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Case series.This study compared the locations of arm pain, sensory symptoms, and subjective complaints of arm weakness in patients with cervical radiculopathy from MRI confirmed C6 and C7 nerve root compression.Cervical radiculopathy is defined as arm pain, sensory and motor symptoms caused by irritation of a cervical nerve root. The C6 and C7 roots are most commonly involved, and differentiating symptoms associated with each root has proven difficult. Cervical MRI allows accurate identification of nerve root compression and therefore makes it possible to explore symptom patterns that may differentiate C6 from C7 radiculopathy.A total of 122 patients with symptoms suggestive of cervical radiculopathy were recruited. Of these, 30 patients had MRI confirmed C6 and 39 patients C7 nerve root compression. By completing a study questionnaire, patients reported specific arm weakness, and marked the location of arm pain and tingling/numbness on graphic representations of the arm. Marked areas were interpreted by superimposing a grid that divided the arm into 54 distinct areas. The frequencies of reported symptoms with C6 and C7 were totaled and then compared with likelihood rations. Power analysis calculated that 27 patients would be needed in each group based on the assumption that a 30 percentage point difference in frequency of specific symptom would be clinically useful for differentiating C6 from C7 radiculopathy.Arm pain and sensory symptoms were diffuse, and were not distinctly different for C6 or C7 radiculopathy. Some weakness was reported by 41 percent of patients, with specific descriptions of weakness having limited value for differentiating between radiculopathies.The location of pain and sensory symptoms, and specific weakness complaints associated with symptomatic C6 and C7 nerve root compression overlap to the extent that caution should be exercised when predicting root involvement based on symptoms.3.

Background: Chin-on-chest deformity is a disabling manifestation of ankylosing spondylitis. Surgical treatment consists of extension osteotomy at the cervicothoracic junction. The purpose of this study was to characterize the clinical presentation of this deformity and to determine the long-term functional and radiographic outcomes of treatment. Methods: The medical records and radiographs of all twenty-six patients treated with cervicothoracic extension osteotomy by one of us between 1976 and 2001 were retrospectively reviewed. Three patients died during the two-year-minimum follow-up period. The remaining twenty-three patients were followed for an average of 4.5 years (range, two years to twenty-one years and ten months). Results: The mean sagittal correction was 38°. Delayed union in two patients and additional cervical trauma in two others resulted in partial loss of the initial correction. Quadriplegia developed in one patient, who died as a result of subluxation at the osteotomy site. Five patients had irritation of the eighth cervical nerve root postoperatively. Conclusions: Extension osteotomy can reliably improve sagittal alignment and horizontal gaze as well as decrease neck pain, eating difficulties, and neurologic abnormalities. Internal fixation is recommended to prevent subluxation, delayed union, nonunion, loss of correction, or neurologic injury. There is a risk of death or catastrophic neurologic injury from the procedure. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Traumatic spondylopelvic dissociation is an extremely rare injury resulting in mechanical dissociation of the pelvis from the spine1. Similar mechanical dysfunction can occur in association with lumbosacral fracture-dislocation or bilateral sacroiliac joint dislocation2-9. However, traumatic spondylopelvic dissociation is a distinct injury pattern, characterized by a transverse sacral fracture in conjunction with bilateral sacroiliac fracture-dislocation, that requires a unique approach to overall patient management and surgical stabilization1,10-12. Options for the surgical treatment of spondylopelvic dissociation are limited as the sacrum may not provide structural support or stability for internal fixation. Our patients were informed that data concerning the cases would be submitted for publication. Case 1. A nineteen-year-old woman who was wearing a helmet while riding as a passenger on a motorcycle was ejected at high speed, struck a tree, and subsequently was run over by an eighteen-wheel tractor-trailer. She initially presented to an outside hospital with a Glasgow Coma Score of 15 but was unable to move either lower extremity. She was intubated because of respiratory distress, and a chest tube was inserted bilaterally for the treatment of pneumothorax. A diagnostic peritoneal lavage was positive, and the patient underwent exploratory laparotomy. She had multiple musculoskeletal injuries, including spondylopelvic dissociation with highly comminuted sacral fractures that had both vertical and transverse components (Fig. 1-A), a closed fracture of the proximal part of the right femoral shaft, a comminuted fracture of the left acetabulum, open midshaft fractures of the left tibia and fibula, left metacarpal fractures, and degloving injuries of both feet. The open fractures of the left tibia and fibula were irrigated and debrided in the operating room and then were stabilized with external fixation. A traction pin was placed in the distal part of each femur. The …

Magnetic resonance imaging (MRI) offers promise as a noninvasive method to determine the potential of an osteochondritis dissecans (OCD) lesion to heal without surgical intervention. The purpose of this study was to compare the value of MRI, plain radiographs, and clinical findings in predicting the success of nonoperative treatment of juvenile OCD lesions. Twenty-seven lesions in 24 patients (mean age 12.2 y) with OCD of the distal femur diagnosed based on MRI were identified. A radiologist or orthopaedist, blinded to the clinical status of the patients, correlated the MRIs with patient outcome. MRIs were assessed for lesion size, location, and four criteria evaluating signal intensity changes and articular surface defects to determine lesion stability. Older, more skeletally mature patients with at least one sign of instability on MRI were most likely to have nonoperative treatment fail. Nonoperative treatment failed most often in patients with large lesions in weightbearing areas, as seen on lateral radiographs. However, location based on anteroposterior radiographs was not statistically significant for predicting treatment outcome. Although no single factor was uniformly predictive of successful nonoperative treatment, younger, skeletally immature patients with no MRI criteria of instability were most amenable to nonoperative treatment.