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Photogrammetric analysis: An objective measure to assess the craniocervical range of motion after cervical laminoplasty surgeries

Janjua, M Burhan; Zhou, Peter L; Vasquez-Montes, Dennis; Moskovich, Ronald
Surgical decompression using laminoplasty is commonly performed for multilevel stenosis with cervical spondylotic myelopathy. However, the long-term effects on the craniocervical range of motion (ROM) after surgery are not well understood. This study represents the first entry into the literature of photogrammetric analysis for clinical measurement of craniocervical ROM. All patients underwent a French-door laminoplasty from 1995 to 2016 and were evaluated radiologically and with postoperative photographs (photogrammetric analysis) to measure craniocervical ROM and axial rotation. Radiographic parameters were occiput to C2 angle, C1-2 angle, C2-7 angle/cervical lordosis (CL), T1-slope (T1S), and TS-CL were measured. Chin-brow vertical angle (CBVA) was utilized for flexion and extension, while nose-turn angle (NTA) was used to assess axial rotation. Forty-four patients (mean age: 65.7 years, 50% female) had a mean follow-up of 37.9 months. Mean values in neutral, flexion, and extension were occiput to C2 = 30°, 15°, and 43°; C1-C2 = -32°, -25°, -32°; and C2-C7 = -4°, 11°, -20°, respectively. Mean CL was within 1 SD of the established -17° (±13.86°). Mean T1S and TS-CL were 33° and 30° in the neutral position, respectively. Mean radiographic full range of motion from flexion to extension was 53°. NTA towards patients' left was 48° and the right side was 45°. Mean CBVA, was -4°, mean flexion 37°, and extension -45°; full range was 81°. Global craniocervical ROM has proven to be well preserved for many years following cervical laminoplasty. Photogrammetric analysis is a cost-effective and radiation-free method, accurate for quantitative assessment of craniocervical and cervical ROM.
PMID: 31708404
ISSN: 1532-2653
CID: 4184872

Incidence of Congenital Spinal Abnormalities Among Pediatric Patients and Their Association With Scoliosis and Systemic Anomalies

Passias, Peter G; Poorman, Gregory W; Jalai, Cyrus M; Diebo, Bassel G; Vira, Shaleen; Horn, Samantha R; Baker, Joseph F; Shenoy, Kartik; Hasan, Saqib; Buza, John; Bronson, Wesley; Paul, Justin C; Kaye, Ian; Foster, Norah A; Cassilly, Ryan T; Oren, Jonathan H; Moskovich, Ronald; Line, Breton; Oh, Cheongeun; Bess, Shay; LaFage, Virginie; Errico, Thomas J
BACKGROUND:Congenital abnormalities when present, according to VACTERL theory, occur nonrandomly with other congenital anomalies. This study estimates the prevalence of congenital spinal anomalies, and their concurrence with other systemic anomalies. METHODS:A retrospective cohort analysis on Health care Cost and Utilization Project's Kids Inpatient Database (KID), years 2000, 2003, 2006, 2009 was performed. ICD-9 coding identified congenital anomalies of the spine and other body systems. OUTCOME MEASURES/METHODS:Overall incidence of congenital spinal abnormalities in pediatric patients, and the concurrence of spinal anomaly diagnoses with other organ system anomalies. Frequencies of congenital spine anomalies were estimated using KID hospital-and-year-adjusted weights. Poisson distribution in contingency tables tabulated concurrence of other congenital anomalies, grouped by body system. RESULTS:Of 12,039,432 patients, rates per 100,000 cases were: 9.1 hemivertebra, 4.3 Klippel-Fiel, 56.3 Chiari malformation, 52.6 tethered cord, 83.4 spina bifida, 1.2 absence of vertebra, and 6.2 diastematomyelia. Diastematomyelia had the highest concurrence of other anomalies: 70.1% of diastematomyelia patients had at least one other congenital anomaly. Next, 63.2% of hemivertebra, and 35.2% of Klippel-Fiel patients had concurrent anomalies. Of the other systems deformities cooccuring, cardiac system had the highest concurrent incidence (6.5% overall). In light of VACTERL's definition of a patient being diagnosed with at least 3 VACTERL anomalies, hemivertebra patients had the highest cooccurrence of ≥3 anomalies (31.3%). With detailed analysis of hemivertebra patients, secundum ASD (14.49%), atresia of large intestine (10.2%), renal agenesis (7.43%) frequently cooccured. CONCLUSIONS:Congenital abnormalities of the spine are associated with serious systemic anomalies that may have delayed presentations. These patients continue to be at a very high, and maybe higher than previously thought, risk for comorbidities that can cause devastating perioperative complications if not detected preoperatively, and full MRI workups should be considered in all patients with spinal abnormalities. LEVEL OF EVIDENCE/METHODS:Level III.
PMID: 31393300
ISSN: 1539-2570
CID: 4033442

Adjacent segment pathology correlated with HRQOL following cervical laminoplasty versus posterior cervical decompression and fusion [Meeting Abstract]

Lafage, V; Protopsaltis, T S; Amitai, A; Boniello, A J; Spiegel, M; Lafage, R; Challier, V; Trimba, Y; Ferrero, E; Smith, M; Passias, P G; Kim, Y H; Razi, A E; Moskovich, R
BACKGROUND CONTEXT: Adjacent segment degeneration (ASD) has been described after anterior cervical fusion surgeries though ASD is not always clinically relevant. Hilibrand et al described a grading system for ASD after anterior cervical fusion. We expand the ASD definition with an analysis of radiographic adjacent segment pathology (RASP) by also assessing the progression of kyphotic alignment, and spondylolisthesis at adjacent segments in patients following cervical laminoplasty (LP) and posterior cervical decompression and fusion (CDF). PURPOSE: To assess radiographic adjacent segment pathology by analyzing adjacent segment degeneration, and the progression of kyphotic alignment and spondylolisthesis at segments adjacent to operated levels for LP and CDF surgery. STUDY DESIGN/SETTING: Retrospective analysis of cervical radiographs in patients undergoing prior LP and CDF surgery. PATIENT SAMPLE: 64 patients undergoing prior LP and CDF surgery. OUTCOME MEASURES: NDI and mJOA. METHODS: Preoperative and postoperative radiographs were analyzed for ASD, progression of adjacent level kyphosis and spondylolisthesis at proximal, distal or any other segments. The RASP was determined by combining proximal and distal ASD, and the adjacent level kyphosis and spondylolisthesis into one spectrum of disease. The presence and rate of development of adjacent segment pathology was compared for LP and CDF. HRQOLs included NDI and mJOA. RESULTS: 64 patients were included (24 LP and 40 CDF) with mean age 59.9 years (46.9% female) and 30.2 months mean follow-up. Spondylolisthesis at the adjacent segment was more prevalent in CDF (29.2% vs 4.5%). Both LP and CDF demonstrated a similar rate of RASP (LP 40.9%, CDF 44%). NDI correlated with proximal adjacent level degeneration (r = 0.34, p = 0.024) and kyphosis (r = 0.36 p = 0.017). CONCLUSIONS: Both cervical laminoplasty and posterior cervical decompression and fusion are associated with adjacent level degeneration. However, there is a higher rate of adjacent segment spondylolisthesis after CDF. Motion preservation procedures may have less of a role in preventing adjacent level degeneration than previously thought. Adjacent segment degeneration correlated with NDI disability in these patients
ISSN: 1529-9430
CID: 1905572

Surgical management of the rheumatoid spine

Chapter by: Moskovich, Ronald; Knox, Jeffrey
in: Spinal disorders and treatments : the NYU-HJD comprehensive textbook by Errico, Thomas J; Cheriyan, Thomas; Varlotta, Gerard P [Eds]
New Delhi : Jaypee Brothers, 2015
pp. 420-428
ISBN: 9351524957
CID: 2709512

Rheumatoid arthritis

Chapter by: Moskovich, R
in: Spine secrets plush : [electronic resource] by Devlin, Vincent J [Eds]
St. Louis, Mo. : Elsevier/Mosby, c2012
pp. 473-479
ISBN: 0323069525
CID: 603092

Biomechanics of the cervical spine

Chapter by: Moskovich, Ronald
in: Basic Biomechanics of the Musculoskeletal System by Nordin, Margareta; Frankel, Victor H [Eds]
Philadelphia : Lippincott Williams and Wilkins, 2012
pp. 286-321
ISBN: 1451117094
CID: 1331532

Rheumatoid arthritis of the cervical spine - clinical considerations

Wasserman, Bradley R; Moskovich, Ronald; Razi, Afshin E
Rheumatoid arthritis (RA) is a chronic, systemic infammatory disorder affecting multiple organ systems, joints, ligaments, and bones and commonly involves the cervical spine. Chronic synovitis may result in bony erosion and ligamentous laxity that result in instability and sublux-ation. Anterior atlantoaxial subluxation (AAS) is the most frequently occurring deformity, due to laxity of the primary and secondary ligamentous restraints. Additional manifestations of RA include cranial settling, subaxial subluxation, or a combination of these. Although clinical fndings can be confounded by the severity of multifocal joint and systemic involvement, a careful history is critical to identify symptoms of cervical disease; serial physical examination is the best noninvasive diagnostic tool. Thorough physical and neurologic examinations should be performed in all patients and serial functional assessments charted. Radiographs of the cervical spine with lateral fexion-extension dynamic views should be obtained periodically and used to 'clear' the cervical spine before elective surgery requiring general anesthesia. Advanced imaging, such as magnetic resonance imaging (MRI) or myelography and computed tomography (CT), may be necessary to evaluate the neuraxis. Early initiation of pharmacotherapy may slow progression of rheumatoid cervical disease. Operative intervention before the onset of advanced myelopathy results in improved outcomes compared to the surgical stabilization of patients whose conditions are more advanced. A multidisciplinary approach involving rheumatology, surgery, and rehabilitation is benefcial to optimize outcomes
PMID: 22035393
ISSN: 1936-9727
CID: 139913

Evaluation of the neck

Chapter by: Moskovich R; Petrizzo A
in: Musculoskeletal disorders in the workplace : principles and practice by Nordin M; Pope MH; Andersson G [Eds]
Philadelphia PA : Mosby Elsevier, 2007
pp. ?-?
ISBN: 0323026222
CID: 5131

Lumbar disc herniations: surgical versus nonsurgical treatment

Awad, John N; Moskovich, Ronald
Lumbar disc herniation is among the most common causes of lower-back pain and sciatica. The cause(s) of lumbar disc herniation and the relation of lumbar disc herniation to back pain and sciatica have not been fully elucidated, but most likely comprise a complex combination of mechanical and biologic processes. Furthermore, the natural history of lumbar disc herniation seems generally to be favorable, leaving the optimum treatment for lumbar disc herniation a debate in the literature. Various nonoperative and operative treatment strategies have been tried with varying degrees of success. Treatment often involves patient education, physical therapy, alternative medicine options, and pharmaco-therapy. If these fail, surgical intervention is usually recommended. A literature search was conducted to evaluate the currently known effectiveness of traditional and novel non-operative and surgical techniques for the treatment lumbar disc herniation and to determine if there are substantive new advantages in these newer contemporary treatments or combinations thereof. A structured approach to treatment of a patient who may have a symptomatic lumbar disc herniation is presented, based on analysis of the current literature. No one method of nonoperative or operative treatment would seem definitively to be superior to another. Appropriate multidisciplinary treatment including behavioral analysis and support may offer the hope of improved outcomes for patients with lumbar disc herniation. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of the levels of evidence
PMID: 16462442
ISSN: 0009-921x
CID: 63075

Surgical versus nonsurgical management of spinal disorders - Comment [Comment]

Moskovich, R; Nordin, M
ISSN: 0009-921x
CID: 69823