indexBasicScienceEffectofPolyetherEtherKetoneonTherapeuticRadiationtotheSpine:APilotStudy聚醚醚酮樹脂PEEK對脊柱放射治療的影響：初步研究DeletionofOpgLeadstoIncreasedNeovascularizationandExpressionofInflammatoryCytokinesintheLumbarIntervertebralDiscofMice敲除小鼠Opg基因導致腰椎間盤中炎癥細胞因子的表達和新生血管形成的增加indexCervicalSpineComplicationandReoperationRatesFollowingSurgicalManagementofCervicalSpondyloticMyelopathyinMedicareBeneficiaries醫療保險受益人髓性頸椎病手術治療后的并發癥和再手術率EfficacyofDiffusionTensorImagingIndicesinAssessingPostoperativeNeuralRecoveryinCervicalSpondyloticMyelopathy擴散張量成像指數在評估頸椎脊髓病性脊髓病術后神經恢復的功效RoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395Cases在ACDF治療髓性或根性頸椎病術中常規使用神經監護是可疑的：回顧15,395例INDEXDeformityDiscrepancyBetweenStandingPostureandSagittalBalanceDuringWalkinginAdultSpinalDeformityPatients成年脊柱畸形患者行走和站立姿勢矢狀平衡之間的差異FunctionandClinicalSymptomsaretheMainFactorsthatMotivateThoracolumbarAdultScoliosisPatientstoPursueSurgery功能和臨床癥狀是促使成人胸腰椎脊柱側凸患者進行手術的主要因素INDEX

EpidemiologyFrequencyandRiskFactorsforAdditionalLesionsintheAxialSpineinSubjectsWithChordoma:IndicationsforScreening脊柱脊索瘤患者脊柱軸向其他病變的頻率和危險因素HealthServicesResearchTheInfluenceofRaceonShort-termOutcomesAfterLaminectomyand/orFusionSpineSurgery種族對椎板切除和/或融合脊柱手術后短期結果的影響INDEXLiteratureReviewASystematicReviewoftheSoft-TissueConnectionsBetweenNeckMusclesandDuraMater:TheMyoduralBridge連接頸部肌肉和硬腦膜之間的軟組織的系統評價：肌肉橋OutcomesComparisonofOutcomesofSingle-LevelAnteriorCervicalDiscectomyWithFusionandSingle-LevelArtificialCervicalDiscReplacementforSingle-LevelCervicalDegenerativeDiscDisease單節段前路頸椎椎間盤切除融合術和單節段頸椎椎間盤置換術對單節段頸椎退行性椎間盤疾病的預后比較TITLEEffectofPolyetherEtherKetoneonTherapeuticRadiationtotheSpine:APilotStudy聚醚醚酮樹脂PEEK對脊柱放射治療的影響：初步研究StudyDesign.Cadavericmodel.研究設計：尸體模型。ABSTRACTObjectives.TocomparetheeffectofPEEK

versus

conventionalimplantsonscatterradiationtoasimulatedtumorbedinthespine目的：比較PEEK與傳統植入物對脊柱模擬放射治療的影響ABSTRACTSummaryofBackgroundData.Giventhehighlyvasculaturenatureofthespine,itisthemostcommonplaceforbonymetastases.Aftersurgicaltreatmentofaspinalmetastasis,adjuvantradiationtherapyistypicallyadministered.Radiationdosingisprimarilylimitedbytoxicitytothespinalcord.Thescattereffectcausedbymetallicimplantsdecreasestheaccuracyofdosingandcanunintentionallyincreasetheeffectivedoseseenbythespinalcord.Thisrepresentsadose-limitingfactorfortherapeuticradiationpostoperatively.背景資料概述：由于椎體的血運豐富，所以是骨轉移最常發生的部位。脊柱轉移癌的外科治療后，通常需要輔助放射治療。輻射劑量主要受脊髓毒性的限制。金屬植入物引起的散射效應降低劑量的準確性，并可以無意中增加脊髓的有效劑量。這代表術后放射治療的劑量限制因素。ABSTRACTResults.Themeandosewassimilaracrossallconstructsandlocations.Therewasmorevariabilityintheupperthoracicspineirrespectiveoftheconstructtype.ThePEEKconstructhadamoreuniformdosedistributionwithastandarddeviationof9.76.Thestandarddeviationoftheothersconstructswas14.26forthecontrolgroup,19.31forthetitaniumcage,and21.57forthecement(polymethylmethacrylate)construct.結果：所有構建體和位置的平均劑量相似。無論內固定類型如何，上胸椎存在更多的變異性。PEEK構建體具有更均勻的劑量分布，標準偏差為9.76。其他構建體的標準偏差：對照組為14.26，鈦籠為19.31，骨水泥（聚甲基丙烯酸甲酯）構建體為21.57。ABSTRACTConclusion.ThePEEKinter-bodycageresultedinasignificantlymoreuniformdistributionoftherapeuticradiationinthespinewhencomparedwiththeotherconstructs.Thismayallowfortheapplicationofhighereffectivedosingtothetumorbedforspinalmetastaseswithoutincreasingspinalcordtoxicitywitheitherfractionatedorhypofractionatedradiotherapy.結論：與其他構建體相比，PEEK籠手術后放射治療的輻射在脊柱中有更顯著均勻的分布。這可以允許對脊柱轉移腫瘤施加更高的有效劑量，而不增加放療的脊髓毒性。SampleradiationplanningmodelcreatedfromaplanningCTscanforoneofourcadavericspecimens.Theseparateiso-denselinescanbeseenwiththepercentageofthetotaldoseadministered.Theyellowareaisthespinalcordthathasbeenselectedduringtheradiationplanningasanareatoprotect.Notetherediso-denseline's,representing100%dose,lackofuniformdistributioninthePMMAconstructanditsoverlapwiththespinalcord..AcartonrepresentationoftheTLDsensorplacementlocation.EachTLDsensorplacementwasconfirmedvisuallybeforeclosingtheincisionandfillingitwiththephantommaterial.RepresentativeimagesfromacompleteplanningCTscanwithbeamanglesandiso-denselinesillustrated.Coronal,sagittal,axial,and3Dimagesareincluded.Thephantomcanbeseeingfillingthelungs.Thelowerconstructdosingwasplannedseparately.ArepresentativeT2sagittalMRIofapatientafterposteriorinstrumentationandanteriorreconstructionwithaPEEKcage.Notethescatterwiththepediclesscrews(redarrows).ThePEEKcagehasminimalscatteraffectingtheimagingsequence(yellowarrow).*Despiteadvances,metastaticdiseasecontinuestoaffectthespineanditcancausesymptomsfrompainandweaknesstocompleteparalysisleadingtosignificantmorbidityanddisability*盡管取得進展，但轉移性疾病任然影響脊柱，并且可引起疼痛和無力，甚至完全癱瘓*ThePEEKinterbodycageresultedinasignificantlymoreuniformdistributionoftherapeuticradiationinthespinewhencomparedwiththeotherconstructsinacadavericspinemodel.*與尸體脊柱模型中的其他內固定構造相比，PEEK椎間融合器的治療輻射在脊柱中有更加顯著均勻的分布。*Thisknowledgemayallowfortheapplicationofhighereffectivedosingtothetumorbedforspinalmetastaseswithoutincreasingspinalcordtoxicitywitheitherfractionatedorhypofractionatedradiotherapy.*這種知識可以對脊柱轉移的腫瘤應用更高的有效劑量，而不增加放療的脊髓毒性。

TITLEDeletionofOpgLeadstoIncreasedNeovascularizationandExpressionofInflammatoryCytokinesintheLumbarIntervertebralDiscofMice敲除小鼠Opg基因導致腰椎間盤中炎癥細胞因子的表達和新生血管形成的增加StudyDesign.NeovascularizationandexpressionofinflammatorycytokineswereexaminedinOsteoprotegerin(Opg)knockout(KO)micethatshowintervertebraldisc(IVD)degeneration.研究設計：研究骨保護素（Opg）敲除（KO）小鼠的椎間盤（IVD）變性模型中炎癥細胞因子的表達和新血管的形成。ABSTRACTObjective.TheaimofthisstudywastoclarifythepathologicalchangesinlumbarIVDdegenerationinOpgKOmice.目的：本研究的目的是闡明OpgKO小鼠腰椎IVD變性的病理變化。ABSTRACTMethods.OpgKOmiceandtheirwild-type(WT)littermateswereeuthanized.LumbarIVDswereharvested.SafraninO/FastGreenstainingwasperformedtoexaminethepathologicalchanges.Microcomputedtomographic(micro-CT)analysiswasperformedtodeterminethestructuralchangesatthejunctionoflumbarIVDcartilageandvertebrae.Tartrate-resistantacidphosphatase(TRAP)stainingwasperformedtoevaluateosteoclastformation.ProteinexpressionofvascularendothelialgrowthfactorA(VEGF-A),CD31,VE-cadherin,CD34,interleukin-1β(IL-1β),andtumornecrosisfactorsα(TNF-α)wereanalyzedbyimmunohistochemistry(IHC)assays.GeneexpressionsofIL-1β,IL-6,andTNF-αwereanalyzedbyreal-timepolymerasechainreaction(RT-PCR).方法：將OpgKO小鼠及其野生型（WT）同窩小鼠安樂死。獲取腰部IVD。進行SafraninO/FastGreen染色以檢查病理變化。進行微計算機斷層掃描（micro-CT）分析以確定腰椎IVD軟骨和椎骨的連接處的結構變化。進行酒石酸鹽抗性酸性磷酸酶（TRAP）染色以評價破骨細胞形成。通過免疫組織化學（IHC）測定分析血管內皮生長因子A（VEGF-A），CD31，VE-鈣粘蛋白，CD34，白細胞介素-1β（IL-1β）和腫瘤壞死因子α。通過實時聚合酶鏈反應（RT-PCR）分析IL-1β，IL-6和TNF-α的基因表達。ABSTRACTResults.In12-week-oldOpgKOmice,newbonewasformedintheendplatecartilageoflumbarIVDsandthisbecamemoreobviousin24-week-oldOpgKOmice.Three-dimensional(3D)μCTreconstructionanalysesshowedthattheedgesoftheL4andL5vertebraewereruggedwithbonemarrowcavitiesinit.ProteinexpressionofVEGF-A,CD31,VE-cadherin,andCD34wasincreasedintheendplateandgrowthplateoflumbarIVDsofOpgKOmice.GeneexpressionofIL-1β,IL-6,andTNF-αaswellasproteinexpressionofIL-1βandTNF-αwerehighlyexpressedinthelumbarIVDsofOpgKOmice.結果：在12周齡的OpgKO小鼠中，腰椎IVD的終板軟骨中形成新骨，這在24周齡的OpgKO小鼠中變得更明顯。三維（3D）μCT重建分析顯示，L4和L5椎骨的邊緣與骨髓腔骨質增生。在OpgKO小鼠的腰椎IVD的終板和生長板中VEGF-A，CD31，VE-鈣粘著蛋白和CD34的蛋白表達增加。IL-1β，IL-6和TNF-α的基因表達以及IL-1β和TNF-α的蛋白表達在OpgKO小鼠的腰部IVD中高度表達。*DeletionofOpgleadstoincreasedneovascularizationinlumbarintervertebraldiscofmice.*DeletionofOpgleadstoincreasedexpressionofinflammatorycytokinesinlumbarintervertebraldiscofmice.*LumbarIVDdegenerationinOpgKOmicecouldbeacceleratedbytheinteractionsamongosteoclastformation,inflammatorycytokines,andneovascularization.*敲除Opg導致小鼠腰椎間盤增加新血管形成。*敲除Opg導致小鼠腰椎間盤中炎癥細胞因子的表達增加。*OpgKO小鼠的腰椎IVD變性可以通過破骨細胞形成，炎癥細胞因子和新血管形成之間的相互作用而加速。TitleComplicationandReoperationRatesFollowingSurgicalManagementofCervicalSpondyloticMyelopathyinMedicareBeneficiariesDepartmentofOrthopaedicSurgery,JohnsHopkinsHospital,Baltimore,MD醫療保險受益人髓性頸椎病手術治療后的并發癥和再手術率StudyDesign.Retrospectivedatabasereview.研究設計：回顧性數據庫審查。ABSTRACTObjective.Tocomparecomplicationandreoperationratesafteranteriorcervicaldiscectomyandfusion(ACDF),posteriorcervicalfusion(PCFs),andanteriorcervicalcorpectomyandfusion(ACCF)forcervicalspondyloticmyelopathy(CSM)usingalargenationaldatabaseofMedicarebeneficiaries.目的：使用國家醫療保險受益人的大型國家數據庫，比較頸椎前路椎間盤切除融合術和頸椎后路融合術（PCF），頸椎前路椎體融合術（ACCF）治療頸椎髓性頸椎病（CSF）的并發癥和再手術率。ABSTRACTSummaryofBackgroundData.CSMisthemostcommoncauseofmyelopathyinpatientsover55yearsandisconsideredthemostcommoncauseofspinalcorddysfunctionintheworld.SurgicaltreatmentincludesACDF,PCF,orACCFprocedures.背景資料概述：CSM是55歲以上患者中脊髓壓迫最常見的原因，并且被認為是世界上導致脊髓功能障礙的最常見原因。手術治療包括ACDF，PCF或ACCF。ABSTRACTMethods.ThePearlDiverdatabase(2005–2012)wasutilizedtodeterminerevisionratesaftersurgicaltreatmentofCSMbyoneoftheaforementionedsurgicaltreatments.Specifically,1to2levelACDF,ACCF,andPCFand3+levelPCFcohortswereincluded.Eachcohortwasstratifiedbytheageof65years.Survivorshipcurvesweregraphedandcompared.方法：使用PearlDiver數據庫（2005-2012）確定上述手術治療的CSM患者的返修率。具體來說，包括1至2階段ACDF，ACCF和PCF和3+PCF隊列。每個隊列按65歲分層。繪制并比較存活曲線。ABSTRACTResults.Ofthepatientsyoungerthan65yearsofage,therewere10,557patientstreatedwith1to2levelACDFprocedures,1319patientswith1to2levelPCFprocedures,1203patientswith1to2levelACCFprocedures,and2312patientstreatedwith3+levelPCFprocedures.Oftheelderlypatients,24,310patientsweretreatedwith1to2levelACDFs,4776with1to2levelPCFprocedures,3109with1to2levelACCFs,and7760with3+levelPCFs.Patientsyoungerthan65yearsofageweresignificantlymorelikelytohaveareoperationprocedure,thanthose65yearsorolderwhenanalyzingACCF,ACDF,and3+levelPCFprocedures.ACCFsweresignificantlymorelikelythanACDFstorequirereoperation.PatientstreatedwithPCFwereconsistentlymorelikelytohavenondysphagia-relatedcomplicationsthanthosetreatedwithACDF.Ratesoftransfusion,dysphagia,andhematoma/seromaformationweresignificantlyincreasedwithACCFcomparedwithACDFwithintheelderlypopulation.結果：在65歲以下的患者中，有10,557例患者接受1?2階段的ACDF手術，1319例患者接受1?2階段的PCF手術，1203例患者接受1?2階段的ACCF手術，2312例患者接受3+級PCF程序。在老年患者中，24,310例患者接受1?2階段的ACDF治療，4776例接受1?2階段的PCF手術，3109例接受1?2階段的ACCF，7760例接受3?4階段的PCF。65歲以下的患者ACCF，ACDF和3+級PCF比65歲或更大的患者明顯更有可能進行再次手術。ACCF明顯比ACDF更可能需要再次手術。PCF治療的患者比用ACDF治療的患者更可能患有非吞咽困難相關的并發癥。輸血，吞咽困難和血腫形成率在老年人口中的ACDF組顯著增加。ABSTRACTConclusion.TheelderlyaresignificantlylesslikelytohavearevisionsurgeryaftersurgicaltreatmentforCSM.PatientstreatedwithACCFaremorelikelytoneedarevisionthanthosetreatedwithACDF.結論：老年人在CSM手術治療后進行返修手術的可能性顯著降低。用ACCF治療的患者比用ACDF治療的患者更可能需要翻修。*PatientstreatedwithACCFaremorelikelytoneedrevisionsurgerythanthosetreatedwithACDForPCF.*ThereisnosignificantdifferenceinrevisionratewhencomparingACDFandPCFprocedures.*Theelderlyweresignificantlylesslikelythanyoungerpatientstohavearevisionsurgerywhenconsideringallsurgeries.*PCFisassociatedwithgreatercomplicationrates,thoughlowerdysphagiarates.*ACCF治療的患者比ACDF或PCF治療的患者更可能需要翻修手術。*當比較ACDF和PCF程序時，翻修率沒有顯著差異。*在考慮所有手術時，老年人比年輕患者進行翻修手術的可能性顯著降低。*PCF與較高的并發癥發生率相關，但吞咽困難率較低。

TITLEEfficacyofDiffusionTensorImagingIndicesinAssessingPostoperativeNeuralRecoveryinCervicalSpondyloticMyelopathyDepartmentofspinesurgery,GangaHospital,Coimbatore,India.擴散張量成像指數在評估頸椎脊髓病性脊髓病術后神經恢復的功效StudyDesign.Prospectiveobservationalcohortstudy.研究設計：前瞻性觀察性隊列研究。ABSTRACTObjective.Theaimofthisstudywastoanalyzetheefficacyofdiffusiontensorimaging(DTI)anisotropyindicesinpredictingthepostoperativerecoveryincervicalspondyloticmyelopathy(CSM)patientsandtodescribepostoperativechangesintheDTIindicesbasedonneurologicalrecoveryaftersurgery.目的：本研究的目的是分析擴散張量成像（DTI）各向異性指數在預測頸髓性脊髓病（CSM）患者的術后恢復的效果，并描述手術后神經恢復的DTI指數的術后變化。

ABSTRACTSummaryofBackgroundData.SurgicalresultsofCSMareunpredictableandcannotbeestimatedbasedonpreoperativeMRI.DTIindiceswerefoundtohavegoodsensitivitytodetectchangesinCSM,buttheirefficacyinpredictingpostoperativerecoveryandpostoperativechangesinDTIindiceshasnotbeenstudiedbefore.背景資料總結：CSM的手術結果是不可預測的，不能基于術前MRI進行估計。DTI指數具有良好的敏感性以檢測CSM的變化，但DTI指數術后變化在預測術后恢復的功效尚未進行過研究。ABSTRACTMethods.Thirty-fivepatientswhounderwentsurgicaldecompressionforcervicalspondyloticmyelopathyunderwentDTIevaluationpreoperativelyandpostoperativelyat12months.DTIindices—fractionalanisotropy,apparentdiffusioncoefficient(ADC),relativeanisotropy,volumeratio,andeigenvectors(E1,E2,andE3)—wereobtainedandclinicalevaluationsweremadepreoperativelyand12monthspostoperatively.方法：35例頸椎病接受手術減壓的患者術前和術后12個月進行DTI評估。獲得DTI指數-分數各向異性，表觀擴散系數（ADC），相對各向異性，體積比和特征向量（E1，E2和E3），并在術前和術后12個月進行臨床評價。ABSTRACTResults.Twenty-sixpatientswereavailableforfinalfollow-upat12months.Twentypatientsshowedimprovementbyatleast1Nurickgrade,fivemaintainedthepreoperativeNurickgradestatusandonepatientwasnotedtohavedeteriorationby1grade.ThepreoperativeDTIvaluescouldnotpredictneurologicalrecoverypatternspostoperatively.AlthoughconventionalMRIshowedadequatedecompressioninallpatientsirrespectiveoftheclinicaloutcome,DTIindicesshowedvariableresults.ThereweresignificantimprovementsinpostoperativeDTIindicesforADC(P

=0.002),E1(P

<0.001),andE2(P

=0.012)valuesinpatientswhoshowedneurologicalrecoveryat12months.PostoperativeDTIindicesforcoefficientsADC,E1,andE2inneurologicallystatic/worsenedindividualsremainedunchangedorinsignificant(P

=0.05)結果：在12個月時有26名患者獲得了最終隨訪。20例患者表現出至少1級的Nurick改善，5例維持術前Nurick分級狀態，1例患者1級惡化。術前DTI值無法預測術后神經恢復。盡管常規MRI在所有患者中顯示充分的減壓，而不管臨床結果如何，但DTI指數顯示可變的結果。在12個月時顯示神經恢復的患者中，ADC（P=0.002），E1（P<0.001）和E2（P=0.012）值的術后DTI指數有顯著改善。在神經靜態/惡化個體中，ADC系數，E1和E2的術后DTI指數保持不變或不顯著（P=0.05）ABSTRACTConclusion.TheDTIindicesweresensitiveenoughtoindicatepostoperativeneurologicalrecoveryobservedfollowingsurgery.PreoperativeDTIevaluationcouldnotpredictpostoperativerecoveryforpatientswithcervicalspondyloticmyelopathy.結論：DTI指數足夠敏感預測手術后觀察到神經恢復。術前DTI評估無法預測髓性頸椎病患者的術后恢復。

*PostoperativeDTIindicesweresensitivetodifferentiatepostoperativeclinicaloutcomefollowingsurgery,showingcomparablechangewithrecoveryandnosignificantchangewasseeninpatientswhoshowednorecoveryorworsenedaftersurgery.*StatisticallysignificantimprovementwasnotedinDTIindicesvaluesforADC,EigenvectorsE1andE2at12monthsfollowingsurgeryinthepatientsshowingneurologicalrecovery.*ThoughpostoperativeMRIshowedsatisfactorydecompressioninallsurgicallytreatedpatientspostoperativeDTIindicesshowedvariableresults.*PreoperativeDTIcouldnotpredictwhichpatientwouldshowclinicalrecoveryfollowingsurgicaldecompression.*術后DTI指數對手術后的臨床結果敏感，顯示與恢復相當的變化，在手術后未恢復或惡化的患者中未見顯著變化。*在顯示神經恢復的患者中，在手術后12個月的ADC，特征向量E1和E2的DTI指數值中觀察到統計學顯著的改善。*雖然術后MRI顯示所有手術治療患者的減壓良好，術后DTI指數顯示可變的結果。*術前DTI無法預測患者在手術減壓后的臨床恢復

磁共振彌散張量成像

（diffusiontensorimaging,DTI）實現活體觀察組織結構的完整性和連通性，利于對各種疾病的引起的白質纖維束的損害程度及范圍的判斷。可用于顯示腦白質內神經傳導束的走行方向，實現對人的中樞神經纖維精細成像。MR圖像的信號：組織T1、T2馳豫時間、H1的密度、分子彌散運動DTI的基本原理：利用擴散敏感梯度脈沖將水分子彌散效應擴大，來研究不同組織中水分子擴散運動的差異（擴散加權相DWI）。DTI可利用擴散敏感梯度從多個方向對水分子的擴散各向異性進行量化，因此有可能反映組織內的細微結構及病理生理改變。擴散張量成像(difusiontensorimaging，DTI)可以觀察脊髓病變及再生修復的動態過程，進行組織微觀結構改變的定量分析，纖維束示蹤成像技術可以立體展現白質纖維束的形態表觀擴散系數(apparentdifusioncoefficient，DCADC值越大，說明水分子的彌散能力越強；三個互相垂直方向的ADC值的平均數是平均擴散率(meandisivity，MD)，它不受方向影響；各向異性包括部分各向異性(fractionanisotropy，FA)和相對各向異性(relativeanisotropy，RA)FA、RA都是非矢量值(數值，無方向性)，取值范圍為是0～1既組織結構排列越規律緊密，組織的各向異性越強，各向異性系數越大張量方向由于彌散張量具有方向性，可以從彌散張量所含信息中顯示出纖維方向的圖，利用纖維束示蹤成像技術，立體展現白質纖維束的形態TheAssessmentofNeuronalStatusinNormalandCervicalSpondyloticMyelopathyUsingDiffusionTensorImaging彌散張量成像在正常和脊髓型頸椎病對神經元的狀態的評價STUDYDESIGN:Aprospectiveobservationalanalysisofdiffusiontensorimaging(DTI)datametricscollectedfromcontrolandpatientswithcervicalspondyloticmyelopathy(CSM).研究設計：收集脊髓型頸椎病（CSM）的彌散張量成像（DTI）數據前瞻性觀察分析。AbstractOBJECTIVE:TheaimsweretostudytheuseofDTIinCSMandtoprobewhetherDTIdatametricsandtractographywillcorrelatewithmagneticresonanceimagingandclinicalfindings.目的：目的是研究在CSM患者中使用DTI和探討DTI跟蹤技術磁共振成像和臨床表現相關。AbstractSUMMARYOFBACKGROUNDDATA:Magneticresonanceimagingisthecurrent"goldstandard"intheassessmentofcordstatusinCSM;however,variousparameterssuchasextentofcompressionandpresenceofsignalintensitychangesdonotcorrelatewellwithclinicalstatus.DTIisanovelinvestigationtoolwithprovenapplicationsinbrainpathologiesbutisnotroutinelyusedinspinalcordevaluation.背景資料概述：磁共振成像是在目前CSM狀況評估的“金標準”;然而，各種參數與臨床情況相關性不是很好。DTI是一種新型的檢測方式，常用在顱腦的診斷中，但在脊柱脊髓的診斷中不常使用。AbstractMETHODS:PatientswithCSM(n=35)whorequiredsurgicaldecompression(meanage=48yr)and40normalindividuals(meanage=38yr)wereincluded.DiffusionTensorImagingofthecervicalspinewasobtainedusinga1.5Tmagneticresonanceimage.Apparentdiffusioncoefficient,fractionalanisotropy,andeigenvalues(E1,E2,andE3)wereobtainedateachcervicallevel.TheDTIdatametricsofCSMpatientswerecomparedwithnormalvolunteersandcorrelatedwithindividualandgroupedNurickgrades,whichindicatetheneurologicalstatusofpatients.方法：35名需要手術減壓的CSM患者（平均年齡=48歲）和40名正常人（平均年齡=38歲）納入研究。頸椎的彌散張量成像是使用1.5T磁共振圖像獲得。獲取每個節段的表觀擴散系數，分數各向異性，和特征值（E1，E2和E3）的數據。CSM患者的DTIdatametrics與正常人進行了比較，并和Nurick等級關聯起來。AbstractRESULTS:TherewassignificantdifferenceinDTIdatametricsbetweenpatientswithmyelopathyandcontrol(P<0.05),withdecreaseinfractionalanisotropy(0.49±0.081vs.0.53±0.07)andincreaseinapparentdiffusioncoefficient(1.8±0.315vs.1.44±0.145)andeigenvalues(E1:2.82±0.395vs.2.37±0.221,E2:1.64±0.39vs.1.18±0.198,E3:0.956±0.277vs.0.76±0.142).Therewasalsoasignificantdifferencebetweenincreasinggradesofmyelopathywhenindividualsweregroupedas-control,self-ambulant(Nurickgrades1and2),anddependent(Nurickgrades3,4,and5).結果：在CMS和對照組中DTIdatametrics存在顯著差異（P<0.05），各向異性分數降低（0.49±0.081與0.53±0.07），表觀擴散系數（1.8±0.315與1.44±0.145）和特征值增加（E1：2.82±0.395與2.37±0.221，E2：1.64±0.391.18與0.198±，E3：0.956±0.277與0.76±0.142）。根據Nurick等級得分的不同，脊髓的MRIDTI也不同。1.Tractographypatterns:(A)normal,(B)waisting,(C)partiallyinterrupted,and(D)completelyinterrupted.Arrowsshowcompressedregions.AbstractCONCLUSION:ThestudyshowsthatDTIisapromisingandusefulinvestigationaltoolinevaluationofCSM.TherewasasignificantdifferenceinallDTIvaluesbetweencontrolandpatientswithCSM,andtherewasasignificanttrendofchangeinvaluesbetweencontrol,self-ambulant,anddependentpatients.Ourresultsencouragefurtherinvestigationofthisimportantmodality.結論：該研究表明，DTI是評價CSM的一個有前途的和有用的研究性的工具。對照組和CMS組的DTI數值是顯著不同的，并且與Nurick等級得分有關系。我們的研究結果指導下一步的繼續研究。TITLERoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395CasesUCLAMedicalCenter,DepartmentofOrthopaedicSurgery,LosAngeles,CA在ACDF治療髓性或根性頸椎病術中常規使用神經監護是可疑的：回顧15,395例StudyDesign.Aretrospectivedatabasestudy.研究設計：回顧性數據庫研究。ABSTRACTObjective.Thegoalofthisstudywasto(1)evaluatethetrendsintheuseofintraoperativeneuromonitoring(ION)foranteriorcervicaldiscectomyandfusion(ACDF)surgeryintheUnitedStatesand(2)assesstheincidenceofneurologicalinjuriesafterACDFswithandwithoutION.目的：本研究的目的是（1）評估在美國使用術中神經監護（ION）用于前頸椎間盤切除術和融合（ACDF）手術的趨勢，以及（2）評估ACDF后神經損傷的發生率有和沒有ION。

ABSTRACTSummaryofBackgroundData.Somatosensory-evokedpotentials(SSEPs)andmotor-evokedpotentials(MEPs)arethecommonlyusedIONmodalitiesforACDFs.ControversyexistsontheroutineuseofIONforACDFsandthereislimitedliteratureonnationalpracticepatternsofitsuse.背景數據的概述：體感誘發電位（SSEP）和運動誘發電位（MEP）是ACDF常用的ION方式。關于ION用于ACDF的常規使用存在爭議，并且關于其使用的國家實踐模式的文獻有限。

ABSTRACTMethods：AretrospectivereviewwasperformedusingthePearlDiverPatientRecordDatabasetoidentifycasesofspondyloticmyelopathyandradiculopathythatunderwentACDFfrom2007to2014.ThetypeofIONmodalityusedandtheratesofneurologicalinjuryaftersurgerywereassessed.方法：使用PearlDiver患者記錄數據庫進行回顧性評估，以確定2007年至2014年期間接受ACDF的髓性頸椎病和根性頸椎病的病例。評估使用ION方式類型和手術后神經損傷的發生率。pearldiver已經建立了一個世界上最大的醫療保健數據庫超過40億符合HIPAA病人記錄。在這個基礎上，pearldiver能夠提供醫院、醫務人員、醫療設備公司高管、分析師和監管機構的關鍵見解和可操作的信息。PearlDiverhaspartneredwithComprehensiveHealthInsightstointegrateHumana’s（醫療保險巨頭）fullclaimsdatabaseintothePearlDiverresearchprogram.AsofJuly,2016Humanarepresents20.9millionpatientsthroughoutthedurationofthesetincludingclaimsfrom2007throughQ32015.Nosamplingisperformedonthisdata.ResearchisconductedoverthefullsetincludingcommercialandMedicareadvantagepopulations.Whilede-identifiedandHIPAAcompliant,thisresearchsetisfullycapableoflongitudinalresearchbaseduponuniquepatientidentifiercodes.ResearchcanbeperformedutilizinganyoneorcombinationofidentifiablefieldsontheclaimrecordprocessedbyHumana.Fieldsincludebutarenotlimitedto;ICD-9&ICD-10diagnosiscoding,DRGproceduralcoding,ICD-9&ICD-10proceduralcoding,CPTproceduralcoding,prescriptionNDCcoding,labrecordLOINCcoding,dischargestatus,demographic,physicianspecialty,andgeographicregionorstate.DETAILSScope:NationalTimePeriod:2007–Q32015TotalPatientVolume:20.9millionLongitudinal:Yes,timespecificcapableProviders:Facility,physician,ancillaryservices,pharmacyGeographicInclusion:AllU.S.statesandterritoriesResearchableprocedure/drug/labcoding:DRG,ICD-9Diagnosis,ICD-10Diagnosis,ICD-9procedural,ICD-10procedural,CPT,NDC,LOINCAdditionalfilters:Age,date,dischargestatus,druggroup,fieldnumber(primary,secondary,tertiary,etc.),gender,lengthofstay,physicianspecialty,plantype,race,region,servicelocation,andstatePayerTypes:Individualcommercial,state-basedMedicaid,MedicarestandalonePDP,groupMedicareAdvantage,andIndividualMedicareAdvantageModifiersincluded:YesCostofCareAvailability:InsurerreimbursedamountperclaimUpdates:DataisupdatedonaquarterlybasisABSTRACTResults.Duringthestudyperiod,15,395patientsunderwentanACDF.Overall,IONwasusedin2627(17.1%)ofthesecases.TherewasadecreaseintheuseofIONforACDFsfrom22.8%in2007to4.3%usein2014(P

<0.0001).TheIONmodalitiesusedfortheseACDFswerequitevariable:SSEPsonly(48.7%),MMEPsonly(5.3%),andcombinedSSEPsandMMEPs(46.1%).Neurologicalinjuriesoccurredin0.23%and0.27%ofpatientswithandwithoutION,respectively(P

=0.84).YoungeragewasassociatedwithahigherutilityofION(<45:20.3%,45–54:19.3%,55–64:16.6%,65–74:14.3%,and>75:13.6%,

P

<0.0001).SignificantregionalvariabilitywasobservedintheutilityofIONforACDFsacrossthecountry(West;21.9%,Midwest;12.9%(P

<0.0001).結果：在研究期間，15,395例患者接受ACDF。總體而言，ION用于2627例（17.1％）的病例。ACDF的ION的使用從2007年的22.8％下降到2014年的4.3％（P<0.0001）。用于這些ACDF的ION模態是相當可變的：僅SSEP（48.7％），僅MMEP（5.3％），以及SSEP和MMEP組合（46.1％）。有和無ION患者神經損傷發生分別為0.23％和0.27％（P=0.84）。年輕與ION的更高效用相關（<45：20.3％，45-54：19.3％，55-64：16.6％，65-74：14.3％和>75：13.6％，P<0.0001）。觀察到ION對全國ACDF的效用具有顯著的區域變異性（西;21.9％，中西部;12.9％（P<0.0001））。ABSTRACTConclusion.TherehasbeenasignificantdecreaseintheuseofIONforACDFs.Furthermore,therewassignificantageandregionalvariabilityintheuseofIONforACDFs.UseofIONdoesnotfurtherpreventtherateofpostoperativeneurologicalcomplicationsforACDFsascomparedwiththecaseswithoutION.TheutilityofroutineIONforACDFsisquestionable.結論：ION用于ACDF的使用顯著減少。此外，使用ION用于ACDF存在顯著的年齡和區域變異性。與沒有ION的情況相比，ION的使用不進一步防止ACDF的術后神經學并發癥的發生率。常規ION對ACDF的效用是值得懷疑的。*Controversyexistsintheutilityofroutineuseofintraoperativeneuromonitoring(ION)foranteriorcervicaldiscectomyandfusion(ACDF)fordegenerativeconditionswithoutdeformity.*Onanationallevel,therehasbeenasignificantdecreaseintheuseofIONforACDF.*TheoverallriskofneurologicalcomplicationsafterACDFislow(<1%).*TheuseofIONdidnotfurtherpreventpostoperativeneurologicalcomplicationsforACDFsascomparedwiththecaseswithoutION.*TheutilityofroutineIONforACDFsisquestionable.對于在沒有畸形的前路頸椎間盤切除和融合術（ACDF）常規使用術中神經監護（ION）是有爭議的。*在全國范圍統計，ACDF術中使用ION逐漸減少。*ACDF后神經系統并發癥的總體風險低（<1％）。*與沒有ION的情況相比，ION的使用沒有進一步防止ACDF的術后神經學并發癥。*常規ION對ACDF的作用是值得懷疑的。

TITLEDermalDiscolorationsandBurnsatNeuromonitoringElectrodesinPediatricSpineSurgeryChildren'sOrthopedicCenter,Children'sHospitalLosAngeles,LosAngeles,CA兒科脊柱手術使用神經電極導致皮膚色素沉著和燒傷StudyDesign.Prospectivereviewofconsecutivepatients.研究設計：連續患者的前瞻性回顧。ABSTRACTObjective.Toevaluatetheincidenceandraiseawarenessofelectrodediscolorationthatcanoccurintheoperatingroomwhenusingneuromonitoring.目的：評估手術