Proposal for a new clinicoradiological classification of type I split-cord malformations: a prospective study of 25 cases.

BACKGROUND AND METHODS: Split-cord malformations (SCMs) are rare malformations of the spinal cord. A new classification is proposed based on intraoperative findings in 25 cases of type I SCMs (with bony spur). Patients' demographic profile, radiological and surgical details, complications and outcome were noted. FINDINGS: All patients had type I SCMs. The mean age of the patients was 6.2 years (female:male ratio 1.2:1). Asymmetric lower-limb and sphincter weakness were present in 17/25 (68%) and 5/25 (20%) cases, respectively. Of the symptomatic cases, 29.4% (5/17) showed improvement in motor power and sensory improvement was recorded in 33.3% (4/12) of patients while 40% (2/5) regained continence. No patient in the asymptomatic group (0/8) showed postoperative neurological deterioration. A new subclassification of type I SCM is proposed based on the location of the bony spur responsible for the split, which can affect surgical dissection and outcome. CONCLUSIONS: In SCM patients, the risk of developing neurological deficits increases with age, hence all SCM patients should undergo prophylactic surgery, even if they are asymptomatic. Our new classification is easy to use and takes into account intraoperative findings that may affect surgical outcome.

Use of quantitative assessment scales in cervical spondylotic myelopathy--survey of clinician's attitudes.

BACKGROUND: There is considerable uncertainty regarding the selection criteria of patients and timing of surgery for cervical spondylotic myelopathy (CSM). Attempts have been made to quantify CSM severity using various assessment scales to provide an adjunct to clinical decision-making. The aim of the present study was to determine, by means of a 7-item questionnaire the attitudes of clinicians regarding the importance of quantitative assessment scales in the management of CSM, their actual use in clinical practice and how current scales fall short of the ideal. FINDINGS: Clinical history, examination, radiological imaging and quantitative functional assessment were regarded by 117 clinicians as being almost equally important in the management of CSM. However, only 22 (19%) of clinicians admitted to using an assessment scale in clinical practice and 4 (3%) believed there was a 'gold-standard' assessment scale. These clinicians also considered 'ease of use' to be the most important attribute of an ideal assessment scale, followed by 'reproducibility', 'sensitivity to change' and 'validity'. CONCLUSIONS: The discrepancy between the importance attached to quantitative measurement and its actual use suggests that current scales are under-utilised or unsuitable for clinical practice. A new easy-to use scale may be required that better reflects clinical requirements.

Spondylolysis and spondylolisthesis in the child and adolescent: a new classification.

Spondylolysis and spondylolisthesis commonly are diagnosed in children and adolescents. The diagnostic workup and treatment plan vary widely among physicians. Although the orthopaedic literature is extensive on the topic, it is our opinion that a lack of clarity exists with regards to etiology, terminology, subtypes of spondylolysis and spondylolisthesis, and treatment. Important basic principles regarding spondylolysis and spondylolisthesis, with emphasis on clinical evaluation and nonsurgical treatment, serve as the basis for a new classification. We propose a new classification for pediatric spondylolysis and spondylolisthesis that is comprehensive, simple, and easily applied. This scheme is based on clinical presentation and spinal morphology and is more appropriate for the child and adolescent than the existing classification schemes of Wiltse-Newman and Marchetti-Bartolozzi. Algorithms for evaluation and treatment of spondylolysis and spondylolisthesis in children and adolescents, based on this new classification, are presented.

[Occupational disease 2108. Degenerative changes of the cervical spine as a causality criterion in the assessment of discogenic diseases according to BeKV 2108]. / Berufserkrankung 2108. Degenerative Veränderungen der Halswirbelsäule als Kausalitätskriterium in der Begutachtung bandscheibenbedingter Erkrankungen gemäss BeKV 2108.

With the second amendment to the Ordinance on Occupational Diseases (BeKV) of 18 December 1992, discogenic diseases of the spine are included in the disease register of occupational diseases for the first time. If occupations that impose stress on the spine have been practised for many years, the possibility exists of recognizing degenerative diseases as an occupational disease. In assessment practice, the radiological data on the spine exposed to stress is compared with that of regions which are remote from the stress (cervical/thoracic spine). This pattern of the distribution of degenerative disease is then used as the basis for determining a causal relationship between the occupation causing the stress and disease of the axial skeleton. The pattern of degeneration of the cervical spine was investigated in two groups, one with ( n =153) and one without ( n =333) occupations that impose stress on the lumbar spine. A cumulative score of degenerative changes was elaborated and presented as a new classification. No differences were found between the groups with regard to either the frequency of occurrence, segmental distribution or severity of disease. In both groups, degenerative changes correlated with age. The prevailing assessment practice is discussed on the basis of these data.