Aims. Degenerative cervical spondylosis (DCS) is a common musculoskeletal disease that encompasses a wide range of progressive degenerative changes and affects all components of the cervical spine. DCS imposes very large social and economic burdens. However, its genetic basis remains elusive. Methods. Predicted whole-blood and skeletal muscle gene expression and genome-wide association study (GWAS) data from a DCS database were integrated, and functional summary-based imputation (FUSION) software was used on the integrated data. A transcriptome-wide association study (TWAS) was conducted using FUSION software to assess the association between predicted gene expression and DCS risk. The TWAS-identified genes were verified via comparison with differentially expressed genes (DEGs) in DCS RNA expression profiles in the Gene Expression Omnibus (GEO) (Accession Number: GSE153761). The Functional Mapping and Annotation (FUMA) tool for genome-wide association studies and Meta tools were used for gene functional enrichment and annotation analysis. Results. The TWAS detected 420 DCS genes with p < 0.05 in skeletal muscle, such as ribosomal protein S15A (RPS15A) (PTWAS = 0.001), and 110 genes in whole blood, such as selectin L (SELL) (PTWAS = 0.001). Comparison with the DCS RNA expression profile identified 12 common genes, including Apelin Receptor (APLNR) (PTWAS = 0.001, PDEG = 0.025). In total, 148 DCS-enriched Gene Ontology (GO) terms were identified, such as mast cell degranulation (GO:0043303); 15 DCS-enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were identified, such as the sphingolipid signalling pathway (ko04071). Nine terms, such as degradation of the extracellular matrix (R-HSA-1474228), were common to the TWAS enrichment results and the RNA expression profile. Conclusion. Our results identify putative susceptibility genes; these findings provide new ideas for exploration of the genetic mechanism of DCS development and new targets for preclinical intervention and clinical treatment. Cite this article: Bone Joint Res 2023;12(1):80–90

Aims: The Attempt to lay down indications for simultaneous applications Cornerstone Carbon Cage (CCS) and titanium plate in surgical treatment of cervical spondylosis with ligamental instability. Methods: Between November 2001 and august 2002 13 patient with ligamental instability underwent applications CCS and cervical plate during one ormultilevel cervical discectomy due to degenerative or posttraumatic cervical spondylosis. We never used external þxation. Results: There were no complications after operations. Preoperative symptoms withdrew in all patient. Good stabilisation was obtained in whole operated group. Conclusions: Simultaneous applications CCS and cervical plate is an effective method in surgical treatment cervical spondylosis with ligament instability. Appropriate stabilisation was obtained without additional external collar þxations and without necessity of autogenic bone graft

Treated conservatively, hyperextension injuries of the cervical spine have a poor outcome, but surgical treatment does not yet provide a realistic alternative. This study was prompted by the lack of classifications of cervical spondylosis and outcome studies of hyperextension in the literature, and the absence of a user-friendly neurological score. The retrospective study included 60 patients admitted over the last 12 years with hyperextension injuries and varying degrees of neurological deficit. The mean age of patients was 52 years and most had radiological evidence of cervical spondylosis. None had any neurological deficit before the accident. Injuries were sustained in falls in 56%, in motor vehicle accidents in 34%, in assaults in 8% and in sports injuries in 2%. The neurological deficits varied: 11% had complete lesions, 33% central cord syndrome, 18% motor complete-sensory incomplete, 33% motor incomplete-sensory incomplete. The nervous system was normal in 2%. The posterior columns were often involved, with loss of pro-prioception. In the majority of cases conservative treatment consisted of six weeks of light traction in gentle flexion, followed by mobilisation in an ABCO brace for six weeks. The results showed that the mean Asia score gain for the group treated conservatively was 23, for the surgically stabilised group 3 and the surgically- decompressed group 55. There was a 16% mortality rate. The mean time for rehabilitation was 5.5 months. Both the final outcome and the time to rehabilitation were extremely variable. We present a classification of cervical spondylosis and ways of measuring congenital and acquired spinal cord narrowing. We combine the Asia and Frankel scoring systems to give a user-friendly guide

Study design: Retrospective review of patients with cervical spondylosis treated with three-level anterior cervical discectomy and fusion with plate fixation. Objective: To assess the radiographic and clinical outcome of three-level instrumented anterior cervical discectomy. Summary of Background data: Three-level cervical discectomy without plate fixation has shown high rates of pseudarthrosis and poor outcomes. The addition of internal fixation may improve these parameters. Methods: 46 patients were observed for an average of 17.6 months (range, 6–51). All had three level anterior cervical discectomy and fusion with tricortical iliac crest autograft (4 cases), fibular ring allograft (38 cases), or titanium cage (four cases). Allografts and cages were filled with iliac crest autograft. All patients had semi-rigid plating. Clinical and radiographic follow-up data were obtained. Clinical outcomes were measured as described by Robinson and with the Nurick scale. Results: Forty-four patients achieved solid fusion. Two patients had additional surgery for junctional disease, and in one of them pseudarthrosis repair was also performed. One asymptomatic pseudarthrosis was noted. With a successful result defined as an excellent or good outcome accompanied by significant pain relief, 38 patients had a successful result (83%). Radiographic adjacent level disease was diagnosed in 11 patients postoperatively and was symptomatic in 5. Conclusion: Three-level anterior cervical discectomy with plate fixation has a high rate of fusion, a low complication rate, and acceptable outcome in the treatment of multilevel cervical spondylosis

Purpose: To assess the outcomes in consecutive 32 patients of two level cervical disc replacement. Methods: In this article, we report 2-year results of anterior cervical decompression and two level cervical disc replacements (prestige) in 32 patients with a diagnosis of symptomatic cervical spondylosis. Dynamic assessment with lateral radiographs of the cervical spine in flexion/extension was done pre and post op. All of them had partial uni/bilateral uncinectomy, which adds in lateral bending. The median age of all patients was 46 years (range 32–61). Levels of surgery included between seven C3–C7, most common were C5–6, C6–7. Results: Neck and arm pain as well as disability scores (VAS, ODI and SF36) were significantly improved by 3 months and remained improved at 2 years. Radiography revealed the complete motion (From flexion to extension) at upper disc replacement level of 11% and 9.6% at the lower level. There is a significant decrease of the facet joint articulation overlap in the sagittal plane. As the diameter of socket is slightly larger than the ball in prestige disc replacement, it helps in additional axial movement. There was reduction in motion at the adjacent segments above and below, preventing adjacent segment problems. Conclusion: Twenty-four months after surgery, patients who underwent two level cervical disc replacements demonstrated greater improvement in neurologic function and neck pain. It helps in restoring sagittal balance, functional outcome of patient because of increased lateral bending, axial rotations and flexion-extension. Ethics approval: done from appropriate authorities. Interest Statement: There is no local grant, national grant, commercial/industry support for this article. There are no interest or gain from any source for this article

Aims: It is believed that arthrodesis of spinal segments leads to excessive stress at unfused adjacent levels. The incidence, prevalence and radiographic progression of symptomatic adjacent-segment disease were studied. Methods: A series of 85 patients who had an anterior cervical arthrodesis for the treatment of cervical spondylosis with radiculopathy or mielopathy were reviewed with a minimum of 7 months and a maximum of ten year follow-up. The annual incidence of adjacent-segment disease was defined as the percentage of patients who had been disease-free at the start of a given year of follow-up in whom new disease developed during that year. The prevalence was defined as the percentage of all patients in whom symptomatic adjacent-segment disease developed within a given period of follow-up. The hypothesis that new disease at an adjacent level is more likely to develop following multilevel arthrodesis was also tested. Results: Symptomatic adjacent-level disease occurred at an incidence of 5,3% per year, with an 18,2% maximum at the third year of follow-up and a final prevalence of 34,1%. The greatest risk of new disease was at the interspaces of the sixth and seventh cervical vertebrae. Patients with a multilevel arthodesis were significantly more likely to have symptomatic adjacent-level disease. Conclusions: Symptomatic adjacent-segment disease may affect more than one-third of all patients within ten years after an anterior cervical arthrodesis. A multilevel arthrodesis and the interspaces between the sixth and seventh cervical vertebrae appear to be the greatest risk factors for new disease

Aims: Presentation and evaluation of clinical outcomes of patients with cervical degenerative disc disease treated by Smith – Robinson method with interbody fusion by Cornerstone Carbon Cage (CCS) in own clinical experience. Methods: We operated 37 patients by anterior cervical discectomy with interbody stabilisation by CCS in the last 11 months. 31 patients were operated for the first time. In 6 cases, patients were reoperated after surgical treatment in other hospitals. The Smith – Robinson cervical discectomy with anterior interbody fusion by CCS was performed in all patients. Additionally, in 12 patients titan cervical plates were used. Follow-up examinations were performed in 2 and 6 months after the treatment. Results: All treated patients experienced total pain termination. In patients with posttraumatical discopathy and heavy cervical spondylosis with ligamental instability (33% all patients) additional internal stabilisation by cervical plate was performed. Neurological or local long-term postoperative complications were not observed. Conclusions: Patients who underwent treatment by anterior cervical discectomy met. S-R with interbody stabilisation by CCS benefited from the treatment and present good clinical outcome with pain termination and gradual disappearance of neurological disabilities. Using of cornerstone carbon cage allows to obtain good stabilisation without the necessity of allogenic bone graft insertion. This kind of stabilisation is sufficient without external collar stabilisation

Aim: To determine the clinical improvement and the radiological time to fusion as well as correction of the lordosis angle in patients undergoing anterior cervical interbody fusion with the use of a silicate substituted calcium phosphate ceramic (Si-CaP) (Actifuse™ Synthetic Bone Graft, ApaTech, Ltd., Elstree, UK) as the bone graft substitute in the cage. Design: We conducted a prospective clinical and radiological study to evaluate the use of Si-CaP as bone graft substitute in anterior cervical fusion for degenerative cervical spondylosis. Materials and methods: Thirty patients were selected prospectively by preoperative and postoperative clinical and radiological assessments. All patients were operated on by a single surgeon (D.A.J.). Neck disability index and visual analogue score were used for the clinical assessment. Radiological assessment included improvement in the lordosis angle and time to fusion. Patients were evaluated at three months, six months and one year post-surgery. Results: At present 14 patients with a total of 19 levels have completed their one year follow-up. The patients had an average of 50.4 years (range 34–69), with ratio of male to female of 6:7. Lordosis angle improved significantly from a mean lordosis angle of 0.31 preoperatively to 4.75 degree postoperatively (p< 0.05). All the levels had fused at the 1 year follow up and there was no radiological evidence of sinkage of the cage. Conclusion: Substitution of silicate ions into calcium phosphate ceramics has been shown to impart a negative surface charge, leading to greater protein absorption, increased osteoblast proliferation, and higher production of extracellular matrix. Our results show that Si-CaP has excellent clinical performance as a synthetic bone graft in anterior cervical discectomy and fusion. Postoperatively, patients demonstrate a good fusion with an excellent correction and maintenance of the lordosis angle

Purpose: MetS has been shown to be a risk factor for chronic diseases such as cardiovascular diseases (CVD), including myocardial infarction and stroke, and dementia. Moreover, the risk factors that make up the MetS (central obesity, diabetes, high blood pressure, and dyslipidemia) have also been demonstrated to have independent relationships to degenerative joint disease. The relationship between the metabolic factors and spine OA have been examined by few, however the predictive value of MetS on the incidence or prevalence of this disease has not been studied. In this study, we asked whether the prevalence of spinal OA increases with the number of MS risk factors. Method: We reviewed data from a single surgeon, high volume, spine surgery practice between the years of 2002–2007. Demographic data including the components of the MetS risk factors were collected. Prevalent severe OA was defined as degenerative spondylolisthesis or cervical or lumbar stenosis causing neurologically based symptoms, and early OA as those with lumbar and cervical spondylosis causing axial pain only. Logistic regression modeling was used to determine the odds (adjusted for age and sex) of having severe spine OA with an increasing number of the MetS risk factors. Results: In our cohort of 1502 patients, there were 839/1502 (55.9%) patients defined as severe spinal OA and 663/839 (44.1%) patients with early OA. Those with severe spinal OA were significantly older, with a greater percentage of females, and had a greater BMI than those with early spinal OA (p < .05). The prevalence of severe spinal OA varied across groups defined by the number of MetS risk factors: 353/748 (47.2%) in those with 0 MetS risk factors, 236/392 (60.2 %) in those with 1 MetS risk factors, 148/228 (64.9 %) in those with 2 MetS risk factors, 76/104 (73.1 %) in those with 3 MetS risk factors, and 26/30 (86.7 %) in those with all 4 MetS risk factors. The overall prevalence of MetS was 30/1502 (2.0%), 26/839 (3.1%) in the severe OA group and 4/663 (0.6%) in the early OA group.(p= .001) Logistic regression modeling showed the odds of having severe spinal OA increased with an increasing number of MetS risk factors relative to having no MetS risk factors. Those patients having defined as MetS had almost a 4 times greater odds of having severe spinal OA as compared to those with no MetS risk factors, adjusted for age and gender [OR 3.9,(1.4, 11.6), p= .01]. Conclusion: The components of MetS are more prevalent in those with severe spinal OA causing neurological symptoms compared to those with spondylosis causing axial pain. Future work should examine for an association between MetS and incident OA

Introduction: This retrospective study examined the clinical characteristics, radiological findings, management, and functional outcome in 34 rehabilitated patients who presented with traumatic central cord syndrome. Methods: Between 1994 and 2004 a total of 34 patients with central cord syndrome were admitted to the National Spinal Injuries Unit. There were 29 men and 5 women. The mean age was 56.1 years (15 to 88). The mean follow up time was 4.9 years. Patients were divided into three groups by age, < 50 years (10 patients), 50–70 years (16 patients), and > 70 years (8 patients). The American Spinal Injury Association (ASIA) system recorded the motor and sensory scores, of upper and lower limbs, on admission, discharge and during rehabilitation. Patients underwent radiological investigation that included plain film, CT, and MRI of the cervical spine. Results: The mechanism of injury was a fall in 58.8%, road traffic accident in 35.2% and other in 6%. Alcohol was a contributing factor in 32.4% of cases. Seven patients had a spinal fracture. The cervical spine was involved in 5 cases with the remaining 2 cases involving the thoracic spine. Seventy percent of patients received intravenous steroids. Over half (53%) of the patients had some degree of cervical spondylosis while cord changes were seen in almost all of the patients (79.4%). In the majority of cases (70.4%) the affected level was C3/4. Disc herniation was present in one third of cases (33.2%). The mean upper limb ASIA score on admission was 7.6, on discharge was 12.4 and at follow up was 20.2. A similar pattern was also observed in the lower limb with scores of 12.1, 13.7, and 20.5 respectively. Sensory loss also improved with time. 88.2% of those admitted required urinary catheterization, with 23.5% being discharged to the National Rehabilitation Hospital with a catheter in situ. Surgical decompression was performed in 7 cases. The remainder of patients wore a Miami-J cervical collar. Conclusion: As was shown in the original paper by Schneider et al (1954), hyperextension of a degenerative cervical spine was the predominant mechanism of injury. The return of lower limb function precedes that of upper limb, with autonomic function recovering in the majority of cases. Discussion: In this study patients in the younger age groups had better recovery of function and had fewer complications. The original paper by Schneider et al. stated that conservative treatment was most appropriate, however, in this review surgery was performed in specific cases such as those with cord compression secondary to disc herniation. Alcohol was a significant contributing factor

Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents.

Cite this article: Bone Joint J 2023;105-B(4):347–355.

Aims

The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons.

The October 2014 Spine Roundup³⁶⁰ looks at: microdiscectomy is not exactly a hands-down winner; lumbar spinal stenosis unpicked; Wallis implant helpful in lumbosacral decompression; multidisciplinary rehabilitation is good for back pain; and understanding the sciatic stretch test.