter, Ron Riesenburger, K. Daniel Riew, Matthew Rogers, Fanor M. Saavedra, Mina G. Safain, Rajiv Saigal, Paul D. Sawin, Justin K. Scheer, Joshua Scheidler, David W. Schippert, Richard Schlenk, Bradley Schmidt, Meic H. Schmidt, Daniel M. Sciubba, Christopher I. Shaffrey, Mark E. Shaffrey, Anoli Shah, Alok Sharan, Ashwini D. Sharan, Daniel Shedid, Steven Shook, Michael P. Silverstein, Venita M. Simpson, Anthony Sin, Harminder Singh, Donald A. Smith, Gabriel A. Smith, Justin S. Smith, Kyle A. Smith, Volker K.H. Sonntag, Hector Soriano-Baron, Robert F. Spetzler, W. Ryan Spiker, Blake Staub, Michael P. Steinmetz, Charles B. Stillerman, Andrea Strayer, Gandhivarma Subramaniam, Hamdi G. Sukkarieh, Andrew Sumich, Derrick Y. Sun, Tarek P. Sunna, Durga R. Sure, Richard A. Tallarico, Lee A. Tan, Claudio E. Tatsui, Fernando Techy, Nicholas Theodore, Alexander A. Theologis, Nicholas W.M. Thomas, Brian D. Thorp, Scott Tintle, Stavropoula Tjoumakaris, William D. Tobler, Daisuke Togawa, David Traul, Vincent C. Traynelis, A. Sophia Tritle, Gregory R. Trost, Eve C. Tsai, Kene Ugokwe, Kutlauy Uluc, Juan S. Uribe, Alexander R. Vaccaro, Alex Valadka, Aditya Vedantam, Anand Veeravagu, Kushagra Verma, Todd Vitaz, Jean-Marc Voyadzis, Scott Wagner, Trevor C. Wahlquist, Robert Waldrop, Kevin M. Walsh, Jeffrey C. Wang, Michael Y. Wang, Patrick T. Wang, John D. Ward, Zabi Wardak, Connor Wathen, Philip R. Weinstein, Michael Weisman, William C. Welch, Simcha J. Weller, L. Erik Westerlund, Jonathan A. White, Robert G. Whitmore, Jack E. Wilberger, Kim A. Williams, Ethan A. Winkler, Christopher D. Witiw, Christopher E. Wolfla, Jean-Paul Wolinsky, Cyrus Wong, Eric J. Woodard, Vijay Yanamadala, Daniel S. Yanni, Philip A. Yazbak, Chun-Po Yen, Mesut Yilmaz, Narayan Yoganandan, Kenneth S. Yonemura, Kazuo Yonenobu, Hansen A. Yuan, John K. Yue, Adam M. Zanation, Salvatore M. Zavarella, Seth M. Zeidman, Mehmet Zileli, Scott Zuckerman, and Holly Zywicke

Published
2017
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17. Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review

Author

Fraser C. Henderson, William A. Wilson, Alexander S. Mark, and Myles Koby

Subjects
Male, Dynamic MRI, Pilot Projects, Craniocervical instability, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Medicine, Prospective Studies, Cervical Atlas, Pain Measurement, Aged, 80 and over, Brainstem deformation, General Medicine, Middle Aged, Cervical medullary syndrome, medicine.anatomical_structure, Treatment Outcome, Cohort, Dynamic contrast-enhanced MRI, Female, Original Article, Neurosurgery, medicine.symptom, Adult, medicine.medical_specialty, SF-36, Clivo-axial angle, Vertebral artery, Clinical Neurology, Basilar invagination, 03 medical and health sciences, Young Adult, medicine.artery, Deformity, Humans, Kyphosis, Aged, business.industry, Spinal cord, medicine.disease, Surgery, Spinal Fusion, Cranial Fossa, Posterior, Neurology (clinical), business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Brain Stem
Abstract

There is growing recognition of the kyphotic clivo-axial angle (CXA) as an index of risk of brainstem deformity and craniocervical instability. This review of literature and prospective pilot study is the first to address the potential correlation between correction of the pathological CXA and postoperative clinical outcome. The CXA is a useful sentinel to alert the radiologist and surgeon to the possibility of brainstem deformity or instability. Ten adult subjects with ventral brainstem compression, radiographically manifest as a kyphotic CXA, underwent correction of deformity (normalization of the CXA) prior to fusion and occipito-cervical stabilization. The subjects were assessed preoperatively and at one, three, six, and twelve months after surgery, using established clinical metrics: the visual analog pain scale (VAS), American Spinal InjuryAssociation Impairment Scale (ASIA), Oswestry Neck Disability Index, SF 36, and Karnofsky Index. Parametric and non-parametric statistical tests were performed to correlate clinical outcome with CXA. No major complications were observed. Two patients showed pedicle screws adjacent to but not deforming the vertebral artery on post-operative CT scan. All clinical metrics showed statistically significant improvement. Mean CXA was normalized from 135.8° to 163.7°. Correction of abnormal CXA correlated with statistically significant clinical improvement in this cohort of patients. The study supports the thesis that the CXA maybe an important metric for predicting the risk of brainstem and upper spinal cord deformation. Further study is feasible and warranted.

Published
2016

18. Cranio-cervical Instability in Patients with Hypermobility Connective Disorders

Author

Fraser C. Henderson

Subjects
musculoskeletal diseases, medicine.medical_specialty, business.industry, Connective tissue, medicine.disease, Dermatology, Joint laxity, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Osteogenesis imperfecta, Rheumatoid arthritis, medicine, Spinal canal, In patient, 030212 general & internal medicine, business, Pathological, 030217 neurology & neurosurgery, Hypermobility (travel)
Abstract

Cranio-cervical instability is well documented in connective tissue disorders such as rheumatoid arthritis, systemic lupus, and genetic disorders such as Down’s syndrome and Osteogenesis Imperfecta. However, less understood are the more than fifty genetic disorders of collagen characterized by joint laxity, and of course, laxity of the ligaments of the spine. Given the propensity in these patients for spinal instability, it is not surprising that the most severe symptoms arise in the most mobile part of the spine, the cranio-cervical junction. The increased recognition of hypermobility syndromic disorders, of which Ehlers Danlos Syndome (EDS) is emblematic, has prompted questions and concern as to what constitutes pathological instability in this category of patient, and how best to diagnose this instability.

Published
2016
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20. Contributors

Author

Mark F. Abel, Kuniyoshi Abumi, Mark S. Adams, Cary D. Alberstone, Joseph T. Alexander, John A. Anson, Ronald I. Apfelbaum, Paul M. Arnold, L. Brett Babat, Julian E. Bailes, Jamie Baisden, Nevan G. Baldwin, Perry A. Ball, Giancarlo Barolat, H. Hunt Batjer, Thomas W. Bauer, James R. Bean, Brion J. Beerle, Gordon R. Bell, Gregory J. Bennett, Edward C. Benzel, Darren Bergey, Marc L. Bertrand, Mark H. Bilsky, Barry D. Birch, Robert S. Biscup, Kevin Blaylock, Oheneba Boachie-Adjei, Maxwell Boakye, Scott D. Boden, Henry Bohlman, Michael Bolesta, Mary B. Bondy, Christopher M. Boxell, Keith H. Bridwell, Darrell S. Brodke, James Butler, David W. Cahill, Robert C. Cantu, Allen L. Carl, John A. Carrino, John R. Caruso, Andrew G. Chenelle, Joseph S. Cheng, Yong-Jun Cho, Tanvir F. Choudhri, Frank Conguista, Edward S. Connolly, Paul R. Cooper, Jean-Valéry C.E. Coumans, Albert E. Cram, H. Alan Crockard, Richard Crownover, Bryan W. Cunningham, William T. Curry, Joseph F. Cusick, Scott D. Daffner, Mark D. D'Alise, Vinay Deshmukh, Denis DiAngelo, Curtis A. Dickman, Thomas B. Ducker, Scott T. Dull, Stewart B. Dunsker, Michael J. Ebersold, Jason Eckhardt, Bruce L. Ehni, Matthew Eichenbaum, Kurt M. Eichholz, Marc E. Eichler, Samer K. Elbabaa, Sanford E. Emery, Nancy E. Epstein, Jennifer Erdos, Thomas J. Errico, Tom Faciszewski, Michael G. Fehlings, Lisa A. Ferrara, Richard G. Fessler, Kevin T. Foley, Robert M. Galler, John W. German, Alexander J. Ghanayem, Zoher Ghogawala, Vijay K. Goel, Jan Goffin, Ziya L. Gokaslan, Sohrab Gollogly, Jorge Gonzalez-Martinez, James E. Greensmith, Jeffrey D. Gross, Regis W. Haid, Andrea L. Halliday MD, Allan J. Hamilton, Fadi Hanbali, Jürgen Harms, James S. Harrop, Blaine I. Hart, Robert A. Hart, Robert F. Heary, Fraser C. Henderson, Patrick W. Hitchon, James P. Hollowell, Paul J. Holman, John K. Houten, Robert E. Isaacs, Manabu Ito, John A. Jane, J. Patrick Johnson, Christopher Kager, Iain H. Kalfas, George J. Kaptain, Saad Khairi, Daniel H. Kim, David H. Kim, Thomas A. Kopitnik, Robert J. Kowalski, Ajit A. Krishnaney, John A. Lancon, Giuseppe Lanzino, Sanford J. Larson, Jorge Lastra-Power, Nathan H. Lebwohl, Isador H. Lieberman, Donlin M. Long, Mark G. Luciano, Charles A. Luevano, Parley M. Madsen III, Dennis J. Maiman, Jacek M. Malik, David G. Malone, Joseph C. Maroon, Eric M. Massicotte, Shunji Matsunaga, Daniel J. Mazanec, Paul C. McAfee, Bruce M. McCormack, Paul C. McCormick, William E. McCormick, Robert A. McGuire, Robert F. McLain, Nagy Mekhail, D. Mark Melton, Carole A. Miller, Jared H. Miller, Sung Min, William Mitchell, Junichi Mizuno, Michael T. Modic, Howard W. Morgan, Robert J. Morlock, Michael A. Morone, Wade M. Mueller, Praveen V. Mummaneni, John S. Myseros, Sait Naderi, Dileep Nair, Hiroshi Nakagawa, Jaime H. Nieto, Russ P. Nockels, Bruce E. Northrup, Chima Ohaegbulam, Tunc Oktenoglu, Bernardo Jose Ordonez, Jeffrey H. Owen, A. Fahir Özer, Stephen M. Papadopoulos, Christopher G. Paramore, Robert S. Pashman, Warwick J. Peacock, Stanley Pelofsky, Noel I. Perin, Christopher J. Pham, Rick J. Placide, Branko Prpa, Gregory J. Przybylski, Ashraf A. Ragab, Y. Raja Rampersaud, Peter A. Rasmussen, Richard B. Raynor, Gary L. Rea, Glenn R. Rechtine, John Regan, Setti S. Rengachary, Daniel K. Resnick, Laurence D. Rhines, Albert J. Rhoton, Donna J. Rodriguez, Gerald E. Rodts, Michael J. Rosner, Alexander Sah, Jared P. Salinsky, Paul Santiago, Mehdi Sarkarati, Richard L. Saunders, Paul D. Sawin, Edward H. Scheid, Meic H. Schmidt, Michael Schneier, Dilip K. Sengupta, Christopher I. Shaffrey, Mark E. Shaffrey, Alok D. Sharan, Ashwini D. Sharan, Christopher B. Shields, Frederick A. Simeone, Kern Singh, Ran Vijai P. Singh, Donald A. Smith, Maurice M. Smith, Volker K.H. Sonntag, Ivan J. Sosa, Micheal J. Speck, Robert F. Spetzler, Sudhakar T. Sridharan, Loretta A. Staudt, Michael P. Steinmetz, Charles B. Stillerman, Kota Suda, Sonia Suys, George W. Sypert, Charles H. Tator, Nicholas Theodore, Ajith J. Thomas, Nicholas W.M. Thomas, Robert E. Tibbs, Daisuke Togawa, Frank J. Tomecek, Richard M. Toselli, Vincent C. Traynelis, Gregory R. Trost, Eeric Truumees, Gary W. Tye, Abm Salah Uddin, Alexander R. Vaccaro, Ceslovas Vaicys, Alex Valadka, Arnold B. Vardiman, Anthony A. Virella, Elizabeth Vitarbo, Todd W. Vitaz, Dennis G. Vollmer, Jean-Marc Voyadzis, John D. Ward, Joseph Watson, John K. Webb, Philip R. Weinstein, Martin W. Weiser, William C. Welch, Simcha J. Weller, L. Erik Westerlund, Jonathan A. White, Melvin D. Whitfield, Gregory C. Wiggins, Jack E. Wilberger, William S. Wilke, Diana Barrett Wiseman, W. Putnam Wolcott, Eric J. Woodard, Philip Yazback, Narayan Yoganandan, Kenneth S. Yonemura, Kazuo Yonenobu, Hansen A. Yuan, Seth M. Zeidman, Barry M. Zide, and Mehmet Zileli

Published
2005
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21. Stretch-associated injury in cervical spondylotic myelopathy: new concept and review

Author

Fraser C, Henderson, Jennian F, Geddes, Alexander R, Vaccaro, Eric, Woodard, K Joel, Berry, and Edward C, Benzel

Subjects
Spinal Osteophytosis, Cervical Vertebrae, Humans, Spondylolysis, Spinal Cord Compression, Spinal Cord Injuries, Biomechanical Phenomena
Abstract

The simple pathoanatomic concept that a narrowed spinal canal causes compression of the enclosed cord, leading to local tissue ischemia, injury, and neurological impairment, fails to explain the entire spectrum of clinical findings observed in cervical spondylotic myelopathy. A growing body of evidence indicates that spondylotic narrowing of the spinal canal and abnormal or excessive motion of the cervical spine results in increased strain and shear forces that cause localized axonal injury within the spinal cord. During normal motion, significant axial strains occur in the cervical spinal cord. At the cervicothoracic junction, where flexion is greatest, the spinal cord stretches 24% of its length. This causes local spinal cord strain. In the presence of pathological displacement, strain can exceed the material properties of the spinal cord and cause transient or permanent neurological injury. Stretch-associated injury is now widely accepted as the principal etiological factor of myelopathy in experimental models of neural injury, tethered cord syndrome, and diffuse axonal injury. Axonal injury reproducibly occurs at sites of maximal tensile loading in a well-defined sequence of intracellular events: myelin stretch injury, altered axolemmal permeability, calcium entry, cytoskeletal collapse, compaction of neurofilaments and microtubules, disruption of anterograde axonal transport, accumulation of organelles, axon retraction bulb formation, and secondary axotomy. Stretch and shear forces generated within the spinal cord seem to be important factors in the pathogenesis of cervical spondylotic myelopathy.

Published
2004

22. Use of the telescopic plate spacer in treatment of cervical and cervicothoracic spine tumors

Author

Jean-Valéry C E, Coumans, Connie P, Marchek, and Fraser C, Henderson

Subjects
Adult, Aged, 80 and over, Bone Transplantation, Spinal Neoplasms, Goats, Equipment Design, Middle Aged, Thoracic Vertebrae, Biomechanical Phenomena, Orthopedic Fixation Devices, Materials Testing, Cervical Vertebrae, Animals, Humans, Bone Plates, Aged
Abstract

We investigated the mechanical and in vivo properties of a novel device, called the telescopic plate spacer (TPS), designed to promote restoration of height, alignment, and stability after cervical corpectomy for tumor.The device first underwent mechanical testing. Comparisons were made with a commercially available anterior cervical plate. A caprine study was then performed. Twelve goats underwent a cervical corpectomy and placement of either a TPS filled with autograft or a plate and autograft. The animals were killed at 28 weeks and assessed for fusion. A prospective human study was then conducted. Fifteen patients with cervical or cervicothoracic tumors underwent corpectomy and placement of allograft-filled TPS. End points included pain scores and radiographic assessment of vertebral height, alignment, and stability.In the mechanical study, the TPS outperformed the anterior cervical plate in all modalities except for torsion stiffness and tension-bending failure load. The caprine study demonstrated fusion in six of six cases at 28 weeks in the TPS group, compared with four of six cases in the plate and autograft group. In the human study, patients (n = 15) were stabilized with the TPS after corpectomy (range, 1-3 levels; average, 1.7 levels). There were no failures of instrumentation or neurological deterioration. Stability was achieved in all patients, with an average follow-up of 9 months. Durable improvements in pain scores (P = 0.001), vertebral height (P = 0.002), and reduction of kyphosis (P = 0.046) were achieved.The TPS can be used to restore height, alignment, and stability after corpectomy.

Published
2001

23. Introduction

Author

Fraser C. Henderson and Christopher Kalhorn

Subjects
Orthopedics and Sports Medicine, Surgery
Published
2005
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