Purpose: The decision of whether or not an injury to the sub-axial cervical spine needs operative management often hinges on the stability of the spine. The posterior Ligamentous Complex (PLC) is one of the primary soft tissue stabilizers of the cervical spine. Fat-saturated T2-wieghted MRI sequences are able to demonstrate soft tissue injury to the cervical spine. No studies to date have assessed the ability of MRI to accurately and reliably demonstrate PLC disruption in the sub-axial cervical spine.

Method: Forty-nine consecutive patients aged 14–85 years presenting to the two participating institutions with injury between C3 and T1 who required posterior surgery as part of their management were prospectively enrolled in the study. All patients had radiographs, CT, and MRI scans preoperatively, which were reviewed by a Neuroradiologist, and the treating surgeon separately. Their posterior intraoperative findings were then recorded by the treating surgeon and his assistant. Statistical analysis included Spearman’s rank order correlation, and Cohen’s kappa score.

Results: There was a moderate level of agreement between the radiologist’s interpretation of the preopera-tive MRI and the surgeon’s intraoperative findings for the supraspinous and intraspinous ligaments, (kappa.49 & .48 respectively). A fair level of agreement was found for the ligamentum flavum, left and right facet capsules, and the cervical fascia (kappa scores.31,.30,.30,.39 respectively).

Conclusion: MRI has a high sensitivity (78.6% to 100%) for detecting cervical PLC injury but a low specificity (53.6% to 75%). On its own MRI is not a useful tool for diagnosing cervical spine PLC injury. The clinician should be aware of the relatively high rate of false positive PLC injury diagnosis with MRI.

Purpose: Oncologic management of primary bone tumors of the spine is inconsistent, controversial and open to individual interpretation. Tumor margin violation intraoperatively increases local recurrence and mortality. The purpose of this study is to determine whether applying Enneking’s principles to the surgical management of primary bone tumors of the spine significantly decreases local recurrence and/or mortality.

Method: A prospective and retrospective multicenter Cohort Study: Inclusion of patients undergoing en bloc or intralesional resection of primary tumors of the spine at four separate quaternary care centers, between January 1994 and January 2008. Patients were staged, using the Enneking system, prior to surgery and baseline demographic and surgical variables were recorded. Outcomes measured were disease local recurrence, or death. The results were statistically analyzed for significance.

Results: One hundred-fifty patients with primary tumors of the spine were recruited. Average age was 47.0 (range 8 to 83). Sixty-two patients were identified to have local recurrence. A statistically significant decrease in local recurrence (p=0.0001) was observed in favor of en bloc resection. In patients with local recurrence there was a significant increased risk of mortality, (p< 0.0001). There was a trend to decreased mortality in the en bloc resection group, not statistically significant (p=0.64).

Conclusion: Wide resection of primary tumors of spine with reconstruction is the standard of care. Application of Enneking’s principles to the spine when managing primary bone tumors significantly reduces local recurrence of the disease process, without an adverse outcome on mortality, and with acceptable HRQOL. Further cohort studies based on stringent data collection prospectively will provide a basis for more detailed study of individual tumor types.