1. Grabowski MM, Recinos PF, Nowacki AS, et al. Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg. 2014; November:1–9. doi:10.3171/2014.7.JNS132449.
The utility of maximal tumor resection in glioblastoma continues to be controversial. The authors performed a retrospective review of 128 patients who underwent primary resection of supratentorial GBM followed by standard radiation/chemotherapy and undertook a quantitative, volumetric analysis of pre- and postoperative MR images. Contrast enhancing residual tumor volume and extent of resection were found to be significant predictors of survival after resection. Residual tumor volume appears to be an even more important predictor of survival compared with extent of resection.
2. De Mello FM, Helito PVP, Bordalo-Rodrigues M, Fuller R, Halpern ASR. Axial gout is frequently associated with the presence of current tophi, although not with spinal symptoms. Spine (Phila Pa 1976). 2014;39(25):E1531–6. doi:10.1097/BRS.0000000000000633.
42 patients with gout underwent thoracic and lumbar spine CT. Scans were read by an experienced radiologist blinded to the features of the patients. Axial gout was defined as the presence of bony erosions, facet joints, or disc calcification and tophi in the axial skeleton. The authors conclude that there is a high prevalence of axial gout not associated with spine symptoms.
Rather subtle findings to my eye. I think you will need a strong clinical history to direct you to these types of findings.
3. Roguski M, Benzel EC, Curran JN, et al. Postoperative Cervical Sagittal Imbalance Negatively affects outcomes Following Surgery for Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976). 2014;39(25):1. doi:10.1097/BRS.0000000000000641.
This is an interesting prospective observational cohort study in 49 patient undergoing surgery for cervical spondylotic myelopathy. Preoperative and postoperative C2–C7 sagittal vertical axis (SVA) was measured on standing lateral cervical spine radiographs. They found that patients with a postoperative C2–C7 SVA measurement greater than 40 mm were unlikely to benefit from surgery from an overall HRQOL perspective. C2–C7 SVA measurement was an independent risk factor for poorer HRQOL outcomes after dorsal surgery.
4. Chandra PS, Goyal N, Chauhan A, Ansari A, Sharma BS, Garg A. The severity of basilar invagination and atlantoaxial dislocation correlates with sagittal joint inclination, coronal joint inclination, and craniocervical tilt: a description of new indexes for the craniovertebral junction. Neurosurgery. 2014;10 Suppl 4(4):621–30. doi:10.1227/NEU.0000000000000470.
The authors evaluated 70 patients with irreducible basilar invagination and atlantoaxial dislocation (from a developmental origin) which were compared with an equal number of age- and sex-matched control subjects. CT studies were used to measure several new indices: sagittal joint inclination, craniocervical tilt, coronal joint inclination, surface area, joint overlap index, and joint reciprocity. As the angle of sagittal, coronal joint inclination, and craniocervical tilt increased, the severity of BI and AAD also increased. The mean sagittal joint inclination for controls was 87 degrees, and in patients with BI and AAD, it was 127 degrees. The mean craniocervical tilt value in controls was 60 degrees and in patients with BI and AAD it was 84 degrees.
While I am not a fan of even more measurements, this does point out the importance of the midline sagittal plane relationships in patients with BI. Sagittal joint inclination and craniocervical tilt are easy to measure, and worth considering.
5. Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the north american spine society, the american society of spine radiology, and the american society of neuroradiology. Spine (Phila Pa 1976). 2014;39(24):E1448–65. doi:10.1097/BRS.0b013e3182a8866d.
To summarize – Much unchanged since the last document, but updated and with new artwork. Here are a few new twists:
Annular tear is dead. Long live annular fissure.
Herniation – Displacement of disc material beyond the ring apophysis with <25% circumferential involvement.
Bulge – Greater than 25% circumferential involvement.
Asymmetric bulge – “Presence of more than 25% of the outer annulus beyond the perimeter of the adjacent vertebrae, more evident in one section of the periphery of the disc than in another but not sufficiently focal to be characterized as a protrusion.” I have always used this term, although I felt slightly unsettled and guilty doing so. Nice that this messy reality is included in the final document.
Acute vs. chronic disc herniation: “There are no universally accepted definitions of the intervals that distinguish between acute, subacute, and chronic disc herniations.” Hooray!
6. Koerner JD, Markova DZ, Yadla S, et al. Differential gene expression in anterior and posterior annulus fibrosus. Spine (Phila Pa 1976). 2014;39(23):1917–23. doi:10.1097/BRS.0000000000000590.
Cytokines are small proteins that are used in cell signaling. The terminology is confusing, but includes chemokines, interferons, interleukins, lymphokines, and tumor necrosis factor. They are produced by many different types of immune cells. In this study, they looked at 9 discs from 7 patients with disc degeneration and 5 discs from 2 patients with scoliosis. They found that the posterior annulus expresses increased levels of cytokines and growth factors compared with the anterior annulus in patients with disc degeneration.
7. Malhotra D, Kalb S, Rodriguez-Martinez N, et al. Instrumentation of the posterior thoracolumbar spine: from wires to pedicle screws. Neurosurgery. 2014;10 Suppl 4(4):497–505. doi:10.1227/NEU.0000000000000489.
Review of the history of posterior spinal fixation. This is not a reference for the myriad of current hardware that is available.
8. Schwarz ST, Afzal M, Morgan PS, Bajaj N, Gowland P a, Auer DP. The “swallow tail” appearance of the healthy nigrosome – a new accurate test of Parkinson’s disease: a case-control and retrospective cross-sectional MRI study at 3T. PLoS One. 2014;9(4):e93814. doi:10.1371/journal.pone.0093814.
Nigrosomes represent small clusters of dopaminergic cells within the healthy substantia nigra (SN). Of the 5 regions that have been described, the largest nigrosome is labeled nigrosome-1 and resides within the caudal and mediolateral SN. A healthy nigrosome-1 can be seen on high-resolution 3T – SWI showing a ‘swallow tail’ appearance of the dorsolateral SN, and this feature is lost in PD.
