Search Our Scientific Publications & Authors

N Am Spine Soc J 2021 Jun 21;6:100057. Epub 2021 Mar 21.

Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Avenue, New Haven, CT 06510, United States.

Background: the demographics, mechanisms of injury, and concurrent injuries associated with cervical, thoracic and lumbar spinal fracture and/or spinal cord injury remain poorly characterized.

Methods: Patients aged 18 and older with spinal injury between 2011 and 2015 in the National Trauma Data Bank (NTDB) were identified. Patient demographics, comorbidity burden, mechanism of injury, and associated injuries were analyzed. Read More

BMJ Case Rep 2021 Aug 25;14(8). Epub 2021 Aug 25.

Neurosurgery, Liverpool Hospital, Liverpool, New South Wales, Australia.

Plain CT is routinely ordered following blunt trauma of the cervical spine, and performs well in the exclusion of significant bony injuries. MRI is reserved for cases of suspected neural or posterior ligamentous compromise, and when other imaging modalities are contraindicated. There are patients however, with unremarkable radiology, and without suggestive clinical features, who are later found to have significant discoligamentous instability. Read More

Radiologe 2021 Aug 9;61(8):710-713. Epub 2021 Jul 9.

Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Deutschland.

Whiplash injury is a common trauma of the cervical spine which usually occurs during motor vehicle accidents, especially involving rear-end collisions. The trauma typically results from a sudden biphasic movement of the head and cervical spine (reclination followed by inclination), which may cause an injury of bony, muscular and ligamentous elements. The most common symptoms of whiplash injury are pain, stiffness and tenderness of the neck, which occur with a latency of several hours and may become chronic in some patients. Read More

Spine J 2021 07 10;21(7):1149-1158. Epub 2021 Feb 10.

Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.

Background Context: The recommended primary treatment for type III odontoid fractures (OFx) is external immobilization, except for patients having major displacement of the odontoid fragment. The bony fusion rate of type III OFx has been reported to be >85%. High compliance to treatment recommendations is favorable only if the treatment leads to a good outcome. Read More

Spine J 2021 04 17;21(4):627-637. Epub 2020 Dec 17.

Department of Neurosurgery, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway.

Background Context: The surgical fixation rate of type II odontoid fracture (OFx) in the elderly (≥65 years) is much lower than expected if the treatment adheres to current general treatment recommendations. Outcome data after conservative treatment for elderly patients with these fractures are sparse.

Purpose: The main aim of this study was to determine the long-term outcome after conservative and surgical treatments of type II OFx (all age-groups) to evaluate whether nonoperative treatment yields an acceptable outcome. Read More

S Afr J Surg 2019 Jun;57(2):54-60

Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.

Background: Community assault (CA) has been increasing in certain Cape Town suburbs over the past decade. There are limited CA-related imaging data. The aim of this study was to review CA-related advanced radiological investigations and findings at a Level 1 South African Trauma Centre. Read More

World Neurosurg 2019 Oct 9;130:179-186. Epub 2019 Jul 9.

Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.

Objective: Besides the facet joints interlocking, the fibrous tissue or bony callus around the dislocated segments make the reduction for this kind of old injury to be more challenging and different from that of acute injuries. This study is aimed to present 4 cases of old subaxial cervical facet dislocations (SCFD) that were successfully treated with posterior unlocking under endoscopy followed by anterior decompression, reduction, and fixation.

Methods: Between January 2017 and December 2017, 4 patients with old SCFD who underwent posterior unlocking of facet joints under endoscopy followed by anterior decompression, reduction, and fixation were enrolled. Read More

J Trauma Acute Care Surg 2019 10;87(4):813-817

From the Division of Pediatric General, Thoracic and Minimally Invasive Surgery (E.B.L., A.N., S.C., L.G.A., R.P., H.G.), Division of Pediatric Radiology (A.M.), St. Christopher's Hospital for Children; Drexel University College of Medicine (A.M., D.P., T.M., L.A., S.C., L.G.A., R.P., M.H., H.G.); and Division of Orthopedic Surgery (M.H.), St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.

Background: Cervical spine injuries (CSI) are rare within the pediatric population. Due to the significant consequences of missed CSI, children are often imaged excessively. In an attempt to decrease imaging of the cervical spine in children, we reviewed abnormal cervical radiographs (XR) to determine if the diagnosis of CSI could be made using a single-lateral cervical radiograph (LAT). Read More

Ital J Pediatr 2018 Nov 16;44(Suppl 2):119. Epub 2018 Nov 16.

Department of Neurosurgery, University of Milan-Bicocca, San Gerardo Hospital, via G.B. Pergolesi 33, 20900, Monza, Italy.

Background: Neurosurgical features of mucopolysaccharidosis (MPS) patients mainly involve the presence of cranio-vertebral junction (CVJ) abnormalities and the development of communicating hydrocephalus. CVJ pathology is a critical aspect that severely influences the morbidity and mortality of MPS patients. Hydrocephalus is slowly progressing; it must be differentiated from cerebral atrophy, and rarely requires treatment. Read More

World Neurosurg 2018 Oct 20;118:e938-e945. Epub 2018 Jul 20.

Division of Neurological Surgery, Azienda Universitaria Integrata di Trieste, Trieste, Trieste, Italy.

Background: Odontoid fractures are the most common acute cervical spinal fractures in the geriatric population. Their rate is increasing along with the rising age of the elderly population. Whereas conservative management with external immobilization is reported as the treatment of choice for type I and III odontoid fractures, there are no clear indications concerning the best treatment for type II fractures. Read More

Br J Radiol 2018 May 13;91(1085):20170744. Epub 2018 Feb 13.

1 Department of Radiology, Hacettepe University Faculty of Medicine , Ankara , Turkey.

Objective: To evaluate spinal MRI features of mucopolysaccharidosis (MPS) VI and to assess the correlation with clinical findings.

Methods: We retrospectively evaluated spinal MRI scans and clinical findings at the time of imaging in 14 patients (8 male, 6 female) with MPS VI. Craniometric measurements were performed and the images were assessed for bony anomalies, spinal stenosis and spinal cord compression. Read More

World Neurosurg 2017 Nov 4;107:194-201. Epub 2017 Aug 4.

Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.

Background: Various surgical techniques have been described for treating odontoid instability and achieving effective stabilization. The earliest technique to be described proposed a C1 lateral mass entry point including neurectomy of the C2 nerve roots to ensure hemostasis. Because C2 neurectomy remains controversial, preservation of the C2 nerve root as described in Goel-Harms technique can lead to intractable occipital neuralgia and significant blood loss. Read More

World Neurosurg 2017 Sep 1;105:145-152. Epub 2017 Jun 1.

Spinal Unit, Royal Victoria Infirmary, Newcastle, United Kingdom.

Objective: The prognosis in cervical spinal cord injury is poor, and surgical and neurointensive care management need further improvement. Monitoring of the intraspinal pressure (ISP) at an early stage after traumatic spinal cord injury (tSCI) is useful clinically.

Materials And Methods: Obtaining continuous spinal cord perfusion pressure (SCPP) measurements based on the difference between mean arterial pressure and ISP allows offering best medical and surgical treatment during this critical phase of tSCI. Read More

Spine J 2017 09 10;17(9):1319-1324. Epub 2017 May 10.

Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.

Background Context: Several prognostic studies looked for an association between the degree of spinal cord injury (SCI), as depicted by primary magnetic resonance imaging (MRI) within 72 hours of injury, and neurologic outcome. It was not clearly demonstrated whether the MRI at any time correlates with neurologic prognosis.

Purpose: The purpose of the present study was to investigate the relationship between acute MRI features and neurologic prognosis, especially walking ability of patients with cervical spinal cord injury (CSCI). Read More

World Neurosurg 2017 May 16;101:623-632. Epub 2017 Feb 16.

Department of Neurosurgery of Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.

Objective: Several studies have looked for an association between radiologic findings and neurologic outcome after cervical trauma. In the current literature, there is a paucity of evidence proving the prognostic role of soft tissue damage or bony integrity. Our objective is to determine radiologic findings related to neurologic prognosis in patients after incomplete acute traumatic cervical spinal cord injury, regardless of initial neurologic examination results. Read More

J Trauma Acute Care Surg 2017 02;82(2):263-269

From the Yale School of Medicine (A.A.M., D.C.J., K.B., K.A.D.), New Haven, Connecticut; Massachusetts General Hospital (T.P., T.M., G.C.V., K.L.B.), Boston, Massachusetts; Boston Medical Center (D.M., G.K.), Boston, Massachusetts; Baystate Medical Center (R.I.G.), Springfield, Massachusetts; Lahey Hospital and Medical Center (M.S.R.), Burlington, Massachusetts; Maine Medical Center (K.C.S., R.J.W.), Portland, Maine; Bridgeport Hospital (W.C.), Bridgeport, Connecticut; and Beth Israel Deaconess Medical Center (S.R.O.), Boston, Massachusetts.

Background: Although cervical spine CT (CSCT) accurately detects bony injuries, it may not identify all soft tissue injuries. Although some clinicians rely exclusively on a negative CT to remove spine precautions in unevaluable patients or patients with cervicalgia, others use MRI for that purpose. The objective of this study was to determine the rates of abnormal MRI after a negative CSCT. Read More

J Neurosurg Spine 2017 Mar 18;26(3):331-340. Epub 2016 Nov 18.

Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

OBJECTIVE The current management of atlantoaxial dislocation (AAD) focuses on the C1-2 joints, commonly approached through a posterior route. The distinction between reducible AAD (RAAD) and irreducible AAD (IrAAD) seems to be less important in modern times. The roles of preoperative traction and dynamic radiographs are questionable. Read More

World Neurosurg 2016 Sep 17;93:279-85. Epub 2016 Jun 17.

Intermountain Medical Center, Murray, Utah, USA; Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA. Electronic address:

Background: Acute complex C2 vertebral body fracture specifically does not involve the odontoid process or C2 pars interarticularis. External stabilization can be effective but may prolong healing and increase morbidity. Many traditional surgical techniques can achieve internal stabilization at the expense of normal cervical motion. Read More

A A Case Rep 2015 Jul;5(2):25-8

From the *Department of Anesthesia, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa; and †Division of Neuroradiology, Department of Radiology, The University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.

A 72-year-old patient with an acute traumatic Type III odontoid fracture presented to the operating room for an urgent orthopedic procedure with a history of uncontrolled gastroesophageal reflux, a full stomach, and active vomiting. Rather than fiberoptic intubation, a rapid sequence intubation with manual inline stabilization was performed using a videolaryngoscope. A lateral cervical spine radiograph immediately after intubation showed no change in alignment of the fracture of C1-C2. Read More

J Orthop Surg Res 2015 Jun 12;10:94. Epub 2015 Jun 12.

Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye-7 dong, 761-1, Nowon-gu, Seoul, 139-707, South Korea.

Background: Ossification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI based on intramedullary signal intensity (SI) changes on magnetic resonance imaging (MRI). Read More

J Med Assoc Thai 2015 Jan;98(1):100-5

Background: Acute distractive-flexion injury of subaxial cervical spine (C3-C7) results in facet subluxation or dislocation. However, when the injury is missed or neglected, it may cause serious complications including axial pain, deformity and neurological deficit.

Objective: To demonstrate the pathoanatomy, presentation and management of these injuries. Read More

Spine (Phila Pa 1976) 2015 Feb;40(3):E186-9

From the Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Japan.

Study Design: Case report.

Objective: To highlight the probability that lateral atlantoaxial subluxation (AAS) exists in patients with rheumatoid arthritis (RA) and induces vertebrobasilar infarctions that are more foregrounded than compressive myelopathy.

Summary Of Background Data: Although lateral subluxation is a well-known subtype of AAS, a case of cerebral ischemia associated with lateral AAS has not been reported before. Read More

J Trauma Acute Care Surg 2013 Nov;75(5):843-7

From the Division of Emergency Medicine (P.M.), Department of Pediatrics, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit; and Departments of Emergency Medicine (A.J.R.) and Pediatrics (A.J.R.), University of Michigan Medical Center and University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Pediatrics (D.M.J., J.C.L.), St. Louis Children's Hospital (D.M.J., J.R.L., J.C.L.) and Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics (C.S.O.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Neurosurgery (J.R.L.), Division of Emergency Medicine (L.E.N.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Departments of Emergency Medicine (N.K.) and Pediatrics(N.K.), University of California, Davis, School of Medicine, Davis, California.

Background: This study aimed to compare children diagnosed with cervical spinal cord injury without radiographic abnormality (SCIWORA) relative to whether there is evidence of cervical spinal cord abnormalities on magnetic resonance imaging (MRI).

Methods: We conducted a planned subanalysis of a cohort of children younger than 16 years with blunt cervical spine injury presenting to Pediatric Emergency Care Applied Research Network centers from January 2000 to December 2004 who underwent cervical MRI and did not have bony or ligamentous injury identified on neuroimaging. We defined SCIWORA with normal MRI finding as children with clinical evidence of cervical cord injury and a normal MRI finding and compared them with children with SCIWORA who had cervical cord signal changes on MRI (abnormal MRI finding). Read More

Trials 2013 Aug 7;14:245. Epub 2013 Aug 7.

Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

Background: The optimal management of acute cervical spinal cord injury (SCI) associated with preexisting canal stenosis remains to be established. The objective of this study is to examine whether early surgical decompression (within 24 hours after admission) would result in greater improvement in motor function compared with delayed surgery (later than two weeks) in cervical SCI patients presenting with canal stenosis, but without bony injury.

Methods/design: OSCIS is a randomized, controlled, parallel-group, assessor-blinded, multicenter trial. Read More

Orthop Surg 2013 May;5(2):94-9

Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.

Objective: The Rule of Spence states that displacement of the C₁ lateral masses by >6.9-8.1 mm suggests loss of transverse ligament integrity. Read More

World J Surg 2013 Aug;37(8):1988-95

Department of Abdominal, Endocrine, and Vascular Surgery, St. Vincentius Kliniken, University of Freiburg, Südendstrasse 32, 76137 Karlsruhe, Germany.

Background: The odontoid lateral mass interspace (OLMI) is the space between the lateral aspect of the dens axis and the medial circumference of the massa lateralis atlantis. The position of OLMI asymmetry as a normal variant or pathologic finding is an area of debate and clinical interest in trauma patients. We designed this prospective study to lay a framework for proposing strategies for the appropriate use of OLMI. Read More

Spinal Cord 2013 Apr 4;51(4):331-3. Epub 2012 Dec 4.

Department of Orthopaedic Surgery, Spinal Injuries Center, Iizuka, Japan.

Study Design: Retrospective radiographic study.

Objective: To investigate the pincers effect on cervical spinal cord in the development of traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation.

Setting: The Japan LHWO Spinal Injuries Center. Read More

Spine (Phila Pa 1976) 2012 Dec;37(25):E1560-6

Department of Orthopaedic Surgery, Spinal Injuries Center, Fukuoka, Japan.

Study Design: A retrospective imaging and clinical study.

Objective: To evaluate the extraneural soft-tissue damage and its clinical relevance in patients with traumatic cervical spinal cord injury (SCI) without major bone injury.

Summary Of Background Data: To date, various kinds of cervical discoligamentous injuries have been demonstrated on magnetic resonance images in patients with SCI without bony injury. Read More

J Trauma Acute Care Surg 2012 Mar;72(3):682-90

Faculty of Medicine, University of Oslo, Oslo, Norway.

Background: The purpose of this study was to determine the incidence of surgery for odontoid fractures and to study surgical mortality, surgical morbidity, and long-term outcome in a large, contemporary, consecutive, single-institution, surgical series of odontoid fractures.

Methods: This is a retrospective study of all odontoid fractures treated by open surgery at our hospital during 2002 to 2009. The fractures were classified according to Grauer. Read More