Attachments of the Posterior Layer of Lumbar Fascia
Priscilla J. Barker and Christopher A. Briggs

Additional attachments of the posterior layer were identified superiorly: the superficial lamina attaching to rhomboids, and the deep to the splenius muscles. Attachments were consistently present and capable of transmitting tension, but were of variable thickness. They may have implications for tests used in assessment and management of low back pain.

Age-Related Changes in Fibromodulin and Lumican in Human Intervertebral Discs
Robert Sztrolovics, Mauro Alini, John S. Mort, and Peter J. Roughley

The collagen-binding keratan sulfate proteoglycans fibromodulin and lumican were investigated in human intervertebral discs. Aging was associated with changes in the abundance and structure of both molecules, albeit in different areas of the disc and at different stages of life. In light of the roles played by fibromodulin and lumican in extracellular matrix interactions, the observed changes may have important consequences on the functional properties of the disc.

Biomechanical Efficacy of Unipedicular Versus Bipedicular Vertebroplasty for the Management of Osteoporotic Compression Fractures
Antoine G. Tohmeh, John M. Mathis, David C. Fenton, Alan M. Levine, and Stephen M. Belkoff

Unipedicular and bipedicular augmentation using polymethylmethacrylate, as used during percutaneous vertebroplasty, increases acute strength and restores stiffness to osteoporotic vertebral bodies with compression fractures. Unaugmented vertebral bodies were significantly weaker and more compliant than they were before fracture.

A Comparison of Various Angles of Halo Pin Insertion in an Immature Skull Model
Lawson A. B. Copley, Matthew D. Pepe, Virak Tan, and John P. Dormans

Varying angles of halo pin insertion were evaluated in an immature skull model to determine the influence the angle might have on the stability of the interaction of pin and bone during insertion. Increasing the angle of insertion from the perpendicular resulted in significantly less load at the pin-bone interface.

Comparison of Computed Tomography Myelography and Magnetic Resonance Imaging in the Evaluation of Cervical Spondylotic Myelopathy and Radiculopathy
Farid F. Shafaie, Franz J. Wippold II, Mokhtar Gado, Thomas K. Pilgram, and K. Daniel Riew

In this cross-sectional retrospective radiologic study, the concordance between the interpretations of computed tomography myelography and magnetic resonance imaging was evaluated in patients with degenerative cervical spine disease. For most parameters evaluated, only moderate concordance between the two modalities was noted. Computed tomography myelography and magnetic resonance imaging should be viewed as complementary studies, and not necessarily as interchangeable modalities.

Vertebral Centroid Measurement of Lumbar Lordosis Compared With the Cobb Technique
Yi-Lang Chen

Vertebral centroid measurement of lumbar lordosis was used to examine lumbar curvature, and the intra- and interobserver reliability of this measurement and that of the Cobb technique were compared. Results show that the vertebral centroid measurement of lumbar lordosis is more reliable than the Cobb method for assessing lumbar lordosis.

Wavelet Analysis of Electromyography for Back Muscle Fatigue Detection During Isokinetic Constant-Torque Exertions
Patrick J. Sparto, Mohamad Parnianpour, Enrique A. Barria, and Jogikal M. Jagadeesh

Temporal alterations in the frequency content of trunk extensor muscle electromyography were quantified using Fourier and wavelet transform-based measures as 16 healthy individuals performed repetitive dynamic trunk extension endurance tests at two load levels and two repetition rates. The changes in the characteristics of the electromyography results were consistent with a shift in the frequency content to lower frequencies: the signal power at higher frequencies was reduced, whereas the power at lower frequencies was elevated. The changes in Fourier and wavelet transform frequency measures were equally highly correlated with the decline in maximal extension torque.

Variability of Somatosensory-Evoked Potentials in Different Stages of Scoliosis Surgery
K. D. K. Luk, Y. Hu, Y. W. Wong, and J. C. Y. Leong

The variability of somatosensory-evoked potentials in different stages of scoliosis surgery was studied to improve the stability and reliability of spinal cord monitoring. The latencies and amplitudes in different stages and their percentage variability were analyzed. A new reference baseline was suggested to make monitoring more reliable.

Responsiveness of Common Outcome Measures for Patients With Low Back Pain
Stewart J. Taylor, Ann E. Taylor, Michael A. Foy, and Anthony J. B. Fogg

The responsiveness of the SF-36 generic health questionnaire was compared with that of the Oswestry Disability Index and that of the Low Back Outcome Score questionnaire by using three methods. Overall, the Oswestry Disability Index was most responsive, although individual scales from the SF-36 matched or outperformed the questionnaire in each of the analyzed patient subgroups.

The Prevalence of Low Back Pain in the Elderly: A Systematic Review of the Literature
Hartley B. Bressler, Warren J. Keyes, Paula A. Rochon, and Elizabeth Badley

The prevalence of low back pain in individuals aged 65 years and older was assessed. Results show that there is wide variability in the reported prevalence of back pain, which demonstrates the need for improved reporting of age information to make prevalence studies more informative and applicable.

The Cochrane Review of Surgery for Lumbar Disc Prolapse and Degenerative Lumbar Spondylosis
J. N. Alastair Gibson, Inga C. Grant, and Gordon Waddell

The Cochrane reviews of lumbar surgery are now available on CD-ROM, with 26 randomized controlled trials of lumbar disc prolapse and 14 of degenerative lumbar spondylosis. There is considerable scientific evidence on the effectiveness of discectomy. There is no scientific evidence on the effectiveness of any form of surgical decompression or fusion for degenerative lumbar spondylosis compared with natural history, placebo, or conservative treatment.

Posterior Lumbar Interbody Fusion: Association Between Disability and Psychological Disturbance in Noncompensation Patients
Vineet Tandon, Fiona Campbell, and E. R. S. Ross

The association between change in disability and psychological distress after posterior lumbar interbody fusion for low back pain was evaluated in noncompensation patients. Improvement in disability was not found to be related to preoperative psychology, but change in disability had a significant association with change in distress.

The Efficacy of Head Immobilization Techniques During Simulated Vehicle Motion
Stephen D. Perry, Barry McLellan, William E. McIlroy, Brian E. Maki, Michael Schwartz, and Geoff R. Fernie

The efficacy of different head immobilization techniques was studied by simulating ambulance transport. Results indicate that somewhat improved head fixation can be achieved by placing wedges under the head; however, the benefits of any fixation method are likely to be limited unless the motion of the trunk is also controlled effectively.

Brown-Sequard Syndrome After Management of Vertebral Hemangioma With Intralesional Alcohol: A Case Report
Thomas Niemeyer, John McClellan, John Webb, Tim Jaspan, and Norlisah Ramli

This report describes Brown-Sequard syndrome after intralesional injection of absolute alcohol into vertebral hemangioma. This case shows that intralesional alcohol injection cannot be considered a safe technique for management of vertebral hemangiomas with spinal cord compression.

Chordoma in the Cervical Spine Managed With En Bloc Excision
Takuya Fujita, Norio Kawahara, Tadami Matsumoto, and Katsuro Tomita The operative technique of en bloc excision in a patient with chordoma in the midcervical spine is described. En bloc excision was achieved using a specially designed saw (T-saw). Although the surgical margin was intralesional in a small area, the authors' procedure demonstrates the feasibility of en bloc excision with a safety margin, even in the cervical spine.

Determining the Lumbar Vertebral Segments on Magnetic Resonance Imaging
Wilfred C. G. Peh, T. H. Siu, and Jimmy H. M. Chan

Identification of transitional vertebrae and correct assignment of lumbosacral vertebrae on magnetic resonance scans of the lumbar spine may be difficult. There is also a relatively large interobserver discrepancy in the numbering of lumbar segments. Using an additional sagittal cervicothoracic localizer scan improves interobserver agreement and is recommended.

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.