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1. The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis.

Author

Jiang, Zhilin, Davies, Benjamin, Zipser, Carl, Margetis, Konstantinos, Martin, Allan, Matsoukas, Stavros, Zipser-Mohammadzada, Freschta, Kheram, Najmeh, Boraschi, Andrea, Zakin, Elina, Obadaseraye, Oke, Fehlings, Michael, Wilson, Jamie, Yurac, Ratko, Cook, Chad, Milligan, Jamie, Tabrah, Julia, Widdop, Shirley, Wood, Lianne, Roberts, Elizabeth, Rujeedawa, Tanzil, and Tetreault, Lindsay

Subjects
cervical, degenerative disc disease, myelopathy
Abstract

STUDY DESIGN: Delayed diagnosis of degenerative cervical myelopathy (DCM) is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for DCM will likely facilitate earlier referral for definitive management. OBJECTIVES: This systematic review aims to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in DCM? METHODS: A search was performed to identify studies on adult patients that evaluated the diagnostic accuracy of a clinical sign used for diagnosing DCM. Studies were also included if they assessed the association between the presence of a clinical sign and disease severity. The QUADAS-2 tool was used to evaluate the risk of bias of individual studies. RESULTS: This review identified eleven studies that used a control group to evaluate the diagnostic accuracy of various signs. An additional 61 articles reported on the frequency of clinical signs in a cohort of DCM patients. The most sensitive clinical tests for diagnosing DCM were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. Five studies evaluated the association between the presence of various clinical signs and disease severity. There was no definite association between Hoffmann sign, Babinski sign or hyperreflexia and disease severity. CONCLUSION: The presence of clinical signs suggesting spinal cord compression should encourage health care professionals to pursue further investigation, such as neuroimaging to either confirm or refute a diagnosis of DCM.

Published
2024

2. The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review.

Author

Jiang, Zhilin, Davies, Benjamin, Zipser, Carl, Margetis, Konstantinos, Martin, Allan, Matsoukas, Stavros, Zipser-Mohammadzada, Freschta, Kheram, Najmeh, Boraschi, Andrea, Zakin, Elina, Obadaseraye, Oke, Fehlings, Michael, Wilson, Jamie, Yurac, Ratko, Cook, Chad, Milligan, Jamie, Tabrah, Julia, Widdop, Shirley, Wood, Lianne, Roberts, Elizabeth, Rujeedawa, Tanzil, and Tetreault, Lindsay

Subjects
cervical, degenerative disc disease, myelopathy
Abstract

STUDY DESIGN: Delayed diagnosis of degenerative cervical myelopathy (DCM) is associated with reduced quality of life and greater disability. Developing diagnostic criteria for DCM has been identified as a top research priority. OBJECTIVES: This scoping review aims to address the following questions: What is the diagnostic accuracy and frequency of clinical symptoms in patients with DCM? METHODS: A scoping review was conducted using a database of all primary DCM studies published between 2005 and 2020. Studies were included if they (i) assessed the diagnostic accuracy of a symptom using an appropriate control group or (ii) reported the frequency of a symptom in a cohort of DCM patients. RESULTS: This review identified three studies that discussed the diagnostic accuracy of various symptoms and included a control group. An additional 58 reported on the frequency of symptoms in a cohort of patients with DCM. The most frequent and sensitive symptoms in DCM include unspecified paresthesias (86%), hand numbness (82%) and hand paresthesias (79%). Neck and/or shoulder pain was present in 51% of patients with DCM, whereas a minority had back (19%) or lower extremity pain (10%). Bladder dysfunction was uncommon (38%) although more frequent than bowel (23%) and sexual impairment (4%). Gait impairment is also commonly seen in patients with DCM (72%). CONCLUSION: Patients with DCM present with many different symptoms, most commonly sensorimotor impairment of the upper extremities, pain, bladder dysfunction and gait disturbance. If patients present with a combination of these symptoms, further neuroimaging is indicated to confirm the diagnosis of DCM.

Published
2024

3. Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey.

Author

Brannigan, Jamie, Davies, Benjamin, Mowforth, Oliver, Yurac, Ratko, Kumar, Vishal, Dejaegher, Joost, Zamorano, Juan, Murphy, Rory, Tripathi, Manjul, Anderson, David, Harrop, James, Molliqaj, Granit, Wynne-Jones, Guy, Arbatin, Jose, Kato, So, Ito, Manabu, Wilson, Jefferson, Romelean, Ronie, Dea, Nicolas, Graves, Daniel, Tessitore, Enrico, Nouri, Aria, and Martin, Allan

Subjects
Humans, Spinal Cord Compression, Cross-Sectional Studies, Magnetic Resonance Imaging, Spinal Cord Injuries, Spinal Cord Diseases, Cervical Vertebrae
Abstract

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice. METHODS: Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC. RESULTS: A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text. CONCLUSIONS: Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.

Published
2024

6. Orthopedic postoperative infection profile and antibiotic sensitivity of 2038 patients across 24 countries – Call for region and institution specific surgical antimicrobial prophylaxis

Author

Mengesha, Mengistu G., Rajasekaran, Shanmuganathan, Ramachandran, Karthik, Sengodan, Vetrivel Chezian, Yasin, Nor Faissal, Williams, Luke Michael, Laubscher, Maritz, Watanabe, Kota, Dastagir, O.Z.M., Akinmade, Akinola, Fisseha, Hizkyas K., Aziz, Amer, Yurac, Ratko, Gebrehana, Ephrem, AlSaifi, Mohammed, Pathinathan, Kalaventhan, Sudhir, G., Shokri, Amran Ahmed, Chan Kim, Yong, Jonayed, Sharif Ahmed, Kido, Gonzalo R., Ignacio, Jose Manuel, Mohammed, Matiyas Seid, Abubakar, Kabir, Hakim, Jonaed, Duwal Shrestha, Sailendra Kumar, Al Mamun Choudhury, Abdullah, Diallo, Malick, Molina, Marcelo, Patwardhan, Sandeep, Hai, Yong, Ramat, Ali M., Kawai, Momotaro, Cho, Jae Hwan, Shah Kalawar, Rosan Prasad, Choi, Sung-Woo, Zarate-Kalfopulos, Baron, Guiroy, Alfredo, Astur, Nelson, Buunaaim, AlexisD.B., Human, Anton L., and Zaman, Atiq Uz

Published
2024
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9. The Surgical Algorithm for the AO Spine Sacral Injury Classification System

Author

Lee, Yunsoo, Lambrechts, Mark, Narayanan, Rajkishen, Bransford, Richard, Benneker, Lorin, Schnake, Klaus, Öner, Cumhur, Canseco, Jose A., Kepler, Christopher K., Schroeder, Gregory D., Vaccaro, Alexander R., Hockley, Aaron, Zubairi, Akbar Jaleel, Barcelos, Alecio, del Arco, Alex, Weening, Alexander, Guiroy, Alfredo, Guiroy, Alfredo, Wael, Alsammak, Bhandutia, Amit, Nishanth, Ampar, Joaquim, Andrei, Joaquim, Andrei, Persin, Andrew, Gupta, Anuj, El Naga, Ashraf, El Naga, Ashraf, Ullrich, Bernhard, Saciloto, Bruno, Cheng, Christina, Bernucci, Claudio, Kleweno, Conor, Cruz, Daniel, Dizon, Dave Anthony, Aponso, Dihan, Patronis, Dimitrios, Martinez, Elias Enmanuel Javier, Pola, Enrico, Gercek, Erol, Lyons, Frank, Camino-Willhuber, Gaston, Tipper, Geoffrey, Okano, Ichiro, Bances, Ignacio Fernández, Paredes, Igor, Parampalli, Janardhana Aithala, Matta, Javier, Subbiah, Jayakumar, Kitzen, Joep, Alves, Jorge, Montoya, Juan Esteban Muñoz, Lourido, Juan, Scherer, Julian, Zhang, Jun, Nitin, Kimmatkar, Margetis, Konstantinos, Rakesh, Kumar, Vineet, Kumar, Lozano, Lady C, Badalassi, Leandro, Rodríguez, Luis Miguel Duchén, Kollintzas, Lykourgos, Ito, Manabu, Ganau, Mario, Estefan, Martin, Holas, Martin, Federico, Martinelli, Duarte, Matias Pereira, Pumberger, Matthias, Scholz, Matti, Diez-Ulloa, Maximo-Alberto, Triffaux, Michel, Khattab, Mohamed, El-Sharkawi, Mohammad, Abdelhafez, Mostafa, Sathish, Muthu, Khan, Nasser, Nicola, Nicassio, Brown, Nolan, Neves, Nuno, Morillo, Olga, Alarcon, Olger, Bazán, Pedro, Loughenbury, Peter, Bancel, Philippe, Cezar, Popescu Eugen, Rabindra, Pradhan, Moraes, Psmar, Banerjee, Purnajyoti, Lakhey, Rajesh Bahadur, Alessamdro, Ramieri, Yurac, Ratko, Vieira, Rian, Bransford, Richard, Kanna, Rishi M, Alakkad, Salah, Samy, Samer, Bigdon, Sebastian, Zylbersztejn, Sergio, Lang, Siegmund, Hashmi, Sohaib, Darwish, Stacey, Corluka, Stipe, haribabu, Subramaniam Macherla, Karimjee, Taha, Elhewala, Tarek, Martin, Tejeda, Benzakour, Thami, Moore, Tim, Adetunji, Toluse, Torres, Valencia Heiller, Loya, Vijay Kumar, Hamouda, Waeel, Söyüncü, Yetkin, Silk, Zacharia, Slavisa, Zagorac, and Klezl, Zdenek

Published
2023
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10. The Surgical Algorithm for the AO Spine Sacral Injury Classification System

Author

Lee, Yunsoo, Lambrechts, Mark, Narayanan, Rajkishen, Bransford, Richard, Benneker, Lorin, Schnake, Klaus, Öner, Cumhur, Canseco, Jose A., Kepler, Christopher K., Schroeder, Gregory D., Vaccaro, Alexander R., Hockley, Aaron, Zubairi, Akbar J., Barcelos, Alecio, del Arco, Alex, Weening, Alexander, Guiroy, Alfredo, Guiroy, Alfredo, Wael, Alsammak, Bhandutia, Amit, Nishanth, Ampar, Joaquim, Andrei, Joaquim, Andrei, Persin, Andrew, Gupta, Anuj, El Naga, Ashraf, El Naga, Ashraf, Ullrich, Bernhard, Saciloto, Bruno, Cheng, Christina, Bernucci, Claudio, Kleweno, Conor, Cruz, Daniel, Dizon, Dave A., Aponso, Dihan, Patronis, Dimitrios, Martinez, Elias E.J., Pola, Enrico, Gercek, Erol, Lyons, Frank, Camino-Willhuber, Gaston, Tipper, Geoffrey, Okano, Ichiro, Bances, Ignacio F., Paredes, Igor, Parampalli, Janardhana A., Matta, Javier, Subbiah, Jayakumar, Kitzen, Joep, Alves, Jorge, Montoya, Juan E.M., Lourido, Juan, Scherer, Julian, Zhang, Jun, Nitin, Kimmatkar, Margetis, Konstantinos, Rakesh, Kumar, Vineet, Kumar, Lozano, Lady C, Badalassi, Leandro, Rodríguez, Luis M.D., Kollintzas, Lykourgos, Ito, Manabu, Ganau, Mario, Estefan, Martin, Holas, Martin, Federico, Martinelli, Duarte, Matias P., Pumberger, Matthias, Scholz, Matti, Diez-Ulloa, Maximo-Alberto, Triffaux, Michel, Khattab, Mohamed, El-Sharkawi, Mohammad, Abdelhafez, Mostafa, Sathish, Muthu, Khan, Nasser, Nicola, Nicassio, Brown, Nolan, Neves, Nuno, Morillo, Olga, Alarcon, Olger, Bazán, Pedro, Loughenbury, Peter, Bancel, Philippe, Cezar, Popescu E., Rabindra, Pradhan, Moraes, Psmar, Banerjee, Purnajyoti, Lakhey, Rajesh B., Alessamdro, Ramieri, Yurac, Ratko, Vieira, Rian, Bransford, Richard, Kanna, Rishi M., Alakkad, Salah, Samy, Samer, Bigdon, Sebastian, Zylbersztejn, Sergio, Lang, Siegmund, Hashmi, Sohaib, Darwish, Stacey, Corluka, Stipe, haribabu, Subramaniam M., Karimjee, Taha, Elhewala, Tarek, Martin, Tejeda, Benzakour, Thami, Moore, Tim, Adetunji, Toluse, Torres, Valencia H., Loya, Vijay K., Hamouda, Waeel, Söyüncü, Yetkin, Silk, Zacharia, Slavisa, Zagorac, and Klezl, Zdenek

Published
2024
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12. Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine

Author

Zanardi, Carlos, Picard, Nelson, Donato, Maximiliano, Gorgas, Alberto, Peña, Efrén, González, Óscar, Mandiola, Sergio, Remondino, Rodrigo, Ortiz, Pablo Nicolas, Jiménez, José, Jesus Gonzalez, Jose de, Martinez, Oscar, Reyes, Pedro, Jara, Juan, Burgos, Julio, Gagliardi, Martin, Ciancio, Alejandro Morales, Uruchi, Daniel, Martínez, Ricardo, Mireles, Nicolás, Meira, Paulo Henrique, Astur, Nelson, Meves, Robert, Vieira, Rian, Borges, Renan, Chaves, Jennyfer, Guimaraes, Ricardo, Balen, Matheus, Zamorano, Juan J., Zanini, Guilherme Rocha, Senna, Germano, Cabrera, Paulo Roberto, Ordoñez, Fausto, Vásquez, FranlyArismendy, Daniel, Jefferson, Veiga, Jose Carlos, Santoro, Pedro Del, Sebben, Andre Luis, Orso, Vinicius, Penteado, Ricardo, Jr., Pino, Christian, Velarde, Esther, Jacob, Charbel, Jr., Dias, Wanderson, Ujhelly, Jose Ignacio, Estay, Ayelen, Noleto, Gustavo, Sousa, Icaro de, Amorim, Robson, Carneiro, Marlon, Montoya, Fabián, Flórez, David, Corrêa, Raphael Augusto, Santiago, Bastianon, Gonzalez, Alvaro Silva, Cabrera, Juan P., Carazzo, Charles A., Guiroy, Alfredo, White, Kevin P., Guasque, Joana, Sfreddo, Ericson, Joaquim, Andrei F., and Yurac, Ratko

Published
2023
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15. SPINE20 Recommendations 2024 -Spinal Disability: Social Inclusion as a Key to Prevention and Management

Author

Menezes, Cristiano M., Tucci, Carlos, Tamai, Koji, Chhabra, Harvinder S., Alhelal, Fahad H., Bussières, André E., Muehlbauer, Eric J., Roberts, Lisa, Alsobayel, Hana I., Barneschi, Guido, Campello, Marco A., Côté, Pierre, Duchén Rodríguez, Luís Miguel, Cristante, Alexandre F., Kamra, Komal, Kitamura, Kazuya, Meves, Robert, Risso-Neto, Marcelo I., Vlok, Adriaan J., Wadhwa, Sanjay, Wiechert, Karsten, Yurac, Ratko, Blattert, Thomas, Costanzo, Giuseppe, Darwono, Bambang, Nordin, Margareta, Al Athbah, Yahya S., Alturkistany, Ahmed, Chahal, Rupinder, Franke, Joerg, Ito, Manabu, Arand, Markus, Pereira, Paulo, Ruosi, Carlo, Sullivan, William J., Andújar, André L. F., Ribeiro, Carlos Henrique, Carelli, Luis Eduardo, Sardá, Jamir, Machado, Ana Lígia G. E., and AlEissa, Sami

Abstract

Spine disorders are the leading cause of disability worldwide. To promote social inclusion, it is essential to ensure that people can participate in their societies by improving their ability, opportunities, and dignity, through access to high-quality, evidence-based, and affordable spine services for all.To achieve this goal, SPINE20 recommends six actions.- SPINE20 recommends that G20 countries deliver evidence-based education to the community health workers and primary care clinicians to promote best practice for spine health, especially in underserved communities.- SPINE20 recommends that G20 countries deliver evidence-based, high-quality, cost-effective spine care interventions that are accessible, affordable and beneficial to patients.- SPINE20 recommends that G20 countries invest in Health Policy and System Research (HPSR) to generate evidence to develop and implement policies aimed at integrating rehabilitation in primary care to improve spine health.- SPINE20 recommends that G20 countries support ongoing research initiatives on digital technologies including artificial intelligence, regulate digital technologies, and promote evidence-based, ethical digital solutions in all aspects of spine care, to enrich patient care with high value and quality.- SPINE20 recommends that G20 countries prioritize social inclusion by promoting equitable access to comprehensive spine care through collaborations with healthcare providers, policymakers, and community organizations.- SPINE20 recommends that G20 countries prioritize spine health to improve the well-being and productivity of their populations. Government health systems are expected to create a healthier, more productive, and equitable society for all through collaborative efforts and sustained investment in evidence-based care and promotion of spine health.

Published
2025
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19. Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures – Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders

Author

Joaquim, Andrei F., Bigdon, Sebastian F., Bransford, Richard, Chhabra, Harvinder Singh, Yurac, Ratko, Kumar, Vishal, El-Sharkawi, Mohammad, Benneker, Lorin M., Karamian, Brian A., Canseco, Jose A., Scherer, Julian, Hassan, Ahmed Abdelazim, Schroeder, Gregory D., Öner, Cumhur F., Rajasekaran, Shanmuganathan, Vialle, Emiliano, Kanna, Rishi M., Vaccaro, Alexander R., Tee, Jin, and Camino-Willhuber, Gaston

Subjects
VERTEBRAL fractures, BONE fractures, MEDICAL research, TREATMENT of fractures
Abstract

Study Design: Literature review with clinical recommendations. Objective: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. Methods: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. Results: 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. Conclusions: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice. [ABSTRACT FROM AUTHOR]

Published
2024
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20. AO Spine-DGOU Osteoporotic Fracture Classification System: Internal Validation by the AO Spine Knowledge Forum Trauma

Author

Scherer, Julian; https://orcid.org/0000-0001-8943-5817, Joaquim, Andrei; https://orcid.org/0000-0003-2645-0483, Vaccaro, Alex, Kanna, Rishi; https://orcid.org/0000-0001-5817-4909, El-Sharkawi, Mohammad; https://orcid.org/0000-0001-6177-7145, Takahata, Masahiko, Aly, Mohamed M; https://orcid.org/0000-0001-5221-8288, Camino-Willhuber, Gaston; https://orcid.org/0000-0002-5684-7679, Spiegl, Ulrich; https://orcid.org/0000-0002-5179-4192, Oner, Cumhur, Canseco, Jose A; https://orcid.org/0000-0002-2152-5725, Yurac, Ratko; https://orcid.org/0000-0003-3603-6294, Benneker, Lorin Michael, Popescu, Eugen Cezar; https://orcid.org/0000-0001-5732-5402, Bransford, Richard, Chhabra, Harvinder Singh, Kandziora, Frank, Neva, Marko H, Schnake, Klaus John; https://orcid.org/0000-0003-3118-0924, Scherer, Julian; https://orcid.org/0000-0001-8943-5817, Joaquim, Andrei; https://orcid.org/0000-0003-2645-0483, Vaccaro, Alex, Kanna, Rishi; https://orcid.org/0000-0001-5817-4909, El-Sharkawi, Mohammad; https://orcid.org/0000-0001-6177-7145, Takahata, Masahiko, Aly, Mohamed M; https://orcid.org/0000-0001-5221-8288, Camino-Willhuber, Gaston; https://orcid.org/0000-0002-5684-7679, Spiegl, Ulrich; https://orcid.org/0000-0002-5179-4192, Oner, Cumhur, Canseco, Jose A; https://orcid.org/0000-0002-2152-5725, Yurac, Ratko; https://orcid.org/0000-0003-3603-6294, Benneker, Lorin Michael, Popescu, Eugen Cezar; https://orcid.org/0000-0001-5732-5402, Bransford, Richard, Chhabra, Harvinder Singh, Kandziora, Frank, Neva, Marko H, and Schnake, Klaus John; https://orcid.org/0000-0003-3118-0924

Published
2024

21. Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders

Author

Joaquim, Andrei F; https://orcid.org/0000-0003-2645-0483, Bigdon, Sebastian F; https://orcid.org/0000-0002-4649-0610, Bransford, Richard, Chhabra, Harvinder Singh, Yurac, Ratko; https://orcid.org/0000-0003-3603-6294, Kumar, Vishal, El-Sharkawi, Mohammad; https://orcid.org/0000-0001-6177-7145, Benneker, Lorin M, Karamian, Brian A, Canseco, Jose A; https://orcid.org/0000-0002-2152-5725, Scherer, Julian; https://orcid.org/0000-0001-8943-5817, Hassan, Ahmed Abdelazim; https://orcid.org/0000-0002-6764-4148, Schroeder, Gregory D, Öner, Cumhur F, Rajasekaran, Shanmuganathan; https://orcid.org/0000-0001-6043-006X, Vialle, Emiliano; https://orcid.org/0000-0003-1157-4889, Kanna, Rishi M; https://orcid.org/0000-0001-5817-4909, Vaccaro, Alexander R, Tee, Jin, Camino-Willhuber, Gaston; https://orcid.org/0000-0002-5684-7679, Fisher, Charles G, Dvorak, Marcel F, Schnake, Klaus J, AO Spine Knowledge Forum Trauma & Infection, Joaquim, Andrei F; https://orcid.org/0000-0003-2645-0483, Bigdon, Sebastian F; https://orcid.org/0000-0002-4649-0610, Bransford, Richard, Chhabra, Harvinder Singh, Yurac, Ratko; https://orcid.org/0000-0003-3603-6294, Kumar, Vishal, El-Sharkawi, Mohammad; https://orcid.org/0000-0001-6177-7145, Benneker, Lorin M, Karamian, Brian A, Canseco, Jose A; https://orcid.org/0000-0002-2152-5725, Scherer, Julian; https://orcid.org/0000-0001-8943-5817, Hassan, Ahmed Abdelazim; https://orcid.org/0000-0002-6764-4148, Schroeder, Gregory D, Öner, Cumhur F, Rajasekaran, Shanmuganathan; https://orcid.org/0000-0001-6043-006X, Vialle, Emiliano; https://orcid.org/0000-0003-1157-4889, Kanna, Rishi M; https://orcid.org/0000-0001-5817-4909, Vaccaro, Alexander R, Tee, Jin, Camino-Willhuber, Gaston; https://orcid.org/0000-0002-5684-7679, Fisher, Charles G, Dvorak, Marcel F, Schnake, Klaus J, and AO Spine Knowledge Forum Trauma & Infection

Abstract

STUDY DESIGN: Literature review with clinical recommendations. OBJECTIVE: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. METHODS: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. RESULTS: 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. CONCLUSIONS: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.

Published
2024

24. Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey

Author

Brannigan, Jamie F. M., primary, Davies, Benjamin M., additional, Mowforth, Oliver D., additional, Yurac, Ratko, additional, Kumar, Vishal, additional, Dejaegher, Joost, additional, Zamorano, Juan J., additional, Murphy, Rory K. J., additional, Tripathi, Manjul, additional, Anderson, David B., additional, Harrop, James, additional, Molliqaj, Granit, additional, Wynne-Jones, Guy, additional, Arbatin, Jose Joefrey F., additional, Kato, So, additional, Ito, Manabu, additional, Wilson, Jefferson, additional, Romelean, Ronie, additional, Dea, Nicolas, additional, Graves, Daniel, additional, Tessitore, Enrico, additional, Martin, Allan R., additional, and Nouri, Aria, additional

Published
2023
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30. Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine

Author

Cabrera, Juan P., primary, Carazzo, Charles A., additional, Guiroy, Alfredo, additional, White, Kevin P., additional, Guasque, Joana, additional, Sfreddo, Ericson, additional, Joaquim, Andrei F., additional, Yurac, Ratko, additional, Zanardi, Carlos, additional, Picard, Nelson, additional, Donato, Maximiliano, additional, Gorgas, Alberto, additional, Peña, Efrén, additional, González, Óscar, additional, Mandiola, Sergio, additional, Remondino, Rodrigo, additional, Ortiz, Pablo Nicolas, additional, Jiménez, José, additional, Jesus Gonzalez, Jose de, additional, Martinez, Oscar, additional, Reyes, Pedro, additional, Jara, Juan, additional, Burgos, Julio, additional, Gagliardi, Martin, additional, Ciancio, Alejandro Morales, additional, Uruchi, Daniel, additional, Martínez, Ricardo, additional, Mireles, Nicolás, additional, Meira, Paulo Henrique, additional, Astur, Nelson, additional, Meves, Robert, additional, Vieira, Rian, additional, Borges, Renan, additional, Chaves, Jennyfer, additional, Guimaraes, Ricardo, additional, Balen, Matheus, additional, Zamorano, Juan J., additional, Zanini, Guilherme Rocha, additional, Senna, Germano, additional, Cabrera, Paulo Roberto, additional, Ordoñez, Fausto, additional, Vásquez, FranlyArismendy, additional, Daniel, Jefferson, additional, Veiga, Jose Carlos, additional, Santoro, Pedro Del, additional, Sebben, Andre Luis, additional, Orso, Vinicius, additional, Penteado, Ricardo, additional, Pino, Christian, additional, Velarde, Esther, additional, Jacob, Charbel, additional, Dias, Wanderson, additional, Ujhelly, Jose Ignacio, additional, Estay, Ayelen, additional, Noleto, Gustavo, additional, Sousa, Icaro de, additional, Amorim, Robson, additional, Carneiro, Marlon, additional, Montoya, Fabián, additional, Flórez, David, additional, Corrêa, Raphael Augusto, additional, Santiago, Bastianon, additional, and Gonzalez, Alvaro Silva, additional

Published
2023
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31. Principios básicos de rayos X en cirugía de columna. Revisión de la literatura. Equipo Iberolatinoamericano de Investigación SILACO

Author

Luis Bazán, Pedro, primary, Salcido Reyna, Marlene Vanessa, additional, Jiménez Ávila, José María, additional, Pereira, Paulo, additional, Mario Muscia, Roberto, additional, Diez Ulloa, Máximo Alberto, additional, Duchén Rodríguez, Luis Miguel, additional, Magalhaes Menezes, Cristiano, additional, Solorio Guerrero, Andrea, additional, Itriago Gómez, Minerva Gabriela, additional, Muleiro Estévez, Paulina, additional, and Yurac, Ratko, additional

Published
2023
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32. A Systematic Review of Current Terminology for Conditions Preceding Degenerative Cervical Myelopathy: Evidence to Inform an AO Spine Expert Opinion Statement

Author

Agrawal, Vinisha, primary, Yasin, Froher, additional, Yurac, Ratko, additional, Kumar, Vishal, additional, Murphy, Rory, additional, Tessitore, Enrico, additional, Molliqaj, Granit, additional, Dejaegher, Joost, additional, Zamorano, Juan Jose, additional, Wynne-Jones, Guy, additional, Kotter, Mark, additional, Davies, Benjamin, additional, Nouri, Aria, additional, and Mowforth, Oliver, additional

Published
2023
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33. Management of Mild Degenerative Cervical Myelopathy and Asymptomatic Spinal Cord Compression: An International Survey

Author

Brannigan, Jamie, primary, Davies, Benjamin, additional, Mowforth, Oliver, additional, Yurac, Ratko, additional, Kumar, Vishal, additional, Dejaeghar, Joost, additional, Zanamorano, Juan, additional, Murphy, Rory, additional, Tripathi, Manjul, additional, Anderson, David, additional, Harrop, James, additional, Molliqaj, Granit, additional, Wynne-Jones, Guy, additional, Arbitin, Jose, additional, Kato, So, additional, Ito, Manabu, additional, Romelean, Ronie, additional, Dea, Nicolas, additional, Graves, Daniel, additional, Tessitore, Enrico, additional, and Nouri, Aria, additional

Published
2023
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34. The Use of Osteobiologics in Single versus Multi-Level Anterior Cervical Discectomy and Fusion: A Systematic Review

Author

Meisel, Hans Jörg, Buser, Zorica, Hoffmann, Jim, Ricciardi, Guillermo A., Yurac, Ratko, Meisel, Hans Jörg, Buser, Zorica, Qian, Bangping, and Vergroesen, Pieter-Paul A.

Abstract

Study Design Systematic literature review.Objectives In this study we assessed evidence for the use of osteobiologics in single vs multi-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spine degeneration. The primary objective was to compare fusion rates after single and multi-level surgery with different osteobiologics. Secondary objectives were to compare differences in patient reported outcome measures (PROMs) and complications.Methods After a global team of reviewers was selected, a systematic review using different repositories was performed, confirming to PRISMA and GRADE guidelines. In total 1206 articles were identified and after applying inclusion and exclusion criteria, 11 articles were eligible for analysis. Extracted data included fusion rates, definition of fusion, patient reported outcome measures, types of osteobiologics used, complications, adverse events and revisions.Results Fusion rates ranged from 87.7% to 100% for bone morphogenetic protein 2 (BMP-2) and 88.6% to 94.7% for demineralized bone matrix, while fusion rates reported for other osteobiologics were lower. All included studies showed PROMs improved significantly for each osteobiologic. However, no differences were reported when comparing osteobiologics, or when comparing single vs multi-level surgery specifically.Conclusion The highest fusion rates after 2-level ACDF for cervical spine degeneration were reported when BMP-2 was used. However, PROMs did not differ between the different osteobiologics. Further blinded randomized trials should be performed to compare the use of BMP-2 in single vs multi-level ACDF specifically.

Published
2024
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38. Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation

Author

Cabrera, Juan P., Guiroy, Alfredo, Carazzo, Charles A., Yurac, Ratko, Valacco, Marcelo, Vialle, Emiliano, and Joaquim, Andrei F.

Subjects
Complications
Abstract

BACKGROUND: Factors influencing the length of spinal instrumentation have been mostly evaluated in burst fractures, receiving more attention than other unstable thoracolumbar injuries. We aimed to evaluate clinical factors affecting surgical decision-making and associated complications. METHODS: This was a multicentric retrospective cohort study. Outcomes of patients with AO Spine injury classification types B2, B3, and C operated through an open posterior-only approach were analyzed. Length of instrumentation was correlated with age, type of injury, comorbidities, level of injury, neurological status, and complications. RESULTS: Among 439 patients, 30.3% underwent short-segment fixation (SSF) and 69.7% underwent long-segment fixation (LSF). Type C injuries were treated with LSF in 89.4% of cases (P < 0.001). On multivariate analysis, age ≤39 years (OR: 2.06), AO spine type B2 (OR: 3.58), and type B3 (OR: 7.48) were statistically significant predictors for SSF, while hypertension (OR: 4.07), upper thoracic injury (OR: 9.48), midthoracic injury (OR: 6.06), and American Spinal Injury Association Impairment Scale A (OR: 3.14) were significantly associated with LSF. Patients with SSF had fewer overall complications (27.1% vs 50.9%, P < 0.001) and were less likely to develop pneumonia (6.0% vs 18.3%, P < 0.001) and urinary tract infections (6.8% vs 16.3%, P < 0.007). CONCLUSIONS: Unstable thoracolumbar injuries were mostly treated by LSF. Length of instrumentation was affected by the type of spinal injury, location of the injury, and neurological status. SSF was associated with lower rates of early complications than LSF. CLINICAL RELEVANCE: The decision on the length of fixation in the surgical treatment of unstable thoracolumbar injuries is affected by different factors, and it will impact the rate of postoperative complications. LEVEL OF EVIDENCE: 3.

Published
2022

41. Degenerative cervical myelopathy

Author

Yurac, Ratko, Matamala, José Manuel, Zamorano, Juan José, Harrop, James S, Davies, Benjamin M, Nouri, Aria, Fehlings, Michael G, Yurac, Ratko, Matamala, José Manuel, Zamorano, Juan José, Harrop, James S, Davies, Benjamin M, Nouri, Aria, and Fehlings, Michael G

Abstract

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.

Published
2022

42. Isolated transverse sacral fractures

Author

Urzúa, Alejandro, Marré, Bartolomé, Martínez, Celmira, Ballesteros, Vicente, Ilabaca, Francisco, Fleiderman, José, Zamorano, Juan J., Yurac, Ratko, Lecaros, Miguel, Munjin, Milan, and Lahsen, Paulina

Published
2011
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50. CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?

Author

Cabrera, Juan P., Yurac, Ratko, Joaquim, Andrei F., Guiroy, Alfredo, Carazzo, Charles A., Zamorano, Juan J., and Valacco, Marcelo

Subjects
DECISION making, COMPUTED tomography, CERVICAL vertebrae, HEALTH outcome assessment, RADIOGRAPHS
Abstract

Study Design: Cross-sectional survey. Objectives: Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. Methods: A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. Results: There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. Conclusions: Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures. [ABSTRACT FROM AUTHOR]

Published
2023
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