One Hundred Top Cited Articles in Cervical Myelopathy: A Bibliographic Analysis.

STUDY DESIGN: A bibliometric review of the literature. OBJECTIVES: The aim of this study was to identify the most highly cited articles relating to cervical myelopathy and to analyze the most influential articles. SUMMARY OF BACKGROUND DATA: Over the past several decades, a lot of research has been conducted regarding the subject of cervical myelopathy. Although there are a large number of articles on this topic, to our knowledge, this is the first bibliometric analysis. METHODS: A selection of search terms and keywords were inputted into the "Dimensions" database and the most highly cited articles in cervical myelopathy were selected from high impact factor journals. The top 100 articles were analyzed for year of publication, authorship, publishing journals, institution and country of origin, subject matter, article type, and level of evidence. RESULTS: The 100 most cited articles in the topic of cervical myelopathy were published from 1956 to 2015. These articles, their corresponding authors, and number of citations are shown in Table 1. The number of citations ranged from 121 times for the 100th article to 541 times for the top article in a total of 20 journals. The most common topic was operative technique, whereas the journals which contributed the most articles were the Spine journal and the Journal of Neurosurgery. CONCLUSION: Our study provided an extensive list of the most historically significant articles regarding cervical myelopathy, acknowledging the key contributions made to the advancement of this field.Level of Evidence: 5.

Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases.

STUDY DESIGN: Retrospective case series. OBJECTIVE: Despite numerous advances in the technology and techniques available to spinal surgeons, lumbar decompression remains the mainstay of degenerative lumbar spine surgery. It has proven efficacy in trials, but only limited evidence of advantage over conservative management in large scale systematic reviews. We collated data from a large surgically managed cohort to evaluate the patient-reported outcomes. METHODS: We performed a retrospective analysis of a prospectively populated database. Patient demographics, surgical details, and patient outcomes (Spine Tango core outcome measures index [COMI]-Low Back) were collected for 2699 lumbar decompression surgeries. RESULTS: Lumbar decompression was shown to be successful at improving leg pain (mean improvement in visual analogue scale [VAS] at 3 months = 4) and to a lesser extent, back pain (mean improvement in VAS at 3 months = 2.61). Mean improvement in COMI score was 3.15 for all-comers. Minimal clinically important improvement (MCID) in COMI score (-2 points) was achieved in 73% of patients by 2-year follow-up. Primary surgery was more effective than redo surgery: odds ratio 0.547 (95% CI 0.408-0.733, P < .001). The benefits across all outcomes were maintained for the 2-year follow-up period. Patients can be classified according to their outcome as "early responders"; achieving MCID by 3 months (61% primary vs 41% redo), "late responders"; achieving MCID by 2 years (15% vs 20%) or nonresponders (24% vs 39%). CONCLUSIONS: Lumbar decompression is effective in improving quality of life in appropriately selected patients. Patient-reported outcome measures collected routinely and collated within a registry are a powerful tool for assessing the efficacy of lumbar spine interventions and allow accurate counseling of patients perioperatively.

The use of shoulder hemiarthroplasty and humeral head resurfacing: a review of current concepts.

Since Neer's early work in the 1950s shoulder arthroplasty has evolved as a treatment option for various glenohumeral joint disorders. Both hemiarthroplasty and total shoulder prostheses have associated problems. This has led to further work with regards to potential resurfacing, with the aim of accurately restoring native proximal humeral anatomy while preserving bone stock for later procedures if required. Hemiarthroplasty remains a valuable treatment option in the low demand patient or in the trauma setting. Additional work is required to further define the role of humeral resurfacing, with the potential for it to become the gold standard for younger patients with isolated humeral head arthritis.

Proximal humeral fractures: a review of current concepts.

The majority of proximal humerus fractures are sustained via low energy falls in the elderly population. These patients can attain an acceptable level of function via non-operative treatment. There is yet to be a clear consensus on treatment options suitable for those that fall outside of this majority group. Open reduction internal fixation, intra medullary nailing and arthroplasty surgery have all been used to varying effects. Good results are achievable if complications such as mal-union, non-union and avascular necrosis can be avoided. This review aims to clarify the options available to the current day trauma surgeon.

A novel method of diagnosing autonomic dysfunction in carpal tunnel syndrome: measuring skin capacitance.

Carpal Tunnel Syndrome (CTS) is normally diagnosed via its sensory and motor manifestations. The associated autonomic dysfunction has not been exploited to its full potential as a diagnostic tool due to the difficulties in quantifying it. We aim to demonstrate that autonomic dysfunction of CTS can be quantified by measuring skin capacitance. Fifty-one patients with clinical signs and electrophysiological evidence of CTS in 89 hands were recruited. Skin capacitance was measured using Corneometer CM825 (C&K Electronic, GmbH) from the palmar aspect of the distal phalanx of the index and little finger of the affected hand. Healthy gender- and age-matched individuals were recruited as controls. The mean ratio of hydration of the index to the little finger was 0.82. The mean difference was 10.98 arbitrary units. The control group consisted of 151 subjects (80 Male & 71 Female) and 302 hands with an average age of 40.1 years (18-81 years). The mean ratio of hydration of the index to the little finger was 0.87. The mean difference was 8.67 arbitrary units. The measurement ratios (index to little finger skin hydration) between the two groups was compared directly and gave a significant mean difference of 0.05 arbitrary units. Statistically significant differences in skin capacitance between CTS patients and controls have been demonstrated and quantified using a rapid and simple method. This can be used in clinic to reduce the reliance on Nerve Conduction Studies for diagnosing CTS.

Anterior cruciate ligament graft choices: a review of current concepts.

The graft choice for anterior cruciate ligament (ACL) reconstruction continues to be controversial. There are several options available for the treating surgeon, including Bone Patellar Tendon Bone (BPTB) grafts, Hamstring tendon (HT) grafts, allografts and synthetic grafts. Within the last decade there have been several comparative trials and meta-analysis, which have failed to provide an answer with regards to the best graft available. The aim of this review is to understand the current concepts in graft choices for ACL reconstruction.

Distal radius volar locking plates: does a variable angle locking system confer a clinical advantage?

This retrospective study compared clinical, radiological and subjective outcomes between patients with a distal radius fracture fixed with a variable angle or fixed angle volar locking plate. Radiological parameters were assessed between initial and final post-operative films. Post-operative clinical range of motion as a proportion of that in the opposite wrist was assessed clinically, and satisfaction and subjective outcomes were assessed by questionnaire. One hundred and seven patients were included in the study; 65 underwent fixation with a variable angle and 42 with a fixed angle locking plate. There were five complications and secondary operations in each group. There was no significant difference between the groups in radiological parameters measured or the proportional range of motion. Visual analogue scale, Mayo Wrist and Quick DASH scores were not significantly different between the groups. Neither the subjective nor clinical outcomes of this study demonstrated clinical superiority of either plate system.

Teaching basic shoulder ultrasonography to orthopaedic postgraduate trainees--effectiveness of a training workshop.

AIM: Ultrasound examination of the shoulder conducted by orthopaedic surgeons in the diagnosis and treatment of shoulder conditions is increasingly reported. Shoulder ultrasound is not a mandatory component of postgraduate orthopaedic training in the United Kingdom. The aim of this study was to assess the effectiveness of the shoulder ultrasound teaching workshop administered to postgraduate orthopaedic surgical trainees. METHODS: Orthopaedic trainees participated in a teaching workshop on shoulder ultrasound examination with particular emphasis on demonstrating the Acromioclavicluar joint (ACJ) and the long head of the biceps (LHB) in the biciptal groove. The ability of the trainees to demonstrate the ACJ and the LHB using ultrasound was then assessed. RESULTS: Thirty three orthopaedic trainees participated in this study. Twenty three (70%) trainees were able to demonstrate the ACJ and 14 (42%) trainees were able to demonstrate the LHB without assistance, following the ultrasound teaching workshop. The skills acquired by the trainees were independent to the year in training and previous shoulder experience (p > 0.05). CONCLUSION: Our study shows that a basic shoulder ultrasound teaching workshop can be effective in equipping postgraduate orthopaedic trainees with basic ultrasound techniques. It could potentially become part of a structured orthopaedic training programme.

The use of ionising radiation in trauma and orthopaedic theatres.

Ionising radiation is used extensively in trauma and orthopaedic perioperative practice for operative planning and intraoperative decision making. Radiation poses risks to patients and theatre staff, and it is important to always justify, optimise and limit the exposure. This is facilitated by a thorough understanding and awareness of radiation, as well as a sound knowledge of the precautions required for using this technology to minimise the risks of radiation.

Recent developments in total hip replacements: cementation, articulation, minimal-invasion and navigation.

Total hip replacement is a commonly performed procedure with good results. The implants could be cemented or cementless, and there has been a resurgence of resurfacing procedures. It is important that special consideration is given to the choice of the material used at the bearing surfaces. There have been many developments in recent years that influence our choice of implant and have shaped our practice, including minimally invasive surgery and computer-assisted surgery. This article aims to provide an overview of these developments.