The Publication Rates of Presentations at Major Spine Specialty Society Meetings (NASS, SRS, ISSLS)
Jeffrey C. Wang, Stephen Yoo, and Rick B. Delamarter

Publication rates for three major spine specialty meetings--the North American Spine Society, Scoliosis Research Society, and International Society for the Study of the Lumbar Spine--were determined for a 3-year period. The publication rates for spine specialty meetings are high and comparable with publication rates for other medical subspecialties. This high rate reflects the quality of the spine meetings and validates their selection process.

Traumatic Instabilities of the Cervical Spine Caused by High-Speed Axial Compression in a Human Model: An in Vitro Biomechanical Study
Qingan Zhu, Jun Ouyang, William Lu, Haijun Lu, Zhonghua Li, Xinhui Guo, and Shizhen Zhong

Instabilities and radiographs of traumatic injuries of the cervical spine were evaluated before and after high-speed axial compressive impacts. The injury patterns and instabilities of the cervical spine were associated with levels of impact energy. In evaluating traumatic injury of the cervical spine, the neutral zone was more sensitive than the range of motion, and instability testing was more sensitive than radiography.

Biomechanical Analysis of Anterior Versus Circumferential Spinal Reconstruction for Various Anatomic Stages of Tumor Lesions
Masahiro Kanayama, Jeremy T. W. Ng, Bryan W. Cunningham, Kuniyoshi Abumi, Kiyoshi Kaneda, and Paul C. McAfee

Anterior versus circumferential thoracolumbar spinal reconstructions were evaluated biomechanically for different stages of tumor resections. For corpectomy or subtotal spondylectomy, anterior reconstruction provided stiffness equivalent to that of the circumferential reconstruction. For total spondylectomy, however, anterior reconstruction alone demonstrated significantly lower stiffness than circumferential reconstruction, suggesting that total spondylectomy requires combined anterior and posterior stabilization.

Anatomic Relation Between the Cervical Pedicle and the Adjacent Neural Structures
Rongming Xu, Alexander Kang, Nabil A. Ebraheim, and Richard A. Yeasting

The anatomic relation of the cervical pedicle to the adjacent neural structures is reported. The results from this study suggest that the incidence of neurologic injuries may be higher in screws penetrating the medial or superior cortex of the pedicle than in screws penetrating the inferior cortex of the pedicle.

Can Intramedullary Signal Change on Magnetic Resonance Imaging Predict Surgical Outcome in Cervical Spondylotic Myelopathy?
Eiji Wada, Kazuo Yonenobu, Shozo Suzuki, Atsunori Kanazawa, and Takahiro Ochi

The authors retrospectively evaluated computed tomographic myelograms, magnetic resonance images, and clinical histories of 50 patients with cervical spondylotic myelopathy to determine whether intramedullary signal change could predict surgical outcome. Patients with multisegmental high-intensity areas on T2-weighted magnetic resonance imaging tended to have poorer surgical results. However, the transverse area of the spinal cord at the level of maximum compression was a better prognostic indicator.

Pachymeningeal Gadolinium Enhancement of the Lumbar Region Secondary to Neuraxis Hypotension
Stephen L. Fedder

Pachymeningeal enhancement of the lumbar region secondary to neuraxis hypotension has not been reported previously. This entity should be considered in the evaluation of lumbar imaging studies. Cognizance of this phenomenon may preclude the need for diagnostic biopsy.

A Controlled Prospective Outcome Study of Implantable Electrical Stimulation With Spinal Instrumentation in a High-Risk Spinal Fusion Population
Donald W. Kucharzyk

The use of instrumentation and electrical stimulation in a high-risk pool of patients showed statistical significance with higher rates of fusion and clinical success when compared with a similar pool that did not receive stimulation.

Intraoperative Radiation Therapy for Metastatic Spinal Tumors
Atsushi Seichi, Taiji Kondoh, Takahiro Hozumi, and Katsuyuki Karasawa

A new technique in which the spinal cord is protected by a lead shield during intraoperative radiation therapy of metastatic spinal lesions, thereby preventing radiation myelopathy, is discussed. The short-term results with respect to local control have been excellent.

Spinal Cord Compression Caused by Unusual Location and Extension of Ossified Ligamenta Flava in a Caucasian Male: A Case Report and Literature Review
Robert J. Van Oostenbrugge, Marcel J. Herpers, and Jelle R. de Kruijk

Compressive myelopathy caused by ossification of the ligamenta flava is a rare entity outside the Far East, and is mostly reported in Asian, and especially in Japanese, people. The authors describe a case of spinal cord compression caused by extended ossification of the thoracic ligamenta flava at an uncommon localization in a white man. A review of the literature is given.

Severe Progressive Osteoporotic Spine Deformity With Cardiopulmonary Impairment in a Young Patient: A Case Report
Robbert J. P. Noorda, Paul I. J. M. Wuisman, Malcolm W. Fidler, Paul T. A. M. Lips, and Henry A. H. Winters

A case is presented of a young patient with a collapsed thoracolumbar spine caused by osteoporosis of unknown etiology, progressive kyphosis, and cardiopulmonary impairment. An operative correction (C7 to S1) was performed using an anterior vascularized fibula graft, in combination with a posterior double Isola rod system, to correct and stabilize the kyphosis. An injectable biocompatible carbonated apatite cancellous bone cement was used for augmentation of the pedicles to achieve strong screw fixation. The operative strategy and difficulties of stabilization are discussed.

Principles of Medical Decision Making
Jon D. Lurie and Harold C. Sox

In this article some principles of medical decision making are described: probability theory, diagnostic test interpretation, the threshold model of decision making, utility assessment, and expected-value decision analysis. Clinical examples related to the diagnosis and management of low back pain illustrate these concepts.