The Influence of Spinal Canal Narrowing and Timing of Decompression on Neurologic Recovery After Spinal Cord Contusion in a Rat Model
John R. Dimar, II, Steven D. Glassman, George H. Raque, Yi Ping Zhang, and Christopher B. Shields

The effect of spinal canal narrowing and time of decompression after spinal cord injury was evaluated using the rat spinal cord model. After injury, neurologic recovery was monitored using motor evoked potentials and lower extremity motor score testing. The results demonstrate significantly less favorable neurologic recovery with increased spinal canal narrowing and duration of compression.

The Stability of Reconstruction Methods After Thoracolumbar Total Spondylectomy: An In Vitro Investigation
Itaru Oda, Bryan W. Cunningham, Kuniyoshi Abumi, Kiyoshi Kaneda, and Paul C. McAfee

After total spondylectomy, five types of spinal reconstruction methods were biomechanically evaluated using human cadaveric spines. Only circumferential instrumentation techniques produced more stability than in the intact spine in all testing modes. Short circumferential reconstruction provided more stability than multilevel posterior instrumentation alone and required fewer levels of spinal reconstruction.

Lumbosacral Chordoma: Prognostic Factors and Treatment
Edward Y. Cheng, Remzi A. Özerdemoglu, Ensor E. Transfeldt, and Roby C. Thompson, Jr.

An analysis of 23 patients with lumbosacral chordoma was undertaken to discern prognostic factors, utility of open versus needle biopsies, and successful treatment method and to correlate the level of nerve resection with subsequent degree of neurologic impairment.

Urgent Surgical Stabilization of Spinal Fractures in Polytrauma Patients
Robert F. McLain and Daniel R. Benson

Urgent treatment of spine fractures in polytrauma patients has not been endorsed in the literature. This prospective series of multiply injured patients treated with urgent (within 24 hours of injury) or early (24-72 hours after injury) stabilization of thoracic and lumbar spine fractures was conducted to determine whether urgent treatment increases risk during surgery.

Maintaining Lumbar Lordosis With Anterior Single Solid-Rod Instrumentation in Thoracolumbar and Lumbar Adolescent Idiopathic Scoliosis
Fred A. Sweet, Lawrence G. Lenke, Keith H. Bridwell, and Kathy M. Blanke

Twenty consecutive patients with primary lumbar or thoracolumbar curves in adolescent idiopathic scoliosis were prospectively evaluated after treatment with anterior convex single solid-rod spinal instrumentation and structural Harms titanium mesh cages. Coronal correction with preservation of lordosis was accomplished using a lordotically contoured single solid rod with structural cages placed anteriorly in the disc spaces.

Spontaneous Lumbar Curve Coronal Correction After Selective Anterior or Posterior Thoracic Fusion in Adolescent Idiopathic Scoliosis
Lawrence G. Lenke, Randal R. Betz, Keith H. Bridwell, Jurgen Harms, David H. Clements, and Thomas G. Lowe

Seventy cases of anterior and 53 of posterior adolescent idiopathic thoracic scoliosis instrumentation and fusions were investigated at a minimum 2-year follow-up to evaluate the spontaneous correction of the lumbar curve. Although both approaches consistently improved the lumbar curve Cobb measurement and apical translation, the anterior approach had better lumbar curve correction.

Spinal Deformity, Pulmonary Compromise, and Quality of Life in Osteogenesis Imperfecta
Roger F. Widmann, Fabien D. Bitan, F. Javier Laplaza, Stephen W. Burke, Mary F. Dimaio, and Robert Schneider

Scoliosis was strongly correlated with pulmonary compromise in this group of 15 adult patients with osteogenesis imperfecta. Kyphosis and chest wall deformity were not correlated with diminished pulmonary function. Physical health was correlated with both scoliosis and vital capacity.

Correlation Between Curve Severity, Somatosensory Evoked Potentials, and Magnetic Resonance Imaging in Adolescent Idiopathic Scoliosis
Jack C. Y. Cheng, Xia Guo, Andy H. L. Sher, Yu-Leung Chan, and Con Metreweli

Somatosensory evoked potentials and whole-spine magnetic resonance imaging were performed in patients with adolescent idiopathic scoliosis and healthy control subjects. Either MRI-detected tonsillar ectopia or syringomyelia or SEP-detected functional disturbance in the somatosensory pathway was found to be significantly more frequent in the group of patients with severe scoliosis curvature. The association between tonsillar ectopia and abnormal SEPs was significant.

Efficacy of Intraoperative Monitoring for Pediatric Patients With Spinal Cord Pathology Undergoing Spinal Deformity Surgery
Tracy J. Wilson-Holden Anne M. Padberg, Lawrence G. Lenke, Brian J. Larson, Keith H. Bridwell, and George S. Bassett

Intraoperative monitoring should be performed in patients with spinal cord disease who undergo surgery for spinal deformity. Because of variability in data, an intraoperative wake-up test should be be used more frequently.

Patients' Perceptions of Overall Function, Pain, and Appearance After Primary Posterior Instrumentation and Fusion for Idiopathic Scoliosis
Sanford F. White, Marc A. Asher, Sue-Min Lai, and Douglas C. Burton

The strongest predictors of favorable outcome, perceived by 121 surgically treated patients with idiopathic scoliosis 2-16 years after surgery were female sex, white race, and possibly, more levels fused.

Complications in the Surgical Treatment of Pediatric High-Grade, Isthmic Dysplastic Spondylolisthesis: A Comparison of Three Surgical Approaches
Robert W. Molinari, Keith H. Bridwell, Lawrence G. Lenke, Felix F. Ungacta, and K. Daniel Riew

Fusion in situ with cast reduction without decompression was compared with two decompression procedures. Complications were similar in all three groups. Pseudarthrosis was much higher in cast reduction and posterior fusion with instrumentation than with circumferential fusion. The higher pseudarthrosis rates were associated with small L5 transverse process surface areas.

Complications and Predictive Factors for the Successful Treatment of Flatback Deformity (Fixed Sagittal Imbalance)
Kevin C. Booth, Keith H. Bridwell, Lawrence G. Lenke, Christy R. Baldus, and Kathy M. Blanke

In 28 patients (with minimum 2-year follow-up) treated with osteotomy for flatback deformity, successful results depended on restoration of neutral or negative sagittal balance and maintenance of coronal balance. Poor satisfaction was associated with more than four major medical problems, resultant pseudarthrosis, coronal imbalance, and sagittal imbalance.

Minimum 5-Year Results of Degenerative Spondylolisthesis Treated With Decompression and Instrumented Posterior Fusion
Kevin C. Booth, Keith H. Bridwell, Bradley A. Eisenberg, Christy R. Baldus, and Lawrence G. Lenke

In patients with minimum 5-year follow-up treated with pedicle screw fixation, fusion, and decompression for degenerative spondylolisthesis, there was a significant reduction in long-term pain and high satisfaction. Thirty-three percent (14% symptomatic) had radiographic adjacent segment degeneration. Satisfaction was less in patients with more than four medical comorbidities.

The Selection of Fusion Levels Using Torsional Correction Techniques in the Surgical Treatment of Idiopathic Scoliosis
Douglas C. Burton, Marc A. Asher, and Sue-Min Lai

The 7-year evolution of a method for the selection of fusion levels using torsional correction techniques in 102 consecutive patients, index patient included, is described. Results were as good as or better than those in other published series.

Langerhans' Cell Histiocytosis of the Spine: Analysis of Twenty-Three Cases
Jin-Sup Yeom, Choon-Ki Lee, Hee Young Shin, Choon-Sung Lee, Chung Soo Han, and Han Chang

Jin-Sup Yeom, Choon-Ki Lee, Hee Young Shin, Choon-Sung Lee, Chung Soo Han, and Han Chang For the treatment of single or dual spinal lesions in Langerhans' cell histiocytosis, observation with or without bracing was sufficient. In patients with multifocal lesions chemotherapy produced good results. For the treatment of neurologic deficit, low-dose radiotherapy was the treatment of choice. Surgery resulted in the poorest outcome.

Extraspinal Bone and Soft-Tissue Tumors as a Cause of Sciatica: Clinical Diagnosis and Recommendations: Analysis of 32 Cases
Jacob Bickels, Neil Kahanovitz, Cynthia K. Rubert, Robert M. Henshaw, David P. Moss, Isaac Meller, and Martin M. Malawer

The authors describe 32 patients with sciatica who eventually were found to have a bone or soft-tissue tumor along the course of the sciatic nerve. To diagnose these rare conditions early and accurately, special attention should be given to the pain pattern, physical examination, and use of appropriate imaging studies.

The Old and the New Camptocormia
Kazimierz Karbowski

A psychogenic forced posture with a forward-bent trunk was termed "camptocormia"by Souques in 1915. This syndrome must be differentiated from recently described "camptocormic" postural anomalies resulting from somatics diseases of the paravertebral muscles.