C1-2 Level Research Articles

Association of familial ATTR amyloidosis and hyperlipoprotein(a)emia in a patient with spinal stenosis. A case report

Introduction: Transthyretin (ATTR) amyloidosis is a rare disease with cardiac involvement, peripheral nervous system involvement, and spinal stenosis. Elevated plasma lipoprotein(a) (Lpa) levels are recognized as a significant risk factor for atherosclerotic cardiovascular and cerebrovascular diseases. Currently, information on the relationship between ATTR amyloidosis and Lpa is very limited. Clinical case: A female patient had suffered from arterial hypertension with an increase in blood pressure (BP) to 150/90 mmHg for 5 years since the age of 45. After suffering from the new coronavirus infection COVID-19 from 02.06 to 25.06.2021, patient began to notice an increase in blood pressure to 290/150 mm Hg, stabbing pains in the left half of the chest lasting up to 20-30 minutes without any connection with physical activity, which are relieved after taking Corvalol, pain in the cervical and thoracic spine. Due to antihypertensive therapy, stabilization of blood pressure at 110/70 mm Hg was noted. Further examination revealed dyslipidemia (low-density lipoprotein cholesterol 4.53 mmol/l), atherosclerosis of the extracranial parts of the brachiocephalic arteries with stenosis of the right internal carotid artery up to 20%, hyperlipoprotein(a)emia 1.46 g/l (normal up to 0.5 g/l). Echocardiography revealed left ventricular wall thickening and preserved ejection fraction, thickening of the interatrial septum, mitral valve cusps. MRI of the spine revealed stenosis of the spinal canal at the level of C5-6 - the "red flag" of amyloidosis. Genetic testing revealed a variant of the nucleotide sequence of the transthyretin gene (Chr18: 29171879 GA, p.Arg5His) in a heterozygous state in the patient and her blood relatives. The issue of specific antiamyloid therapy with tafamidis was considered, lipid-lowering therapy was prescribed. Conclusion. In patients with spinal canal stenosis syndrome and left ventricular wall thickening, even in the presence of arterial hypertension, a comprehensive examination is necessary for timely diagnosis and adequate therapy of amyloid cardiomyopathy. The combination of familial ATTR amyloidosis and familial hyperlipoprotein(a)emia has been described for the first time.

Brainstem hemorrhage associated with venous hypertensive myelopathy without dural arteriovenous fistula: illustrative case.

Venous hypertensive myelopathy (VHM), formerly known as "Foix-Alajouanine syndrome," is a spinal cord dysfunction caused by impaired perfusion of the spinal cord. Most cases are attributed to spinal dural arteriovenous fistulas (dAVFs), but there are scattered reports of VHM without concomitant dAVF. Furthermore, no cases of VHM associated with intracranial hemorrhage exist. A 68-year-old man with a history of hypertension presented with a sudden headache, proximal paresis of the left upper extremity, impaired pain and temperature sensation in the right upper extremity, dysphagia, and dysarthria. Computed tomography scans showed intraparenchymal hemorrhage in the left medulla oblongata and a linear, continuous high-density area extending from the medulla oblongata to the cervical spinal cord. Magnetic resonance images showed cervical spondylosis at the C5-6 and C6-7 levels, with high signal intensity changes from the medulla oblongata to the lower cervical cord on T2-weighted images. Cerebral angiography showed no abnormal vessels. Conservative treatment gradually improved symptoms and the high signal intensity areas. This case highlights intracranial hemorrhage occurring from extracranial causes and the possibility of VHM due to cervical spondylosis. When hemorrhagic lesions of the craniovertebral junction or spinal parenchymal lesions are encountered, the underlying pathology should be investigated thoroughly and systematically. https://thejns.org/doi/10.3171/CASE24441.

Cervical Lordosis Correction and Segmental Height in Anterior Cervical Surgeries; The Role of Implant Choice

This study aims to compare the impact of 3 surgical techniques-stand-alone cage placement (SAC), anterior cervical plate (ACP) fixation, and total disc replacement (TDR)-on cervical lordosis restoration and segmental height after anterior cervical discectomy at C5-6 level. To eliminate the effect of lordosis between different levels, patients operated on at the same level were included in the study. Restoring cervical lordosis is crucial for improving patient outcomes, including pain reduction and preventing mechanical complications. A retrospective screening of 89 patients who underwent single-level C5-6 surgery between 2011 and 2021 was analyzed. Patients were categorized into 3 groups based on the surgical technique used: SAC, ACP, or TDR. Lordotic angles and segmental heights were measured preoperatively, first-month follow-up, and at the 24-month follow-up. Statistical analysis was conducted using the Wilcoxon Signed Rank test and ANOVA, with a significance threshold set at P < 0.05. All 3 techniques resulted in significant early and late postoperative increases in both global and segmental lordosis. The early postoperative height gain was most pronounced in the ACP group. However, no significant differences in lordosis or height preservation were observed among the groups at the 24-month follow-up. These findings align with previous studies, indicating comparable long-term outcomes across these surgical approaches. SAC placement, ACP fixation, and TDR, all effectively restore cervical lordosis and segmental height after anterior cervical discectomy at the C5-6 level. Despite early differences, the long-term results were similar, suggesting that the choice of technique should be based on individual patient needs and specific surgical considerations.

Unstable C2-3 Posterior Ligamentous Injury in a Pediatric Patient with Successful Nonoperative Treatment: A Case Report.

The authors present a case of a 6-year-old boy who was treated nonoperatively for an unstable C2-3 hyperflexion injury with posterior cervical ligamentous disruption 8 years ago. The patient was managed with cervical collar immobilization for 2.5 years with long-term follow-up demonstrating complete healing of posterior element disruption, normal sagittal vertebral alignment on dynamic imaging, and full return to activities of daily living and sports. Pediatric spine injuries up to the C2-3 level with posterior ligamentous disruption alone without neurological deficit may be successfully treated nonoperatively with careful long-term immobilization and close follow-up.

Surgery on the C3-4 Level and the Presence of Ligamentum Flavum Hypertrophy Increases the Risk of 30-Day Reoperation Rate After Anterior Cervical Discectomy and Fusion

BACKGROUND AND OBJECTIVES: Cervical myelopathy caused by C3-4 level degeneration often exhibits different characteristics after anterior cervical discectomy and fusion (ACDF) than other cervical levels. This study compared the outcomes of C3-4 ACDF with surgeries at other levels and identified risk factors of 30-day reoperation after ACDF. METHODS: We retrospectively analyzed patients who underwent ACDF for degenerative cervical disease from 2018 to 2023. The patients were divided into 2 groups based on the level of surgery: C3-4 and non–C3-4 groups. Radiological outcomes, including cervical alignment and range of motion (ROM), were analyzed. Clinical outcomes were assessed with patient-reported outcomes and the rates of 30-day reoperation and complications after ACDF. Patient-reported outcomes included visual analog scale for neck pain, visual analog scale for arm pain, and modified Japanese Orthopedic Association scores. Risk factors of 30-day reoperation were assessed. RESULTS: Of 259 patients, 74 (28.6%) and 185 (71.4%) were in the C3-4 and non–C3-4 groups, respectively. The C3-4 group exhibited lower C2-7 ROM (P = .019), higher C3-4 ROM (P = .015), and greater C3-4 %ROM (P = .014). The C3-4 group demonstrated lower preoperative and 1-month postoperative modified Japanese Orthopedic Association scores (P &lt; .001; P &lt; .001, respectively). The rate of 30-day reoperation was significantly higher in the C3-4 group (9.5%) compared with the non–C3-4 group (2.2%) (P = .014). In addition, C3-4 surgical level (odds ratio = 4.99, P = .034) and ligament flavum hypertrophy (odds ratio = 5.84, P = .018) were identified as independent risk factors of 30-day reoperation after ACDF. CONCLUSION: Surgery on C3-4 level showed a higher risk of 30-day reoperation than other levels. It is likely due to C3-4 surgical level, and ligament flavum hypertrophy contributes to cord compression, particularly in the unstable early postoperative period.

Commentary: Surgery on the C3-4 Level and the Presence of Ligamentum Flavum Hypertrophy Increases the Risk of 30-Day Reoperation Rate After Anterior Cervical Discectomy and Fusion

Commentary: Surgery on the C3-4 Level and the Presence of Ligamentum Flavum Hypertrophy Increases the Risk of 30-Day Reoperation Rate After Anterior Cervical Discectomy and Fusion

Reappraisal of the Previously Described False Localizing Sign at C1-2 in Cases of Spontaneous Intracranial Hypotension

BACKGROUND AND OBJECTIVES: We present an illustrative case of spontaneous intracranial hypotension (SIH) in the setting of a suspected C1-2 cerebrospinal fluid (CSF) leak that was successfully treated with muscle, collagen, and epidural blood patch. We examined the literature to identify similar cases reporting Cl-2 retrospinal fluid collections identified on imaging in the setting of SIH and quantified the success of targeted treatment to this area despite previous reports that caution about a “C1-2 false localizing sign.” METHODS: A systematic search was performed identifying cases of SIH resulting from CSF leak with C1-2 fluid collection observed on imaging. PubMed, Google Scholar, and Web of Science were queried, and articles were screened for possible inclusion by 2 authors and supervised by the senior author. RESULTS: In total, 28 studies were included with a total of 32 patients. The number of patients in each study with C1-2 fluid collections, number of patients with fluid collections at multiple levels, specific intervention used, and outcomes of each intervention were recorded, with a focus on whether treatment occurred at the levels exhibiting fluid signal. CONCLUSION: Although the C1-2 fluid signal in SIH has previously been described as a “false localizing sign,” our study indicates that treating this level as the source of CSF leak results in successful and durable outcomes. Most SIH cases with signal at C1-2 did not have a fluid signal at any other level and were treated successfully and most commonly through epidural blood patch at the C1-2 level. Symptom resolution was also reported after direct repair of C1-2 CSF leaks through primary closure, Gelfoam patch, and muscle fragment with fibrin. In patients with SIH, C1-2 fluid signal, and no other source of CSF leak identified on imaging, surgical intervention at the C1-2 level seemed to have a high success rate.

Hounsfield units of vertebrae as a predictor of cervical deep paraspinal muscles atrophy and neck pain in degenerative cervical myelopathy.

This study investigated the correlation between Hounsfield units (HU) of the cervical vertebrae and atrophy of the cervical deep paraspinal muscles, namely the multifidus and semispinalis cervicis (SCer), in patients diagnosed with degenerative cervical myelopathy (DCM). The authors retrospectively analyzed data from 136 patients aged 50-79 years (81 males and 55 females) who underwent surgical intervention for DCM. HU measurements of the cancellous bone in the C4 vertebra were acquired through standardized techniques. The authors evaluated fatty infiltration (FI); analyzed functional and vertebral cross-sectional area (CSA) of the multifidus and SCer at the C4-5, C5-6, and C6-7 levels; and analyzed the presence of Modic changes (MCs) and the incidence of axial neck pain. Patients were categorized into group A (n = 56) with mean ± SD HU of 293.3 ± 15.6 and group B (n = 80) with mean ± SD HU of 389.5 ± 10.6. Both groups demonstrated significant improvements in postoperative clinical outcomes (p < 0.05); however, no statistically significant difference was observed (p > 0.05). Significant disparities in HU measurements and visual analog scale (VAS) scores for neck pain were observed between the groups (p < 0.05). The highest VAS score correlated with MCs-1 type (i.e., low signal on T1-weighted images and high signal on T2-weighted images). The functional CSA to vertebral CSA ratios of the multifidus and SCer in group A were markedly reduced compared to those of group B (p < 0.05). No significant difference was noted in functional CSA asymmetry between the groups for both muscles (p > 0.05). Lower HU measurements directly correlated with increased FI in the multifidus (p = 0.002) and SCer (p = 0.035). Furthermore, a strong positive association was found between the functional CSA to vertebral CSA ratio of the multifidus and HU values (p = 0.003), whereas HU measurements and VAS scores exhibited a negative correlation (p = 0.020). Among those patients older than 50 years with DCM, those with decreased HU values demonstrated elevated FI levels in the multifidus and SCer muscles. Moreover, these patients presented with pronounced muscle atrophy, which correlated with axial neck pain. A significant relationship was also identified between MCs and diminished HU values.

Early effects of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis

To investigate the early efficacy and safety of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis (CS). The clinical data of 28 patients with CS treated by unilateral biportal endoscopic posterior total laminectomy decompression from January 2021 to October 2022 in the Henan NO.3 Provincial People's Hospital were retrospectively analyzed. Of the patients, 16 were male and 12 were female, the mean age was (55.6±9.6) years. The CS occurred at C3-4 level in 1 cases, at C4-5 level in 3 cases, at C5-6 level in 16 cases and at C6-7 level in 8 cases. Each case was compared at the moment of pre-operation and final follow-up by the Japanese Orthopedic Association (JOA) score. The postoperative complications were recorded. The JOA improvement rate was computed at the final follow-up. As a result, all patients underwent successful surgery and were followed up for (11.6±4.7) months. The operation time was (43.0±5.3) min. Intraoperative blood loss (7.9±2.8) ml; Postoperative drainage volume (8.1±2.3) ml. The JOA score increased from 7.9±1.2 before surgery to 13.5±1.3 six months after surgery, and it was 13.7±1.2 at the last follow-up, the differences between postoperative and preoperative were both statistically significant (both P<0.001). No complications occurred, such as cerebrospinal fluid leakage, nerve injury and intraspinal hematoma. At the last follow-up, cervical spine X-ray or CT evaluation showed no instability in the operative segment. The overall curative effect was evaluated according to JOA score at the last follow-up: 16 cases got excellent outcome, 7 cases got good and 2 cases got medium outcome, with an excellent and good rate of 89.3% (25/28). This study shows that unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of single-level cervical stenosis can achieve satisfactory efficacy, has no impact on spinal stability, and has a high safety.

Anterior cervical corpectomy and fusion-derived adjacent segment disease managed via channel-repairing anterior endoscopic transcorporeal cervical discectomy: a case report

BackgroundManagement of anterior cervical corpectomy and fusion (ACCF)-derived adjacent segment disease (ASD) represented a challenge facing the surgeons.MethodsA 41-year man diagnosed as C3-4 level ASD derived from C5-level ACCF surgery 13 years ago was admitted to the hospital for numbness and pain in the right shoulder and upper limb. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) was performed, and pre- and postoperative clinical and imaging data were collected.ResultsThe operation was completed within 70 min, and no clinical or radiological complication was reported. The visual analog scale (VAS) score decreased from preoperative 5 points to postoperative 1 point. Numbness was relieved postoperatively and disappeared completely at postoperative 3 months. Imaging data indicated sufficient spinal cord decompression, good channel repairing and cervical alignment.ConclusionsChannel-repairing PEATCD was successfully performed to treat ACCF-derived ASD, nevertheless, the long-term efficacy remained tracing and further clinical trials were needed to validate its efficacy.

Clinical and Radiological Outcomes in C2 Recapping Laminoplasty for the Pathologies in the Upper Cervical Spine.

To evaluate C2 muscle preservation effect and the radiological and clinical outcomes after C2 recapping laminoplasty. Fourteen consecutive patients who underwent C2 recapping laminoplasty around C1-2 level were enrolled. To evaluate muscle preservation effect, the authors conducted a morphological measurement of extensor muscles between the operated and nonoperated side. Two surgeons measured the cross-sectional area (CSA) of obliquus capitis inferior (OCI) and semispinalis cervicis (SSC) muscle before and after surgery to determine atrophy rates (ARs). Additionally, we examined range of motion (ROM), sagittal vertical axis (SVA), neck visual analogue scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) score to assess potential changes in alignment and consequent clinical outcomes following posterior cervical surgery. We measured the CSA of OCI and SSC before surgery, and at 6 and 12 months postoperatively. Based on these measurements, the AR of the nonoperated SSC was 0.1% ± 8.5%, the AR of the operated OCI was 2.0% ± 7.2%, and the AR of the nonoperated OCI was -0.7% ± 5.1% at the 12 months after surgery. However, the AR of the operated side's SSC was 11.2% ± 12.5%, which is a relatively higher value than other measurements. Despite the atrophic change of SSC on the operated side, there were no prominent changes observed in SVA, C0-2 ROM, and C2-7 ROM between preoperative and 12 months postoperative measurements, which were 11.8 ± 10.9 mm, 16.3° ± 5.9°, and 48.7° ± 7.7° preoperatively, and 14.1 ± 11.6 mm, 16.1° ± 7.2°, and 44.0° ± 10.3° at 12 months postoperative, respectively. Improvement was also noted in VAS, NDI, and JOA scores after surgery with JOA recovery rate of 77.3% ± 29.6%. C2 recapping laminoplasty could be a useful tool for addressing pathologies around the upper cervical spine, potentially mitigating muscle atrophy and reducing postoperative neck pain, while maintaining sagittal alignment and ROM.

Posterolateral Paramass Approach to Lesions Located at the Anterior C1-2 Level: A Cadaver Study

A novel posteriolateral surgical approach is described that will provide safe access to intradural and extradural lesions located in the anterior part of the spinal cord (SC) at the C1-2 level and to the odontoid in single session. A total of five cadavers and two dry C1 vertebrae were used in this study. The study involved obtaining computed tomography magnetic resonance imaging scans and magnetic resonance imaging of all cadaver groups before and after the procedures. Group 1: Control; Group 2: Unilateral C1 posterior arch was removed, the inferomedial part of C1 lateral mass was removed, and access the anterior and lateral aspects of the SC. Group 3: In addition, odontoid was removed, Group 4: In addition, unilateral C1- C2 screw was placed. Group 5: In addition, bilateral C1-C2 screw was placed. The median distance from the midpoint of C1 posterior tubercle to vertebral groove which was removed in groups is 21.4 ± 2.88mm. The average width of C1 lateral mass was 13.4±2.4mm. After the lateral mass was drilled, its width decreased to 10,2mm.This area was sufficient to open a surgical corridor and reach the anterior of SC and odontoid. After the procedure, no instability was found in group 2 without instrumentation on computed tomography and magnetic resonance imaging scans. It is possible to access the anterior C1-C2 via a posterolateral paramass approach by drilling 20%-30% of the lateral mass, providing an open pathway for easy intervention in C1-C2 intradural lesions. It is also possible to perform odontoid resection using this approach.

Cervical Disc Hernia Following a Jet-Ski Accident

Authors report the case of an adult man showing cervical spine involvement with radicular pain of acute onset. The happening followed a Jet Ski use for recreational purposes, and the patient did not had any training before the event. MRI of the cervical spine showed a massive disc involvement at the C6-7 level, and a conservative treatment with supportive collar was warranted. Particular attention should be made with the advent of personal watercraft (PWC) engines and devices in our area, unknown before both to users or clients as well as to medical staff. PWC might show a wide range of bodily injuries, some of them even lethal, therefore guidelines and precautions might be needed extensively in the next future.

Clinical efficacy of motion-insensitive imaging technique with deep learning reconstruction to improve image quality in cervical spine MR imaging.

To demonstrate that a T2 periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique using deep learning reconstruction (DLR) will provide better image quality and decrease image noise. From December 2020 to March 2021, 35 patients examined cervical spine MRI were included in this study. Four sets of images including fast spin echo (FSE), original PROPELLER, PROPELLER DLR50%, and DLR75% were quantitatively and qualitatively reviewed. We calculated the signal-to-noise ratio (SNR) of the spinal cord and sternocleidomastoid (SCM) muscle and the contrast-to-noise ratio (CNR) of the spinal cord by applying region-of-interest at the spinal cord, SCM muscle, and background air. We evaluated image noise with regard to the spinal cord, SCM, and back muscles at each level from C2-3 to C6-7 in the 4 sets. At all disc levels, the mean SNR values for the spinal cord and SCM muscles were significantly higher in PROPELLER DLR50% and DLR75% compared to FSE and original PROPELLER images (P < .0083). The mean CNR values of the spinal cord were significantly higher in PROPELLER DLR50% and DLR75% compared to FSE at the C3-4 and 4-5 levels and PROPELLER DLR75% compared to FSE at the C6-7 level (P < .0083). Qualitative analysis of image noise on the spinal cord, SCM, and back muscles showed that PROPELLER DLR50% and PROPELLER DLR75% images showed a significant denoising effect compared to the FSE and original PROPELLER images. The combination of PROPELLER and DLR improved image quality with a high SNR and CNR and reduced noise. Motion-insensitive imaging technique (PROPELLER) increased the image quality compared to conventional FSE images. PROPELLER technique with a DLR reduced image noise and improved image quality.

Infrequently diagnosed common gait disorder in outpatients with cervical spinal stenosis: A retrospective cohort study

Background. Degenerative cervical myelopathy (DCM) is poorly recognized and infrequently diagnosed. Objectives. To identify symptoms or signs in the lower extremities physically and radiologically in outpatients with DCM. Methods. In 2023, a retrospective cohort study was performed to review the medical records from 2016 to 2020. A total of 28 (24 women) patients were included. All patients were physically examined. Sagittal magnetic resonance imaging (MRI) of the cervical spinal canal was performed and its anteroposterior diameter was calculated in patients with hyperreflexia and/or gait disorder. Results. Sixteen (13 women) patients presented with symptoms or signs in the lower extremities only (group A) and 12 patients (11 women) presented with those in the upper and lower extremities (group B). The mean [SD] ages were 70.06 [17.49] and 58.67 [11.80] years, respectively. Pseudo-polyneuropathic patterns of sensory dysfunction in the lower extremities were identified in 14 patients (88%) of group A and 11 patients (92%) of group B. Also, 16 patients (100%) of group A and 11 patients (92%) of group B presented with hyperreflexia of the triceps and/or patellar tendons. Sagittal MRI showed a minimum value of stenosis at the C5-6 level in 9 patients (56%) of group A and 7 patients (58%) of group B. The mean [SD] anteroposterior diameters at the most stenotic level in patients of groups A and B were 9.63 [2.02] and 10.17 [1.23] mm, respectively. Conclusion. Hyperreflexia of the triceps and/or patellar tendons is one of the most important neurological findings to suspect DCM.

Outcome of Multilevel Anterior Cervical Discectomy and Fusion without Plating

Background: Multilevel anterior cervical discectomy and fusion (ACDF) procedure had traditionally been associated with plating, however, the increase in cost and complications associated with plating led us to investigate results of multilevel ACDF with polyether ether ketone (PEEK) cages without plating and study complication and fusion rates.&#x0D; Objective: To evaluate the clinical and radiological outcome of patients underwent multilevel Anterior Cervical Discectomy and Fusion (ACDF) using polyether ether ketone (PEEK) cage with no plating.&#x0D; Patients and Methods: Sixty patients underwent multilevel Anterior Cervical Discectomy and Fusion (ACDF), Surgical approach, using Polyether Ether Ketone (PEEK) cages with synthetic bone graft material with no plating. Their mean age was 48 year. All patients were evaluated clinically and radiologically for a mean time of one year. Assessment done comparing early and late post-operative cervical spinal x-rays for cage subsidence and migration. Improvement in axial neck and radicular pain were assessed using the Visual Analogue Score (VAS). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), A p value of ≤ 0.05 was considered statistically significant.&#x0D; Results: Sixty patients underwent Anterior Cervical Discectomy with Fusion (ACDF) through Cloward approach. F:M ratio was 1:1. Two levels were operated in 75% of patients, while in 25% three levels were operated. The majority 85% underwent operation at C5-6 level, least operated levels were C3-C4 and C6-C7 36.7% and 66.7% underwent operation at C4-C5 level. None underwent operation at C2-C3 level. There was significant improvement in axial neck pain with VAS decreasing from 6 to 2, radicular pain improved from 7 to 2. Only one patient (1.7%) showed radiological subsidence of 3 mm after 6 months of operation with no further progression, cage slippage was observed in 2 patients (3.3%) by 1 mm in both cases but no radiological progression. All patients (100%) showed good fusion.&#x0D; Conclusion: Multilevel ACDF with PEEK cages without plating showed to be safe option and provided good fusion rates and clinical outcome in our patients.

Outcome of Multilevel Anterior Cervical Discectomy and Fusion without Plating

Background: Multilevel anterior cervical discectomy and fusion (ACDF) procedure had traditionally been associated with plating, however, the increase in cost and complications associated with plating led us to investigate results of multilevel ACDF with polyether ether ketone (PEEK) cages without plating and study complication and fusion rates. Objective: To evaluate the clinical and radiological outcome of patients underwent multilevel Anterior Cervical Discectomy and Fusion (ACDF) using polyether ether ketone (PEEK) cage with no plating. Patients and Methods: Sixty patients underwent multilevel Anterior Cervical Discectomy and Fusion (ACDF), Surgical approach, using Polyether Ether Ketone (PEEK) cages with synthetic bone graft material with no plating. Their mean age was 48 year. All patients were evaluated clinically and radiologically for a mean time of one year. Assessment done comparing early and late post-operative cervical spinal x-rays for cage subsidence and migration. Improvement in axial neck and radicular pain were assessed using the Visual Analogue Score (VAS). Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), A p value of ≤ 0.05 was considered statistically significant. Results: Sixty patients underwent Anterior Cervical Discectomy with Fusion (ACDF) through Cloward approach. F:M ratio was 1:1. Two levels were operated in 75% of patients, while in 25% three levels were operated. The majority 85% underwent operation at C5-6 level, least operated levels were C3-C4 and C6-C7 36.7% and 66.7% underwent operation at C4-C5 level. None underwent operation at C2-C3 level. There was significant improvement in axial neck pain with VAS decreasing from 6 to 2, radicular pain improved from 7 to 2. Only one patient (1.7%) showed radiological subsidence of 3 mm after 6 months of operation with no further progression, cage slippage was observed in 2 patients (3.3%) by 1 mm in both cases but no radiological progression. All patients (100%) showed good fusion. Conclusion: Multilevel ACDF with PEEK cages without plating showed to be safe option and provided good fusion rates and clinical outcome in our patients. Keywords: Cervical spondylosis, Multilevel ACDF, ACDF without plating, Subsidence, Migrati on.

Newborn screening for fatty acid oxidation disorders in a southern Chinese population

Background and aimsFatty acid oxidation disorders (FAODs) are a group of autosomal recessive metabolic diseases included in many newborn screening (NBS) programs, but the incidence and disease spectrum vary widely between ethnic groups. We aimed to elucidate the incidence, disease spectrum, and genetic features of FAODs in a southern Chinese population. Materials and methodsThe FAODs screening results of 643,606 newborns from 2014 to 2022 were analyzed. ResultsNinety-two patients were eventually diagnosed with FAODs, of which 61 were PCD, 20 were MADD, 5 were SCADD, 4 were VLCADD, and 2 were CPT-IAD. The overall incidence of FAODs was 1:6996 (95 % CI: 1:5814–1:8772) newborns. All PCD patients had low C0 levels during NBS, while nine patients (14.8 %) had normal C0 levels during the recall review. All but one MADD patients had elevated C8, C10, and C12 levels during NBS, while eight patients (40 %) had normal acylcarnitine levels during the recall review. The most frequent SLC22A5 variant was c.760C > T (p.R254*) with an allele frequency of 29.51 %, followed by c.51C > G (p.F17L) (17.21 %) and c.1400C > G (p.S467C) (16.39 %). The most frequent ETFDH variant was c.250G > A (p.A84T) with an allelic frequency of 47.5 %, followed by c.524G > A (R175H) (12.5 %), c.998A > G (p.Y333C) (12.5 %), and c.1657T > C (p.Y553H) (7.5 %). ConclusionThe prevalence, disease spectrum, and genetic characteristics of FAODs in a southern Chinese population were clarified. PCD was the most common FAOD, followed by MADD. Hotspot variants were found in SLC22A5 and ETFDH genes, while the remaining FAODs showed great molecular heterogeneity. Incorporating second-tier genetic screening is critical for FAODs.

Kinematic alteration in three-dimensional reaching movement in C3-4 level cervical myelopathy.

This study aimed to compare the reaching movement between two different spinal cord compression level groups in cervical myelopathy (CM) patients. Nine CM patients with maximal cord compression at the C3-4 level (C3-4 group) and 15 CM patients with maximal cord compression at the C4-7 level (C4-7 group) participated in the study. We monitored three-dimensional (3D) reaching movement using an electronic-mechanical whack-a-mole-type task pre-and post-operatively. Movement time (MT) and 3D movement distance (MD) during the task were recorded. An analysis of variance for split-plot factorial design was performed to investigate the effects of compression level or surgery on MT and MD. Moreover, we investigated the relationship between these kinematic reaching parameters and conventional clinical tests. The 3D reaching trajectories of the C3-4 group was unstable with higher variability. The C3-4 group showed longer MT (p < 0.05) and MD (p < 0.01) compared with the C4-7 group both before and after surgery. Moreover, MT was negatively correlated with the Japanese Orthopedic Association score only in the C3-4 group (r = - 0.48). We found that spinal cord compression at the C3-4 level had a negative effect on 3D reaching movement and the kinematic alteration influenced the upper extremity performance. This new knowledge may increase our understanding of kinematic alteration in patients with CM.

Degenerative Cervical Disc Herniation: Prevalence of Affected Cervical Level in a Hispanic Population in Puerto Rico

BackgroundIn the literature, degenerative cervical disc herniation is considered to occur more frequently at the C5-C6 and C6-C7 levels. This study aimed to evaluate the operated cervical level prevalence among patients with degenerative cervical disc herniation in a Hispanic Puerto Rico population. MethodsThe University of Puerto Rico Neurosurgery database was used to identify patients who underwent anterior cervical discectomy for degenerative cervical disc herniation during a 15-year period from January 1, 2006 until December 31, 2020. Operated cervical levels for each patient were analyzed. ResultsDuring the study period, 409 patients were operated on for degenerative cervical disc herniation. Two hundred-eight patients (50.8%) had disc herniations at more than one cervical level for 663 treated levels. The most prevalent cervical levels in this Hispanic population were C5-C6 (34.8%) and C4-C5 (28.1%). The C6-C7 level was involved in 18.9% of the operated levels, and the C3-C4 level in 17.3%. The C7-T1 level was involved in only 0.6% of the operated levels, and the C2-3 level in 0.3%. The cohort included 51.3% of men and 48.7% of women, with a men-to-women ratio of 1.05:1. The median age of females was 56.5 (range 26 - 82) and 59.0 (range 31 - 85) for males. Operated cervical discs were most common between the ages of 48 and 66 years for either sex. ConclusionIn a Hispanic Puerto Rico population, the most prevalent operated degenerative cervical disc levels were C5-C6 and C4-C5.