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Clinical Spine Surgery Editor-in-Chief: Alexander R. Vaccaro, MD, PhD Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.

Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews sect

ion. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology.

Houten et al review degenerative cervical myelopathy (DCM) in December’s Clinical Spine Surgery. DCM is characterized by...
09/12/2022

Houten et al review degenerative cervical myelopathy (DCM) in December’s Clinical Spine Surgery. DCM is characterized by central canal stenosis caused by spondylosis, flavum hypertrophy and ossification, as well as ossification of the posterior longitudinal ligament. Patients with DCM may present with distal upper extremity numbness and weakness. In its severe form, DCM causes gait incoordination, bowel/bladder dysfunction and quadraparesis. The authors review clinical evaluation tools like the modified Japanese Orthoapedic Association score that groups patients into mild (15-17), moderate (12-14) and severe (

Moawad et al. review a case series of 36 patients who underwent short-segment fixation of low-lumbar (L3-5) burst fractu...
20/09/2022

Moawad et al. review a case series of 36 patients who underwent short-segment fixation of low-lumbar (L3-5) burst fractures in this month's CSS. The authors discuss incidence, surgical management, and outcome for this technique. Their series describes pedicle-screw instrumentation of the levels above, in (when possible), and below the injured segment. They report an 86.1% fusion rate and 11.1% stable pseudoarthrosis rate. At one-year follow-up, 70.6% of patients had no back pain, 14.7% had mild back pain, and 14.7% had moderate back pain. Head to the CSS website (link in bio) for the free article.

Drs. Vaccaro, Schroeder et al. describe a new AO upper cervical spine classification system in this month's Clinical Spi...
04/07/2022

Drs. Vaccaro, Schroeder et al. describe a new AO upper cervical spine classification system in this month's Clinical Spine Surgery in an article entitled "Update on Upper Cervical Injury Classifications: The New AO Upper Cervical Spine Classification System." There are many classification schemes that individually describe various upper cervical spine injuries. These authors attempt to unify and simplify upper cervical spine trauma into a repeatable, reliable AO classification system. Injuries are classified by Type (I, II, or III) with a letter grade (A, B, or C). Type I: occipital condyle and craniocervical junction. Type II: C1 ring and C1-2 joint. Type III: C2 and C2-3 joint. The type is followed by an A (isolated bony), B (ligamentous or tension-band injuries), or C (rotationally/translationally unstable) designation. The authors' initial attempt at validation was performed with 4 senior spine surgeons and 4 senior neurosurgery residents and achieved excellent reliability. Head to CSS (link in bio) for the full article.

Authors Zavras et al. performed a prospective RCT with 46 patients randomized into 1 and 2-level ACDFs performed with pl...
23/05/2022

Authors Zavras et al. performed a prospective RCT with 46 patients randomized into 1 and 2-level ACDFs performed with plate supplementation versus stand-alone interbody devices for degenerative cervical conditions. The authors found worse transient dysphagia in both 1 and 2-level ACDFs performed with anterior plating, but these differences were no longer detectable at final follow up. Conversely, patients treated with anterior plating had less initial neck pain and better early neck patient reported outcomes, possibly due to added mechanical stability. Head to this month’s Clinical Spine Surgery for the full article.

Second panel: aseptic screw loosening and subsidence seen in the stand-alone group. No significant differences in complications were seen between groups.

Authors Donnally et al review cervical myelopathy in this month's Clinical Spine Surgery. Cervical Spondylotic Myelopath...
08/02/2022

Authors Donnally et al review cervical myelopathy in this month's Clinical Spine Surgery. Cervical Spondylotic Myelopathy (CSM) is attributed to several static, dynamic, and vascular factors. Osteophyte formation, ligamentous hypertrophy, ossification of the posterior longitudinal ligament, disk herniation, morphological changes to the vertebral body, cervical flexion/extension, and vascular insufficiency have each been associated with CSM. Patients with CSM may present with decreased hand dexterity, gait imbalance, upper/lower extremity numbness, bowel/bladder incontinence, neck pain, and Lhermitte's sign; characteristic physical exam findings are described. Patients with moderate-to-severe myelopathy usually do not fully recover neurologic function post-operatively, leading the authors to conclude that early surgical intervention is warranted. Surgical options including anterior cervical discectomy and fusion, cervical disc arthroplasty, cervical corpectomy, posterior laminectomy and instrumented fusion, as well as laminoplasty all serve a role in treatment of this condition. Head on over to Clinical Spine Surgery (link in bio) for the free article.

Authors Donnally et al review cervical myelopathy in this month's Clinical Spine Surgery. Cervical Spondylotic Myelopath...
08/02/2022

Authors Donnally et al review cervical myelopathy in this month's Clinical Spine Surgery. Cervical Spondylotic Myelopathy (CSM) is attributed to several static, dynamic, and vascular factors. Osteophyte formation, ligamentous hypertrophy, ossification of the posterior longitudinal ligament, disk herniation, morphological changes to the vertebral body, cervical flexion/extension, and vascular insufficiency have each been associated with CSM. Patients with CSM may present with decreased hand dexterity, gait imbalance, upper/lower extremity numbness, bowel/bladder incontinence, neck pain, and Lhermitte's sign; characteristic physical exam findings are described. Patients with moderate-to-severe myelopathy usually do not fully recover neurologic function post-operatively, leading the authors to conclude that early surgical intervention is warranted. Surgical options including anterior cervical discectomy and fusion, cervical disc arthroplasty, cervical corpectomy, posterior laminectomy and instrumented fusion, as well as laminoplasty all serve a role in treatment of this condition. Head over to Clinical Spine Surgery (link in bio) for the free article. 

Drs. Virk et al. examine the impact of rod configuration on the incidence of rod fracture in patients undergoing three-c...
31/12/2021

Drs. Virk et al. examine the impact of rod configuration on the incidence of rod fracture in patients undergoing three-column osteotomy for adult spinal deformity. Applying principles learned from external fixation of long bones, the authors posit that increased fixation points, rod diameter, number of rod, rod working length between adjacent pedicle screws, and multiaxial rod placement can provide a stronger construct which in turn can reduce hardware failure. For example, in the first image, the patient in figure B with a decreased distance between pedicle screws surrounding the three-column osteotomy site sustained a rod fracture, whereas the patient in figure A did not. Ultimately, the authors conclude that Arbeitsgemeinschaft Osteosynthesefragen (AO) principles can be applied to fixation around a three-column osteotomy site and reduce rod fracture rates. Look for this article in the next issue of Clinical Spine Surgery.

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