Goals of cervical disc replacement.

The goals of cervical arthroplasty are reviewed against a backdrop of adjacent segment disease, restoring normal kinematics to the motion segment, and avoidance of fusion in situations where fusion may be difficult to obtain or unwanted.

The surgical management of thoracolumbar injuries.

This review addresses the epidemiology, clinical examination, and radiographic evaluation and fracture classification of thoracolumbar injuries. The factors that indicate surgical intervention and the surgical management of specific injuries such as compression fractures, burst fractures, flexion-distraction, and fracture-dislocation injuries are described, as well as their potential complications. In addition, postoperative management is covered, including deep venous thrombosis prophylaxis.

Nonbridging external fixation of distal radius fractures.

Surgical management of distal radius fractures continues to evolve because of their high incidence in an increasingly active elderly population. Traditional radiocarpal external fixation relies on ligamentotaxis for fracture reduction but has several drawbacks. Nonbridging external fixation has evolved to provide early wrist mobility in the setting of anatomic fracture reduction. Several studies of the nonbridging technique have demonstrated satisfactory results in isolated nonbridging external fixation series and in comparison with traditional spanning external fixation. Nonbridging external fixation for surgical treatment of distal radius fractures can be technically demanding and requires at least 1 cm of intact volar cortex in the distal fracture fragment for successful implementation.

The effect of anterior cervical fusion on neck motion.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To precisely measure the effect of anterior cervical fusion on neck motion. SUMMARY OF BACKGROUND DATA: Anterior cervical decompression and stabilization procedures are successful in treating recalcitrant cervical radiculopathy and cervical myelopathy. Most assume that these "fusion" procedures result in a loss of neck motion, although changes in overall motion following anterior cervical fusion have never been precisely quantified. METHODS: Twenty-five consecutive patients undergoing anterior cervical fusion of one to four levels underwent cervical range of motion testing in three planes using an unconstrained instrumented linkage before surgery and more than 3 months after surgery. These data were compared with that of 10 volunteers with no prior history of neck complaints. Motion data were compared between patients and volunteers, and between the patients before surgery and at last follow-up, using RMANOVA and Fisher's PLSD post hoc test. RESULTS: Before surgery, the patients had significantly less motion than the volunteers in all directions. Following surgical fusion, patients gained a statistically significant amount of motion in all planes, although they did not achieve the motion seen among the volunteers. Gains in motion were seen among all patients, including those undergoing four-level fusions, and there was no correlation between postoperative motion and the number of levels fused. CONCLUSIONS: Patients undergoing anterior cervical fusion have diminished neck motion compared with normal volunteers. Following surgery, they may be expected to gain motion, even when undergoing multilevel fusions. However, these patients are unlikely to regain the neck motion seen among normal individuals without neck complaints.

Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score.

STUDY DESIGN: Prospective study of 5 spine surgeons rating 71 clinical cases of thoracolumbar spinal injuries using the Thoracolumbar Injury Severity Score (TLISS) and then re-rating the cases in a different order 1 month later. OBJECTIVE: To determine the reliability of the TLISS system. SUMMARY OF BACKGROUND DATA: The TLISS is a recently introduced classification system for thoracolumbar spinal column injures designed to simplify injury classification and facilitate treatment decision making. Before being widely adopted, the reliability of the TLISS must be studied. METHODS: A total of 71 cases of thoracolumbar spinal trauma were distributed on CD-ROM to 5 attending spine surgeons, including clinical/radiographic data, details of the TLISS, and a scoring sheet in which cases would be scored using the system. The surgeons were later assigned the task with the cases reordered. Intraobserver and interobserver reliability was calculated for TLISS components, total score, and surgeon's treatment decision using the Cohen unweighted kappa coefficients and Spearman rank-order correlation. RESULTS: Interrater reliability assessed by generalized kappa coefficients was 0.33 +/- 0.03 for injury mechanism, 0.91 +/- 0.02 for neurologic status, 0.35 +/- 0.03 for posterior ligamentous complex status, 0.29 +/- 0.02 for TLISS total, and 0.52 +/- 0.03 for treatment recommendation. Respective results using the Spearman correlation were 0.35 +/- 0.04, 0.94 +/- 0.01, 0.48 +/- 0.04, 0.65 +/- 0.03, and 0.51 +/- 0.04. Surgeons agreed with the TLISS recommendation 96.4% of the time. Intrarater kappa coefficients were 0.57 +/- 0.04 for injury mechanism, 0.93 +/- 0.02 for neurologic status, 0.48 +/- 0.04 for posterior ligamentous complex status, 0.46 +/- 0.03 for TLISS total, and 0.62 +/- 0.04 for treatment recommendation. Respective results using the Spearman correlation were 0.70 +/- 0.04, 0.95 +/- 0.02, 0.59 +/- 0.05, 0.77 +/- 0.04, and 0.59 +/- 0.05. CONCLUSIONS: The TLISS has good reliability and compares favorably to other contemporary thoracolumbar fracture classification systems.