Journal of Spinal Disorders & Techniques最新文献

{"title":"Lateral Mass Fixation in the Subaxial Cervical Spine.","authors":"Mark F Kurd,&nbsp;Paul W Millhouse,&nbsp;Gregory D Schroeder,&nbsp;Christopher K Kepler,&nbsp;Alexander R Vaccaro","doi":"10.1097/BSD.0000000000000302","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000302","url":null,"abstract":"<p><p>The use of lateral mass screws and rods in the subaxial spine has become the standard method of fixation for posterior cervical spine fusions. Multiple techniques have been described for the placement of lateral mass screws, including the Magerl, the Anderson, and the An techniques. While these techniques are all slightly different, the overall goal is to obtain solid bony fixation while avoiding the neurovascular structures. The use of lateral mass screws has been shown to be a safe and effective technique for achieving a posterior cervical fusion. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"259-63"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33366609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing the Delivery of Health Care: What Can Health Care Learn From the Business Community?","authors":"Alok D Sharan,&nbsp;Paul W Millhouse,&nbsp;Michael E West,&nbsp;Gregory D Schroeder,&nbsp;Alexander R Vaccaro","doi":"10.1097/BSD.0000000000000308","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000308","url":null,"abstract":"<p><p>The passage of the Patient Protection and Affordable Care Act in March 2010 has resulted in dramatic changes to the delivery of health care in the United States toward a value-based system. While this is a significant change from the previous model, it presents an opportunity for high-quality health care providers to improve patient outcomes while also increasing revenue. However, those that lack a clear strategy to effectively implement change and communicate the increased value to the patients likely will suffer, regardless of how successful or prestigious they seem today. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"254-7"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34001010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Degenerative Spondylolisthesis.","authors":"Theodore D Koreckij,&nbsp;Jeffrey S Fischgrund","doi":"10.1097/BSD.0000000000000298","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000298","url":null,"abstract":"<p><p>Degenerative spondylolisthesis (DS) is one of the more commonly encountered spine conditions. The diagnosis of DS has changed little in the last 30 years. However, there has been an evolution in the treatment of this disease entity. There have been several landmark papers that helped govern our treatment. These helped serve as the basis for the treatment arms of the Spine Patient Outcomes Research Trial (SPORT), which offers the highest quality evidence to date. Although few would argue that the fusion of the diseased segment appears to offer the best and most durable results, treatment of this disease is best tailored to the individual. Fusion may offer the best results in the young active patient, but the same results may never become evident in the medically infirm patient. Laminectomy or unilateral laminoforaminotomy still plays a role in disease treatment. This review will focus on the diagnosis and the treatment of DS as well as discuss the author's preferred treatment of this disease. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"236-41"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34287709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Intraoperative LIV-Tilt and Disk Angle Remain Stable at 2-year Follow-up Compared With Upright Radiographs in Patients With Idiopathic Scoliosis?: A Retrospective Cohort Study.","authors":"James Barsi,&nbsp;Brendan Caprio,&nbsp;Sumeet Garg,&nbsp;David Baulesh,&nbsp;Mark Erickson","doi":"10.1097/BSD.0b013e3182aa4c4b","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182aa4c4b","url":null,"abstract":"<p><strong>Study design: </strong>This study was a retrospective chart and radiographic review.</p><p><strong>Objective: </strong>The aim of this study was to determine if lowest instrumented vertebra (LIV) tilt and disk wedging measured intraoperatively correlated to their respective values on standing radiographs at intermediate follow-up.</p><p><strong>Summary of background data: </strong>No guidelines exist regarding an acceptable intraoperative LIV-tilt.</p><p><strong>Materials and methods: </strong>After IRB approval, a consecutive series of patients with adolescent idiopathic scoliosis (AIS) and structural lumbar curves treated with posterior spinal fusion (PSF) at a single institution between 2007 and 2010 was identified. A total of 163 patients with AIS underwent PSF during this time period. Seventeen patients had fusion of structural lumbar curves with adequate imaging and a minimum 2-year follow-up. The LIV-tilt and disk angle below the LIV was measured on the preoperative standing, intraoperative supine fluoroscopy and postoperative standing radiographs, and coronal balance was measured on the preoperative and postoperative standing radiographs using a standardized method separately by 2 authors.</p><p><strong>Results: </strong>The curve distribution was as follows: Lenke 3 (29%), Lenke 5 (47%), and Lenke 6 (24%). There was agreement on radiographic measurements between the 2 authors with a correlation coefficient of 0.98 for coronal balance, 0.91 for LIV-tilt, and 0.65 for disk angle. LIV-tilt improved from 19.4 degrees preoperatively to 3.6 degrees intraoperatively. At minimum 2-year follow-up, LIV had on average progressed to 8.6 degrees. The disk angle improved from 5.4 degrees preoperatively to 2.5 degrees intraoperatively. This improvement was maintained at 2 years (2.8 degrees). Coronal balance also improved during the postoperative period from 17.9 mm immediately following surgery to 11.1 mm at the last follow-up.</p><p><strong>Conclusions: </strong>Compared with prone intraoperative fluoroscopic images, disk wedging below LIV remains stable at 2 years postsurgery on standing radiographs in patients with AISundergoing PSF, including structural lumbar curves, whereas LIV-tilt improvement is not maintained. Intraoperative fluoroscopy provides a reliable prediction of disk wedging below LIV, 2 years after surgery on standing radiographs.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"264-9"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182aa4c4b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32203688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Motor Weakness and Delayed Recovery in Cervical Disk Herniation.","authors":"Tae Wook Nam,&nbsp;Hong Seok Lee,&nbsp;Tae Sik Goh,&nbsp;Jung Sub Lee","doi":"10.1097/BSD.0b013e31829f5a1f","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31829f5a1f","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Objective: </strong>To identify the significant risk factors for motor weakness caused by cervical disk herniation and for delayed recovery after surgery.</p><p><strong>Summary of background data: </strong>There were a few clinical trials for detecting the significant risk factors for motor weakness after anterior cervical surgery.</p><p><strong>Materials and methods: </strong>We retrospectively examined 72 patients with degenerative disk disease of the cervical spine who were treated with single-level anterior cervical discectomy and fusion. The possible risk factors, including age, sex, symptom duration, operation time, surgery level, preoperative radiologic parameters, and preoperative Neck Disability Index score, were evaluated using multivariate logistic regression analysis.</p><p><strong>Results: </strong>The patients included 22 women and 50 men; average age, 47.1±7.8 years. Of these 72 patients, 38 (52.8%) patients had motor deficit before surgery. Complete recovery of motor deficit was seen in 33 (86.8%) patients, and the average duration from surgery to complete recovery was 4.2 months. Multivariate logistic regression analysis showed that disk height (P=0.001, odds ratio=0.32), percentage of herniated nucleus pulposus (HNP) in the spinal canal (P=0.0012, odds ratio=1.24), and presence of signal intensity change in the spinal cord (P=0.0015, odds ratio=35.57) were important risk factors for motor weakness. When the cut-off value of disk height was 5.8 mm, the sensitivity and specificity were 39.5% and 94.1%, respectively. When the cut-off value of HNP in the spinal canal was 28.1%, the sensitivity and specificity were 57.9% and 82.4%, respectively. Furthermore, signal intensity change was identified as an important risk factor for delayed recovery.</p><p><strong>Conclusions: </strong>Decreased disk height, percentage of HNP in the spinal canal, or presence of signal intensity change in the spinal cord seem to be the important risk factors for motor weakness in patients with cervical disk herniation. Moreover, the presence of signal intensity change in the spinal cord seems to be an important risk factor for delayed recovery.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E405-9"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31829f5a1f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33870862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective, Self-controlled, Comparative Study of Transposterior Arch Lateral Mass Screw Fixation and Lateral Mass Screw Fixation of the Atlas in the Treatment of Atlantoaxial Instability.","authors":"Baorong He,&nbsp;Liang Yan,&nbsp;Zhengwei Xu,&nbsp;Zhen Chang,&nbsp;Tuanjiang Liu,&nbsp;Dingjun Hao","doi":"10.1097/BSD.0b013e3182a35572","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a35572","url":null,"abstract":"<p><strong>Study design: </strong>A prospective self-controlled study.</p><p><strong>Objective: </strong>The aim of the present study was to compare the application and clinical outcomes of transposterior arch lateral mass screw and lateral mass screw fixation of the atlas in the treatment of atlantoaxial instability.</p><p><strong>Summary of background data: </strong>Atlas posterior screw fixation techniques comprise transposterior arch lateral mass screw fixation and lateral mass screw fixation. Previous studies have focused mainly on the feasibility of the anatomy and the biomechanics of the methods.</p><p><strong>Methods: </strong>From June 2006 to February 2011, 66 patients with atlantoaxial instability were randomly assigned for treatment with transposterior arch lateral mass screw or lateral mass screw fixation of the atlas, combined with axis pedicle screw fixation. Patients were followed up regularly. The operation time, blood loss, intraoperative complications, Japan Department of Orthopedics Association Score, visual analog scale score, and bone fusion rates were recorded.</p><p><strong>Results: </strong>The operation was successful in all 66 cases, with all patients showing improvement in clinical symptoms. There were significant differences in operation time and blood loss between the 2 groups (P<0.001). The mean follow-up time was 49 months. At the final follow-up, the Japan Department of Orthopedics Association score was significantly better than the preoperative score (mean, 13.5; P<0.05). The mean postoperative improvement rate was 88.2% and the mean visual analog scale score was 1.9; both results were significant as compared with preoperative results (P<0.05). Bone fusion was achieved within 6 months after operation. No screw loosening, shifting, breakage, or atlantoaxial instability was observed. Six patients with atlas lateral mass screw placement had burst bleeding of C1-C2 venous plexus during surgery. Five patients had immediate pain and numbness at the occipitocervical region.</p><p><strong>Conclusions: </strong>Atlas transposterior arch lateral mass screw fixation is less invasive, simple, has fewer complications, and offers good fixation results for atlantoaxial instability as compared with lateral mass screw fixation.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E427-32"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a35572","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31616521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stand-alone Cervical Cages Versus Anterior Cervical Plates in 2-Level Cervical Anterior Interbody Fusion Patients: Analysis of Adjacent Segment Degeneration.","authors":"Gyu Yeul Ji,&nbsp;Chang Hyun Oh,&nbsp;Dong Ah Shin,&nbsp;Yoon Ha,&nbsp;Keung Nyun Kim,&nbsp;Do Heum Yoon,&nbsp;Farid Yudoyono","doi":"10.1097/BSD.0b013e3182a355ad","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a355ad","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Objective: </strong>To analyze adjacent segment degeneration (ASD) in 2-level anterior cervical discectomy, comparing fusion with stand-alone cages [anterior cervical discectomy and fusion (ACDF)-CA] and fusion with cage and plate constructs (ACDF-CPC) with respect to clinical outcomes and radiologic changes.</p><p><strong>Summary of background data: </strong>ACDF using a stand-alone cage or a cage and plate construct is a popular procedure. However, there is lack of knowledge concerning ASD between the 2 procedures.</p><p><strong>Methods: </strong>A total of 42 consecutive patients who underwent 2-level ACDF-CA or ACDF-CPC for 2-level cervical disk disease and who completed 2 years of follow-up were included in this study. The patients were divided into 2 groups: ACDF-CA group (n=22) and ACDF-CPC group (n=20). The following parameters were assessed using radiographs: disk space narrowing, anterior osteophyte formation, calcification of the anterior longitudinal ligament, and fusion status. Clinical outcomes were assessed using the Robinson criteria.</p><p><strong>Results: </strong>No difference in clinical outcomes was observed between the 2 groups. Moreover, the ACDF-CPC group showed a similar fusion rate compared with the ACDF-CA group (100% vs. 95%, P=0.335). There was also no statistical significance in anterior osteophyte formation and calcification of the anterior longitudinal ligament. However, mean intervertebral disk height change of an adjacent segment was significantly lower in the ACDF-CA group than the ACDF-CPC group (upper level: 0.08±0.24 vs. 0.49±0.35; lower level: 0.06±0.41 vs. 0.49±0.28; P<0.01).</p><p><strong>Conclusions: </strong>The use of a cage with or without plate constructs in 2-level ACDF provides similar clinical results and fusion rates. Notwithstanding, ACDF-CPC showed a higher incidence of ASD than ACDF-CA over the 2-year follow-up.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E433-8"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a355ad","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31616523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of Thoracolumbar Junction Injuries Using the Thoracolumbar Injury Severity and Classification Score, American Spinal Injury Association Class, Injury Severity Score, Age, Sex, and Length of Hospitalization.","authors":"Shah-Nawaz M Dodwad,&nbsp;Shah-Jahan M Dodwad,&nbsp;Ronald Wisneski,&nbsp;Safdar N Khan","doi":"10.1097/BSD.0b013e3182a14743","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182a14743","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of patient cohort.</p><p><strong>Objective: </strong>Our goal was to assess the validity of the Thoracolumbar Injury Classification and Severity (TLICS) score system by comparing the TLICS system to prior management of thoracolumbar injuries at our institution between January 1, 2006 to March 31, 2011.</p><p><strong>Summary of background data: </strong>TLICS was introduced in 2005 to classify and assign treatment recommendations for injuries based on 3 axes: mechanism of injury, integrity of the posterior ligamentous complex, and neurological status.</p><p><strong>Methods: </strong>We retrospectively obtained and analyzed patient data regarding thoracolumbar junction injuries at a major academic medical center servicing level I trauma. In addition, we compared the American Spinal Injury Association (ASIA) class at time of injury to last follow-up to determine if there was any change in neurological status after intervention. We also compared sex, injury severity score (ISS), length of hospitalization, and age between nonoperatively and operatively treated patients.</p><p><strong>Results: </strong>Included in our study were 201 patients (70% male and 30% female). We found the TLICS system agreed with prior thoracolumbar junction injury management at our institution 98% of the time in nonoperatively treated patients and 78% of the time in operatively treated patients. Age, sex, and ISS were not statistically significant factors in patients who were treated operatively versus nonoperatively, however, there was a trend towards higher ISS in operatively treated patients. Average TLICS score between nonoperative and operative groups was 1.56 and 4.8, respectively, and was a statistically significant difference. There was no statistically significant difference in ASIA class improvement between operative and nonoperative treatment, however, this is likely because of having only 20 patients in this subcohort. Of note, about 50% of the 17 operatively treated patients had improvement in ASIA class.</p><p><strong>Conclusions: </strong>Our data suggest that TLICS is a valuable tool in a spine surgeon's armamentarium in treating thoracolumbar junction injuries. Some surgeons might be more likely to operate on thoracolumbar junction injuries that should be treated nonoperatively according to the TLICS score. As with all classification schemes, the TLICS system should be used in conjunction with sound clinical judgment.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"E410-6"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182a14743","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33870863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controlling for Multiple Tests.","authors":"Mitchell G Maltenfort","doi":"10.1097/BSD.0000000000000301","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000301","url":null,"abstract":"<p><p>In a statistical test, the P-value is the likelihood that the observed results are just due to chance, and by convention a P-value of <0.05 is considered significant. However, this means that if a study performs 20 individual statistical analyses, assuming the null hypothesis is true in all of them, we expect one to fall below the P<0.05 threshold and give us a false positive. Advanced statistical tests should be used to prevent this from occurring. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"258"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33366611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Starting Point and Bicortical Purchase of C1 Lateral Mass Screws on Atlantoaxial Fusion: Meta-Analysis and Review of the Literature.","authors":"Robert E Elliott,&nbsp;Omar Tanweer,&nbsp;Michael L Smith,&nbsp;Anthony Frempong-Boadu","doi":"10.1097/BSD.0b013e31828ffc97","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31828ffc97","url":null,"abstract":"<p><strong>Study design: </strong>Structured review of literature and application of meta-analysis statistical techniques.</p><p><strong>Objectives: </strong>Review published series describing clinical and radiographic outcomes of patients treated with C1 lateral mass screws (C1LMS), specifically analyzing the impact of starting point and bicortical purchase on successful atlantoaxial arthrodesis.</p><p><strong>Summary of background data: </strong>Biomechanical studies suggest posterior arch screws and C1LMS with bicortical purchase are stronger than screws placed within the center of the lateral mass or those with unicortical purchase.</p><p><strong>Methods: </strong>Online databases were searched for English-language articles between 1994 and 2012 describing posterior atlantal instrumentation with C1LMS. Thirty-four studies describing 1247 patients having posterior atlantoaxial fusion with C1LMS met inclusion criteria.</p><p><strong>Results: </strong>All studies provided class III evidence. Arthrodesis was quite successful regardless of technique (99.0% overall). Meta-analysis and multivariate regression analyses showed that neither posterior arch starting point nor bicortical screw purchase translated into a higher rate of successful arthrodesis. There were no complications from bicortical screw purchase.</p><p><strong>Conclusions: </strong>The Goel-Harms technique is a very safe and successful technique for achieving atlantoaxial fusion, regardless of minor variations in C1LMS technique. Although biomechanical studies suggest markedly increased rigidity of bicortical and posterior arch C1LMS, the significance of these findings may be minimal in the clinical setting of atlantoaxial fixation and fusion with modern techniques. The decision to use either technique must be made after careful review of the preoperative multiplanar computed tomography imaging, assessment of the unique anatomy of each patient, and the demands of the clinical scenario such as bone quality.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 7","pages":"242-53"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31828ffc97","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31337730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}