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Study Objective(Purpose of Study)
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Study Quality
1. Nordin M, Carragee EJ, Hogg-Johnson S, et al. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. [Review] [125 refs][Erratum appears in Spine. 2009 Mar 15;34(6):640], [Erratum appears in Spine (Phila Pa 1976). 2009 Mar;18(3):435-6], [Reprint in J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S117-40; PMID: 19251060]. Spine. 33(4 Suppl):S101-22, 2008 Feb 15. Review/Other-Dx 95 articles To critically appraise and synthesize the literature on assessment of neck pain. CT scans had better validity (in adults and elderly) than radiographs in assessing high-risk and/or multi-injured blunt trauma neck patients. In the absence of serious pathology, clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression. One exception is the manual provocation test for cervical radiculopathy, which has high PPV. There was no evidence that specific MRI findings are associated with neck pain, cervicogenic headache, or whiplash exposure. No evidence supports using cervical provocative discography, anesthetic facet, or medial branch blocks in evaluating neck pain. Reliable and valid self-report questionnaires are useful in assessing pain, function, disability, and psychosocial status in individuals with neck pain. 4
2. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310(6):591-608. Review/Other-Dx 488 scientists To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, Healthy life expectancy (HALE) increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of Years of life lost (YLLs) in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of Years lived with disability (YLDs) in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of Disability-adjusted life-years (DALYs) than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. 4
3. Binder AI.. Neck pain. [Review]. Clinical Evidence. 2008, 2008 Aug 04. Review/Other-Dx N/A To answer the following clinical questions: What are the effects of treatments for people with non-specific neck pain without severe neurological deficit? What are the effects of treatments for acute whiplash injury? What are the effects of treatments for chronic whiplash injury? What are the effects of treatments for neck pain with radiculopathy? We found 91 systematic reviews, RCTs, or observational studies that met our inclusion criteria.We performed a GRADE evaluation of the quality of the evidence for interventions. 4
4. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15(6):834-848. Review/Other-Dx 21 studies To determine the prevalence of neck pain (NP) in the world population and to identify areas of methodological variation between studies. No results stated in abstract. 4
5. Fernandez-de-las-Penas C, Hernandez-Barrera V, Alonso-Blanco C, et al. Prevalence of neck and low back pain in community-dwelling adults in Spain: a population-based national study. Spine (Phila Pa 1976). 2011;36(3):E213-219. Review/Other-Dx 29,478 subjects To determine the 1-year prevalence of neck pain and low back pain in the Spanish population and their association with sociodemographic and lifestyle habits, self-reported health status and comorbidity with other chronic disorders. The 1-year prevalence was 19.5% (95% CI: 18.9-20.1) for neck pain and 19.9% (95% CI: 19.3-20.5) for low back pain. Both neck pain and low back pain were higher among female (26.4% and 24.5%) than male (12.3% and 15.1%). Subjects in the 31 to 50 years group were 1.5 times (95% CI: 1.3-1.8) more likely to report low back pain than participants in the 16 to 30 years group. Individuals reporting neck or low back pain showed worse self-reported health status (OR: 4.9, 95% CI: 4.5-5.3 for neck pain; OR: 4.7, 95% CI: 4.3-5.1 for low back pain) and were more likely to complain of depression (OR: 4.3, 95% CI: 3.9-4.7 or OR: 3.6, 95% CI: 3.3-3.9, respectively). Further, a strong association between neck and low back pain was found (OR: 15.6, 95% CI: 14.2-17.1). Finally, neck pain and low back pain were also associated with several other chronic conditions, particularly arthrosis (OR: 6.5, 95% CI: 6.0-7.0), and headaches (OR: 4.3, 95% CI: 3.9-4.8) for neck pain, and both arthrosis (OR: 5.7, 95% CI: 5.3-6.2), and osteoporosis (OR: 6.3, 95% CI: 5.6-7.2), for low back pain. 4
6. Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. [Review] [140 refs][Reprint in J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S46-60; PMID: 19251074]. Spine. 33(4 Suppl):S39-51, 2008 Feb 15. Review/Other-Dx N/A To undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated disorders in the general population. We identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles related to the burden and determinants of neck pain in the general population. Incidence ranged from 0.055 per 1000 person years (disc herniation with radiculopathy) to 213 per 1000 persons (self-reported neck pain). Incidence of neck injuries during competitive sports ranged from 0.02 to 21 per 1000 exposures. The 12-month prevalence of pain typically ranged between 30% and 50%; the 12-month prevalence of activity-limiting pain was 1.7% to 11.5%. Neck pain was more prevalent among women and prevalence peaked in middle age. Risk factors for neck pain included genetics, poor psychological health, and exposure to tobacco. Disc degeneration was not identified as a risk factor. The use of sporting gear (helmets, face shields) to prevent other types of injury was not associated with increased neck injuries in bicycling, hockey, or skiing. 4
7. Son KM, Cho NH, Lim SH, Kim HA. Prevalence and risk factor of neck pain in elderly Korean community residents. J Korean Med Sci. 2013;28(5):680-686. Review/Other-Dx N/A To evaluate the prevalence, the severity and the risk factors of neck pain in middle-to-old age Korean community residents. The lifetime prevalence of neck pain was 20.8% with women having a higher prevalence. The prevalence did not increase with age, and the majority of individuals had low-intensity/low-disability pain. Subjects with neck pain had a significantly worse SF-12 score in all domains except for mental health. The prevalence of neck pain was significantly associated with female gender, obesity and smoking. This is the first large-scale Korean study estimating the prevalence of neck pain in elderly population. 4
8. Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis & Rheumatism. 57(4):656-65, 2007 May 15. Review/Other-Dx N/A To estimate the US prevalence and psychological and health behavior correlates of low back pain and/or neck pain. No current US national prevalence estimates of low back and neck pain exist and few studies have investigated the associations between low back and neck pain, psychological factors, and health behaviors in a representative sample of US community dwellers. The 3-month US prevalence of back and/or neck pain was 31% (low back pain: 34 million, neck pain: 9 million, both back and neck pain: 19 million). Generally, adults with low back and/or neck pain reported more comorbid conditions, exhibited more psychological distress (including serious mental illness), and engaged in more risky health behaviors than adults without either condition. 4
9. Cohen SP.. Epidemiology, diagnosis, and treatment of neck pain. [Review]. Mayo Clinic Proceedings. 90(2):284-99, 2015 Feb. Review/Other-Dx N/A To include epidemiological aspects, classification, the natural course of neck pain, and an evidencebased, comprehensive guide to work-up, diagnosis, and treatment. No results stated in abstract. 4
10. Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017;358:j3221. Review/Other-Dx N/A To review the Advances in the diagnosis and management of neck pain No results stated in abstract. 4
11. American College of Radiology. ACR Appropriateness Criteria®: Suspected Spine Trauma. Available at: Review/Other-Dx N/A To provide evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
12. American College of Radiology. ACR Appropriateness Criteria®: Neck Mass/Adenopathy. Available at: Review/Other-Dx N/A To provide guidelines on neck Mass/Adenopathy. No results stated in abstract. 4
13. Roth CJ, Angevine PD, Aulino JM, et al. ACR Appropriateness Criteria Myelopathy. J. Am. Coll. Radiol.. 13(1):38-44, 2016 Jan. Review/Other-Tx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for myelopathy No results stated in abstract. 4
14. Bykowski J, Aulino JM, Berger KL, et al. ACR Appropriateness Criteria(R) Plexopathy. J Am Coll Radiol. 2017;14(5S):S225-S233. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for plexopathy. No results stated in abstract. 4
15. American College of Radiology. ACR Appropriateness Criteria®: Headache. Available at: Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
16. Patel ND, Broderick DF, Burns J, et al. ACR Appropriateness Criteria Low Back Pain. J Am Coll Radiol. 2016;13(9):1069-1078. Review/Other-Dx N/A To provide clinical guidelines for Low Back Pain. No results stated in abstract. 4
17. American College of Radiology. ACR–ASNR–SPR Practice Parameter For The Performance Of Myelography And Cisternography. Available at: Review/Other-Dx N/A To provide Practical Parameter For The Performance Of Myelography And Cisternography. No results stated in abstract. 4
18. Vasseljen O, Woodhouse A, Bjorngaard JH, Leivseth L. Natural course of acute neck and low back pain in the general population: the HUNT study. Pain. 154(8):1237-44, 2013 Aug. Observational-Dx 219 subjects To describe the natural course of Neck pain (NP) and low back pain (LBP) over 1 year in cases of the general population with a new episode of NP or LBP. Use of medication and health care was described and associations between pain intensity and seeking health care were estimated. Pain declined rapidly within 1 month after a new pain episode, with a reduction of 0.91 (95% confidence interval [CI] 0.50-1.32) for neck pain and 1.40 (95% CI 0.82-1.99) for low back pain with little change thereafter. However, pain remained unchanged over the follow-up year for those with equal pain in the neck and low back areas at baseline and for those reporting 4 or more pain sites at baseline. Only 1 in 5 sought health care for their complaints. Still, the course of pain was comparable to effect sizes reported in interventional studies. 2
19. Vos CJ, Verhagen AP, Passchier J, Koes BW. Clinical course and prognostic factors in acute neck pain: an inception cohort study in general practice. Pain Medicine. 9(5):572-80, 2008 Jul-Aug. Observational-Dx 187 patients To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave. One hundred eighty-seven patients were included and 138 (74%) provided follow-up data. After 1 year, 76% of the patients stated to be fully recovered or much improved, although 47% reported to have ongoing neck pain. Almost half of the patients on sick leave at baseline returned to work within 7 days. Multivariate analysis showed that the highest association with recovery was the advice of the general practitioner (GP) "to wait and see" (odds ratio [OR] 6.7, 95% confidence interval [CI] 1.6-31.8). For sick leave, referral by the GP, for physical therapy or to a medical specialist, showed the highest association (OR 2.8, 95% CI 1.0-8.4). 3
20. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. [Review]. AJNR Am J Neuroradiol. 36(4):811-6, 2015 Apr. Review/Other-Dx 33 articles To estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals. Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met the study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age. 4
21. Lehto IJ, Tertti MO, Komu ME, Paajanen HE, Tuominen J, Kormano MJ. Age-related MRI changes at 0.1 T in cervical discs in asymptomatic subjects. Neuroradiology. 1994;36(1):49-53. Observational-Dx 89 subjects To determine the age-dependent occurrence of degenerative disc disease in the cervical spine in asymptomatic subjects. Abnormalities were commoner in older subjects, 62% of being seen in those over 40 years old. In subjects aged less than 30 years there were virtually no abnormalities. DD was the most common abnormality, seen in 10% of discs; 57% DD was in subjects aged over 40. DD at the C5/6 level was the most common finding. No differences in abnormal findings between males and females was observed, nor any statistically significant association between DD and other abnormalities. Thus, DD begins later age in the cervical spine than in the lumbar region. 3
22. Machino M, Yukawa Y, Imagama S, et al. Age-Related and Degenerative Changes in the Osseous Anatomy, Alignment, and Range of Motion of the Cervical Spine: A Comparative Study of Radiographic Data From 1016 Patients With Cervical Spondylotic Myelopathy and 1230 Asymptomatic Subjects. Spine. 41(6):476-82, 2016 Mar. Observational-Dx 1025 patients To establish cervical spine morphometry, alignment, and range of motion (ROM) and to clarify the impact of these age-related and degenerative changes. Cervical lordosis in the neutral position increased gradually with age in both groups. Cervical spondylotic myelopathy (CSM) patients showed significantly smaller lordotic angles compared with those shown by asymptomatic subjects within each decade. The total ROM decreased with increasing age in both groups. The total ROM of females was larger than males. The ROM of CSM patients was significantly smaller than asymptomatic subjects. The flexion ROM did not change with aging in either group. There was no significant difference in the flexion ROM between males and females in the two groups. However, the extension ROM decreased gradually in both groups. The extension ROM of CSM patients was significantly smaller than asymptomatic subjects. 3
23. Matsumoto M, Fujimura Y, Suzuki N, et al. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br. 1998;80(1):19-24. Observational-Dx 497 volunteers To prospectively investigate the degenerative changes on Magnetic Resonance Imaging (MRI) in the cervical discs of a sample of an asymptomatic Japanese population. The frequency of all degenerative findings increased linearly with age. Disc degeneration was the most common observation, being present in 17% of discs of men and 12% of those of women in their twenties, and 86% and 89% of discs of both men and women over 60 years of age. We found significant differences in frequency between genders for posterior disc protrusion and foraminal stenosis. The former, with demonstrable compression of the spinal cord, was observed in 7.6% of subjects, mostly over 50 years of age. 2
24. Kalichman L, Hunter DJ. Lumbar facet joint osteoarthritis: a review. Semin Arthritis Rheum. 2007;37(2):69-80. Meta-analysis N/A To review the anatomy, biomechanics, and possible sources of pain of the FJ, natural history, and risk factors of lumbar FJ osteoarthritis and briefly reviewed the relevant imaging methods. The FJ play an important role in load transmission; they provide a posterior load-bearing helper, stabilizing the motion segment in flexion and extension and also restricting axial rotation. The capsule of the FJ, subchondral bone, and synovium are richly innervated and can be a potential source of the low back pain. Degenerative changes in the FJ comprise cartilage degradation that leads to the formation of focal and then diffuse erosions with joint space narrowing, and sclerosis of the subchondral bone. Because the most prominent changes occur in bone, the best method of evaluation of the FJ is computed tomography. Risk factors for lumbar FJ osteoarthritis include advanced age, relatively more sagittal orientation of the FJ, and a background of intervertebral disk degeneration. Inadequate
25. McLaughlin PD, Ouellette HA, Louis LJ, et al. The emergence of ultra-low--dose computed tomography and the impending obsolescence of the plain radiograph? Can Assoc Radiol J. 2013;64(4):314-318. Review/Other-Dx N/A To review The emergence of ultra-low--dose computed tomography and the impending obsolescence of the plain radiograph. No results stated in abstract. 4
26. Matar HE, Navalkissoor S, Berovic M, et al. Is hybrid imaging (SPECT/CT) a useful adjunct in the management of suspected facet joints arthropathy?. International Orthopaedics. 37(5):865-70, 2013 May. Observational-Dx 72 patients To assess the value of single photon emission computed tomography (SPECT)/CT imaging in patients with chronic spinal pain. Seventy-two patients were included (37 females, 35 males, mean age of 53.9 years). There were 25 cervical spine scans and 49 lumbar spine scans. In the cervical spine group, 13 (52 %) patients had scintigraphically active cervical facet joint arthropathy and ten (36 %) had other pathology identified. Two thirds of patients diagnosed with facet joint arthropathy received steroid guided injections following their scans. In the lumbar spine group 34 (69.4 %) patients had scintigraphically active lumbar facet joint arthropathy and eight had other pathology identified. Twenty patients (58.8 %) diagnosed with facet joint arthropathy subsequently received steroid guided injections. 3
27. White AP, Biswas D, Smart LR, Haims A, Grauer JN. Utility of flexion-extension radiographs in evaluating the degenerative cervical spine. Spine (Phila Pa 1976). 2007;32(9):975-979. Review/Other-Dx 258 patients To determine the: (1) percentage of flexion-extension radiographs that revealed pathology not appreciated on neutral radiographs in the nontrauma population, and (2) frequency that these views led to a change in the management of these patients. Listhesis was observed on 23 of the neutral lateral images; 6 of these were found to have changes between flexion and extension (2-4 mm). 2 patients (1%) had spondylolisthesis on flexion-extension radiographs not visualized on neutral lateral radiographs. A subsequent review of these patients' charts revealed no change in management based on these findings. 4
28. Johnson MJ, Lucas GL. Value of cervical spine radiographs as a screening tool. Clinical Orthopaedics & Related Research. (340)102-8, 1997 Jul. Review/Other-Dx 470 patients To assess the yield of useful and critical information in a group of patients without trauma. No results stated in the abstract. 4
29. Leichtle UG, Wunschel M, Socci M, Kurze C, Niemeyer T, Leichtle CI. Spine radiography in the evaluation of back and neck pain in an orthopaedic emergency clinic. Journal of Back & Musculoskeletal Rehabilitation. 28(1):43-8, 2015. Review/Other-Dx 484 patients To analyze and optimize diagnostics and treatment of patients with acute back pain. Radiographs of the lumbar, cervical, or thoracic spine were performed in 338 cases (70%). Radiographs were normal in 142 patients (42%) and degenerative changes were identified in 123 patients (36%). Only 2 patients (0.4%) had radiographic findings that had direct therapeutic relevance: 1 patient with metastatic disease and 1 patient with posttraumatic C1-C2 instability. For most patients without sensorimotor deficits and absent specific indications for radiography (“red flags”), therapy was not affected by the results of radiography. 4
30. Bogduk N.. The anatomy and pathophysiology of neck pain. [Review] [107 refs]. Physical Medicine & Rehabilitation Clinics of North America. 14(3):455-72, v, 2003 Aug. Review/Other-Dx N/A To review the anatomy and pathophysiology of neck pain. No results stated in the abstract. 4
31. Radhakrishnan K, Litchy WJ, O'Fallon WM, Kurland LT. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117 ( Pt 2):325-335. Review/Other-Dx N/A To review the population-based study from Rochester, Minnesota, 1976 through 1990. The median duration of symptoms prior to diagnosis was 15 days. A monoradiculopathy involving C7 nerve root was the most frequent, followed by C6. A confirmed disc protrusion was responsible for cervical radiculopathy in 21.9% of patients; 68.4% were related to spondylosis, disc or both. During the median duration of follow-up of 4.9 years, recurrence of the condition occurred in 31.7%, and 26% underwent surgery for cervical radiculopathy. A combination of radicular pain and sensory deficit, and objective muscle weakness were predictors of a decision to operate. At last follow-up 90% of our population-based patients were asymptomatic or only midly incapacitated due to cervical radiculopathy. The average annual age-adjusted incidence rates per 100,000 population for cervical radiculopathy in Rochester were 83.2 for the total, 107.3 for males and 63.5 for females. The age-specific annual incidence rate per 100,000 population reached a peak of 202.9 for the age group 50-54 years. 4
32. Thoomes EJ, van Geest S, van der Windt DA, et al. Value of physical tests in diagnosing cervical radiculopathy: a systematic review. [Review]. Spine Journal: Official Journal of the North American Spine Society. 18(1):179-189, 2018 01. Meta-analysis 3 articles To summarize and update the evidence on diagnostic performance of tests carried out during a physical examination for the diagnosis of cervical radiculopathy. Five diagnostic accuracy studies were identified. Only Spurling's test was evaluated in more than one study, showing high specificity ranging from 0.89 to 1.00 (95% confidence interval [CI]: 0.59-1.00); sensitivity varied from 0.38 to 0.97 (95% CI: 0.21-0.99). No studies were found that assessed the diagnostic accuracy of widely used neurological tests such as key muscle strength, tendon reflexes, and sensory impairments. Not Assessed
33. Kuijper B, Tans JT, van der Kallen BF, Nollet F, Lycklama A Nijeholt GJ, de Visser M. Root compression on MRI compared with clinical findings in patients with recent onset cervical radiculopathy. J Neurol Neurosurg Psychiatry. 82(5):561-3, 2011 May. Observational-Dx 82 patients To evaluate the occurrence of symptomatic and asymptomatic root compression caused by herniated discs and spondylotic foraminal stenosis by magnetic Resonance Imaging (MRI) in patients with recent onset cervical radiculopathy. In 73% of patients, the clinically affected root was compressed on MRI. In 45%, MRI showed root compression without clinical substrate together with, or to a lesser extent without, the coexistence of compression of the clinically affected root. MRIs were assessed as normal in 13-15% of cases, and in 9-10% only asymptomatic roots were compressed. Herniated discs without spondylosis were more often responsible for root compressions only at the clinically affected level and spondylotic foraminal stenosis for multiple root compression including compression of clinically unaffected roots. 2
34. Woods BI, Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. [Review]. J Spinal Disord Tech. 28(5):E251-9, 2015 Jun. Review/Other-Dx N/A To review the epidemiology, etiology, diagnosis, and treatment of Cervical radiculopathy. No results stated in abstract. 4
35. Brown BM, Schwartz RH, Frank E, Blank NK. Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging. AJR Am J Roentgenol. 1988;151(6):1205-1212. Review/Other-Dx 256 patients To retrospectively review 2-year experience with Magnetic Resonance (MR) and plain-film screening for surgically proved lesions in the cervical spine MR correctly predicted 88% of all surgically proved lesions compared with 81% for computed tomography (CT) myelography, 58% for myelography, and 50% for CT. Missed herniated disks on either MR or CT myelography usually were the result of technically suboptimal studies caused by motion artifacts on MR and beam-hardening artifacts on CT myelography. Small osteophytes adjoining herniated disks sometimes were not predicted on MR, although such osteophytes invariably were seen on plain films and were palpable during standard anterior cervical diskectomy procedures. Herniated disks in the lateral root canals found in two patients appeared to be detected more readily by CT myelography than by MR. All proved lesions were detected by either screening MR images and plain films or by follow-up CT myelograms. MR replaced invasive evaluations by myelography and CT myelography in 32% of preoperative patients. 4
36. van Rijn JC, Klemetso N, Reitsma JB, et al. Observer variation in the evaluation of lumbar herniated discs and root compression: spiral CT compared with MRI. Br J Radiol. 2006;79(941):372-377. Observational-Dx 171 intervertebral discs To compare radiological evaluation of spiral computed tomography (CT) with Magnetic Resonance Imaging (MRI) in patients suspected of herniated discs. For detection of herniated or bulging discs, we observed no significant difference in interobserver agreement (CT kappa 0.66 vs MRI kappa 0.71; p = 0.40). For root compression, we observed significantly better interobserver agreement at MRI evaluation (CT kappa 0.59 vs MRI kappa 0.78; p = 0.01). In 30 of 171 lumbar discs (18%) and in 54 of 456 nerve roots (12%), the observers disagreed on whether CT results were similar to MRI. In the cases without disagreement, CT differed from MRI in 6 discs (3.5%) and in 3 nerve roots (0.7%). For radiological evaluation of lumbar herniated discs, we found no evidence that spiral CT is inferior to MRI. 2
37. Modic MT, Masaryk TJ, Ross JS, Mulopulos GP, Bundschuh CV, Bohlman H. Cervical radiculopathy: value of oblique MR imaging. Radiology. 1987;163(1):227-231. Observational-Dx 18 patients To study the accuracy of surface coil magnetic resonance (MR) versus metrizamide myelognaphy and computed tomography (CT) with metnizamide in patients with cervical madiculopathy. Nine of 18 patients subsequently underwent cervical surgery with an anterior interbody approach at 11 levels. The surface coil MR findings concerning disease topography and type concurred with the surgical findings at nine of 11 levels (82%). At three levels, the oblique view added important information not available on the sagittal images or clarified changes seen on the axial images. Metrizamide myelography with CT metrizamide myelography had findings concurrent with surgical findings at ten of 11 levels (91%). 2
38. Bartlett RJ, Hill CR, Gardiner E. A comparison of T2 and gadolinium enhanced MRI with CT myelography in cervical radiculopathy. Br J Radiol. 1998;71(841):11-19. Observational-Dx 21 patients To investigate the value of fat saturated gadolinium enhanced 2 dimentional axial images. Gadolinium (dimeglumine gadopentetate, Schering Ltd) enhanced images did not confer any benefit in the investigation of this condition, probably due to enhancement of herniated disc material and osteophytes adjacent to the neurocentral joint. Three-dimensional (3D) T2* white cerebrospinal fluid images had an accuracy approaching 90% for the diagnosis of foraminal encroachment, compared with a gold standard. MRI including a 3D T2* sequence is thus an acceptable primary investigation for cervical radiculopathy, but when the findings are incompatible with clinical symptomatology, CT myelography is still indicated. 2
39. Abbed KM, Coumans JV. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. [Review] [36 refs]. Neurosurgery. 60(1 Supp1 1):S28-34, 2007 Jan. Review/Other-Dx N/A To determine the pathophysiology, presentation, and clinical evaluation of cervical radiculopathy. No results stated in the abstract 4
40. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72(8):1178-1184. Observational-Dx 100 total subjects: 63 healthy volunteers, 37 randomized symptomatic lesion of the cervical spine To evaluate MRI finding in asymptomatic subjects. The disc was degenerated or narrowed at 1 level or more in 25% of the subjects who were >40 years old and in almost 60% of those who were >40. The prevalence of abnormal MRI of the cervical spine as related to age in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely matching those findings with clinical signs and symptoms. 3
41. Mostofi K, Khouzani RK. Reliability of cervical radiculopathy, its congruence between patient history and medical imaging evidence of disc herniation and its role in surgical decision. Eur. j. orthop. surg. traumatol.. 26(7):805-8, 2016 Oct. Observational-Dx 10 patients To investigate patients who present with discrepancy between classical radiculopathy and imaging findings in the daily practice of our profession. We found an apparent discrepancy between clinical and radiological findings, patients complained of radiculopathy on one side, and magnetic resonance imaging (MRI) scan or CT scan finding on the other side in ten patients (10.2 %). We did not found any other abnormalities in preoperative and post-operative period. All patients underwent cervical diskectomy via anterior approach. Six weeks after surgery eight patients (80 %) recovered completely, and 3 months after all ten patients (100 %) had been relieved totally. 3
42. Friedenberg ZB, Miller WT. Degenerative Disc Disease of the Cervical Spine. J Bone Joint Surg Am. 1963;45:1171-1178. Review/Other-Dx N/A To review the Degenerative Disc Disease of the Cervical Spine. No results stated in abstract. 4
43. Buchowski JM, Anderson PA, Sekhon L, Riew KD. Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. Surgical technique. J Bone Joint Surg Am. 91 Suppl 2:223-32, 2009 Oct 01. Experimental-Dx 199 patients To performe a cross-sectional analysis of two large, prospective, randomized multicenter trials to evaluate the efficacy of cervical disc arthroplasty for the treatment of myelopathy. A total of 199 patients were included in the present study; 106 patients (53%) underwent arthroplasty, whereas ninety-three (47%) underwent arthrodesis. The Neck Disability Index, Short Form-36 scores, and specific arm and neck pain scores improved significantly from baseline at all time points. Patients in all four groups had improvement in the postoperative neurological status and gait function; at twenty-four months after surgery, 90% (95% confidence interval, 77.8% to 96.6%) of the patients in the arthroplasty group and 81% (95% confidence interval, 64.9% to 92.0%) of those in the arthrodesis group had improvement in or maintenance of the neurological status in the Prestige ST trial and 90% (95% confidence interval, 75.8% to 97.1%) of the patients in the arthroplasty group and 77% (95% confidence interval, 57.7% to 90.1%) of those in the arthrodesis group had improvement in or maintenance of the neurological status in the Bryan trial. 2
44. Rao RD, Currier BL, Albert TJ, et al. Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management. J Bone Joint Surg Am. 2007;89(6):1360-1378. Review/Other-Dx N/A To review the clinical syndromes, pathogenesis, and management of Degenerative cervical spondylosis No results stated in abstract. 4
45. Shriver MF, Lewis DJ, Kshettry VR, Rosenbaum BP, Benzel EC, Mroz TE. Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis. Spine J. 15(9):2016-27, 2015 Sep 01. Meta-analysis 17 studies To identify all prospective studies reporting pseudoarthrosis rates for Anterior cervical discectomy and fusion (ACDF)  with plate fixation. Of the 7,130 retrieved articles, 17 met the inclusion criteria. The overall pseudoarthrosis rate was 2.6% (95% CI: 1.3-3.9). Use of autograft fusion (0.9%, 95% CI: -0.4 to 2.1) resulted in a reduced pseudoarthrosis rate compared with allograft fusion procedures (4.8%, 95% CI: 1.7-7.9). Studies were separated based on the length of follow-up: 12 to 24 and greater than 24 months. These groups reported rates of 3.1% (95% CI: 1.2-5.0) and 2.3% (95% CI: 0.1-4.4), respectively. Studies performing single-level ACDF yielded a rate of 3.7% (95% CI: 1.6-5.7). Additionally, there was a large difference in the rate of pseudoarthrosis in randomized controlled trials (4.8%, 95% CI: 2.6-7.0) versus prospective cohort studies (0.2%, 95% CI: -0.1 to 0.5), indicating that the extent of follow-up criteria affects the rate of pseudoarthrosis. Good
46. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999;81(4):519-528. Review/Other-Dx 11,555,823 live births To determine, with use of the nationwide Kids’ Inpatient Database, the incidence of brachial plexus injuries in the United States and to identify risk factors associated with this injury. Symptomatic adjacent-segment disease occurred at a relatively constant incidence of 2.9 percent per year (range, 0.0 to 4.8 percent per year) during the ten years after the operation. Survivorship analysis predicted that 25.6 percent of the patients (95 percent confidence interval, 20 to 32 percent) who had an anterior cervical arthrodesis would have new disease at an adjacent level within ten years after the operation. There were highly significant differences among the motion segments with regard to the likelihood of symptomatic adjacent-segment disease (p<0.0001); the greatest risk was at the interspaces between the fifth and sixth and between the sixth and seventh cervical vertebrae. Contrary to our hypothesis, we found that the risk of new disease at an adjacent level was significantly lower following a multilevel arthrodesis than it was following a single-level arthrodesis (p<0.001). More than two-thirds of all patients in whom the new disease developed had failure of nonoperative management and needed additional operative procedures. 4
47. Lee JC, Lee SH, Peters C, Riew KD. Adjacent segment pathology requiring reoperation after anterior cervical arthrodesis: the influence of smoking, sex, and number of operated levels. Spine. 40(10):E571-7, 2015 May 15. Observational-Dx 1038 patients To determine, using survivorship analysis, the rate of adjacent segment pathology (ASP) development and to identify the risk factors for reoperation. Secondary surgery on adjacent segments occurred at a relatively constant rate of 2.4% per year (95% confidence interval, 1.9-3.0). The Kaplan-Meier analysis predicted that 22.2% of patients would need reoperation at adjacent segments by 10 years postoperatively. Factors increasing the risk were smoking, female sex, and the number of arthrodesis segments. One or 2-segment arthrodesis had an 1.8 times greater risk than arthrodesis involving 3 or more segments. Age, neurological diagnosis, diabetes, Klippel-Feil syndrome, and noncontiguous segmental-type ossification of posterior longitudinal ligament were not significant risks. 3
48. Buchowski JM, Liu G, Bunmaprasert T, Rose PS, Riew KD. Anterior cervical fusion assessment: surgical exploration versus radiographic evaluation. Spine (Phila Pa 1976). 2008;33(11):1185-1191. Observational-Dx 14 patients To assess the reliability of plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) to detect a pseudarthrosis after an anterior cervical fusion compared with intraoperative exploration. Of the 14 patients included, 8 had pseudarthroses. Assessment of the agreement between intraoperative and radiographic findings revealed a mean Kappa statistic of 0.67 (range, 0.51-0.75, P < 0.05) for plain radiographs, 0.81 (range, 0.71-0.87, P < 0.05) for CT, and 0.48 (range, 0.32-0.71, P < 0.05) for MRI. When all studies were taken into consideration, the mean Kappa statistic increased to 0.85 (range, 0.71-1.00, P < 0.05). Assessment of paired interobserver reliability revealed a mean Kappa statistic of 0.46 (range, 0.31-0.55, P < 0.05) for plain radiographs, 0.82 (range, 0.73-0.87, P < 0.05) for CT, and 0.32 (range, 0.21-0.40, P < 0.05) for MRI. When all radiographic studies were taken into consideration, paired interobserver reliability had a mean Kappa statistic of 0.70 (range, 0.55-0.85, P < 0.05). 2
49. Ploumis A, Mehbod A, Garvey T, Gilbert T, Transfeldt E, Wood K. Prospective assessment of cervical fusion status: plain radiographs versus CT-scan. Acta Orthop Belg. 2006;72(3):342-346. Observational-Dx 47 patients To compare the pseudarthrosis rate after anterior cervical fusion, estimated either with static and dynamic plain radiographs or with two-dimensional CT-scans. CT assessment led to higher pseudarthrosis rates than plain radiographs: 13 to 31% according to CT; 2 to 16% according to plain radiographs. The difference averaged 11%. Consistency between reviewers was higher with CT (average agreement: 89%; range 82%-96%) than with plain radiographs (average agreement: 81%; range: 76% to 87%). The need to accurately document pseudarthrosis is critical as it helps direct the postoperative management of the patient. 2
50. Selby MD, Clark SR, Hall DJ, Freeman BJ. Radiologic assessment of spinal fusion. J Am Acad Orthop Surg. 20(11):694-703, 2012 Nov. Review/Other-Dx N/A To review the Radiologic assessment of spinal fusion. No results stated in abstract. 4
51. Nunley PD, Jawahar A, Cavanaugh DA, Gordon CR, Kerr EJ 3rd, Utter PA. Symptomatic adjacent segment disease after cervical total disc replacement: re-examining the clinical and radiological evidence with established criteria. Spine J. 13(1):5-12, 2013 Jan. Meta-analysis N/A To predict the true incidence of symptomatic adjacent segment disease (ASD) after total disc replacement (TDR) surgery in the cervical spine at one or two levels at a median follow-up period of 4 years. Twenty-six patients (15.2%) were identified to satisfy our criteria for ASD at the median follow-up of 51 months, with the annual incidence of 3.1% as calculated by life tables. The actuarial 5-year freedom from ASD rate was 71.6%+/-0.6%, and the mean period for freedom from ASD was 70.4+/-2.1 months. Not Assessed
52. Pessis E, Campagna R, Sverzut JM, et al. Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics. 2013;33(2):573-583. Review/Other-Dx N/A To review the theory of VMS imaging and describe our clinical experience with a single-source dual-energy scanner with fast kilovoltage switching (ie, rapid alternation between high- and low-kilovoltage settings) to reduce beam-hardening artifact, using optimized protocols to improve diagnostic performance inpatients with metal implants. Despite advances in detector technology and computer software, artifacts from metal implants can seriously degrade the quality of CT images, sometimes to the point of making them diagnostically unusable. Several factors may help reduce the number and severity of artifacts at multidetector CT, including decreasing the detector collimation and pitch, increasing the kilovolt peak and tube charge, and using appropriate reconstruction algorithms and section thickness. More recently, dual-energy CT has been proposed as a means of reducing beam-hardening artifacts. The use of dual-energy CT scanners allows the synthesis of virtual monochromatic spectral (VMS) images. Monochromatic images depict how the imaged object would look if the x-ray source produced x-ray photons at only a single energy level. For this reason, VMS imaging is expected to provide improved image quality by reducing beam-hardening artifacts. 4
53. Derakhshan A, Lubelski D, Steinmetz MP, Benzel EC, Mroz TE. Utility of Computed Tomography following Anterior Cervical Diskectomy and Fusion. Global Spine J. 2015;5(5):411-416. Observational-Dx 690 patients To assess the utility of postoperative computed tomography (CT) following anterior cervical diskectomy and fusion (ACDF) and to determine the clinical circumstances most likely to lead to an abnormal CT scan. The charts of 690 patients who underwent ACDF were reviewed. Of the 690 patients, 45 (7%) had postoperative CTs. These patients accounted for 53 postoperative CT scans, 45 (85%) of which were taken for patients who expressed persistent postoperative symptoms and/or had abnormal imaging. There were no indications for 8 (15%) of the CTs. Patients who had a CT for persistent symptoms and/or abnormal preliminary imaging were significantly more likely to have an abnormal CT (p = 0.03) and/or an alteration in treatment course (p = 0.04) compared with those with no symptomatic or radiologic indication for CT. 3
54. American College of Radiology. ACR–ASNR–ASSR–SPR Practice Parameter for the Performance of Computed Tomography (CT) of the Spine. Available at: Review/Other-Dx N/A To provide clinical practice Parameters for the Performance of Computed Tomography (CT) of the Spine. No results stated in abstract. 4
55. Ross JS.. Magnetic resonance imaging of the postoperative spine. [Review] [50 refs]. Seminars in Musculoskeletal Radiology. 4(3):281-91, 2000. Review/Other-Dx N/A To evaluate the magnetic resonance imaging of the postoperative spine. No results stated in the abstract 4
56. Hueftle MG, Modic MT, Ross JS, et al. Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology. 167(3):817-24, 1988 Jun. Observational-Dx 30 patients To evaluate the effectiveness of magnetic resonance (MR) imaging with gadolinium-diethylenetriaminepentaacetic acid/dimeglumine (Gd-DTPA) in differentiating postoperative epidural fibrosis (scar) from recurrent disk herniation. The precontrast studies had a sensitivity, specificity, and accuracy of 100%, 71%, and 89%, respectively. The enhanced MR studies correctly depicted the character of abnormal epidural soft tissue in 17 patients at all 19 levels. Scar showed heterogeneous enhancement on the early T1-weighted spin-echo images obtained within 10 minutes after contrast material administration. Herniated disk did not show significant enhancement on the early studies but showed variable degrees of enhancement on delayed images in nine of 12 cases. Other criteria were found to be less useful than the pattern of enhancement. Results indicate that precontrast and early postcontrast T1-weighted spin-echo studies are highly accurate in separating epidural fibrosis from herniated disk. 2
57. Ross JS, Masaryk TJ, Schrader M, Gentili A, Bohlman H, Modic MT. MR imaging of the postoperative lumbar spine: assessment with gadopentetate dimeglumine. AJR. American Journal of Roentgenology. 155(4):867-72, 1990 Oct. Review/Other-Dx 193 patients To  define the accuracy of gadopentetate-dimeglumine-enhanced MR imaging in patients with failed back surgery syndrome by comparing the imaging studies with surgical findings in a large patient population. No results stated in the abstract. 4
58. Iseda T, Nakano S, Suzuki Y, et al. Radiographic and scintigraphic courses of union in cervical interbody fusion: hydroxyapatite grafts versus iliac bone autografts. J Nucl Med. 2000;41(10):1642-1645. Experimental-Dx 12 patients To clarify the course of union of HAgrafts with adjacent vertebrae using serial plain radiographs and 99mTc-hydroxymethylene diphosphonate (HMDP) bone scintigrams. In the HA graft group, the plain radiographs of all patients showed a radiolucent stripe that disappeared 7.3 +/- 1.5 (mean +/- SD) months after surgery. In the autograft group, a radiolucent stripe around the graft was not seen for any patient, and union was confirmed by follow-up radiographs within 6 mo after surgery. The serial changes in the 99mTc-HMDP uptake ratio showed no difference between the 2 groups. The 99mTc-HMDP uptake ratio peaked 1 mo after surgery and decreased rapidly to a plateau within 2 mo. 1
59. Coric D, Branch CL, Jr., Jenkins JD. Revision of anterior cervical pseudoarthrosis with anterior allograft fusion and plating. J Neurosurg. 1997;86(6):969-974. Observational-Dx 19 patients To provide Revision of anterior cervical pseudoarthrosis with anterior allograft fusion and plating. The mean age of the nine men and 10 women undergoing treatment was 49.1 years (range 25-72 years). Eleven patients (57.9%) exhibited pseudarthrosis at one level, six (31.5%) at two levels, and two (10.5%) at three levels. The indications for revision were intractable neck pain with radiculopathy (17 patients) or myelopathy (two patients), with evidence of pseudarthrosis on plain cervical radiography as well as computerized tomography (CT) or single-photon emission computerized tomography (SPECT) scanning, or both. All eight patients evaluated with SPECT showed increased focal uptake consistent with pseudarthrosis, which was subsequently confirmed intraoperatively in all eight. The average follow-up period was 22.4 months (range 12-42 months). Solid osseous fusion was achieved over all 28 levels in all 18 patients available for follow-up review (100%). One patient died 4 months postoperatively from myocardial infarction related to preexisting coronary artery disease. There were no intraoperative complications; postoperatively, two patients (10.5%) experienced transient hoarseness. Anterior revision of failed cervical fusions using allograft interbody fusion material and anterior plating is a safe and efficacious procedure. 3
60. Park JY, Kim KH, Kuh SU, Chin DK, Kim KS, Cho YE. What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT. Eur Spine J. 2013;22(5):1078-1089. Observational-Dx 22 patients of arthroplasty group and 21 patients of fusion group To determine associative factors of ASD after anterior cervical spine surgery. The study compared anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT. The study groups were demographically similar, and substantial improvements in visual analog scales (for arm) and NDI (for neck) scores were noted, and there were no significant differences between groups. Fusion rates were 95.2 % in the fusion group and 4.5 % in the arthroplasty group. ASD rates of the fusion and arthroplasty groups were 42.9% and 50%, respectively. Among the radiologic parameters, operated segmental height and operated segmental ROM significantly decreased, while the upper segmental ROM significantly increased in the fusion group. In a comparative study between patients with ASD and without ASD, the clinical results were found to be similar, although preexisting ASD and other segment degeneration were significantly higher in the ASD group. C2-7 ROM was significantly decreased in ASD group, and other radiologic parameters have no significant differences between groups. 2
61. Yi S, Lee DY, Ahn PG, Kim KN, Yoon do H, Shin HC. Radiologically documented adjacent-segment degeneration after cervical arthroplasty: characteristics and review of cases. Surg Neurol. 2009;72(4):325-329; discussion 329. Review/Other-Dx 72 patients To retrospectively study the incidence and characteristics of radiologically documented adjacent-segment degeneration after single-level diskectomy and subsequent cervical arthroplasty using the Bryan (Medtronic Sofamor Danek; Memphis, TN) disk prosthesis. Among the 72 patients, 9 patients (12.5%) showed radiological evidence of adjacent-segment degeneration. The mean age was 43.3 years old, with a male-female ratio 1:3. The mean follow-up period was 24.2 (12.1-35.9) months. The mean period of onset was 16.3 months. Upper-segment degeneration was documented in 4 cases (3 new osteophyte, 1 enlargement of osteophyte), whereas lower-segment degeneration was noted in 5 cases (1 new osteophyte, 3 enlargement of osteophyte, 1 decreased disk height). Among the degenerated cases, 4 cases (44.4%) also showed various degrees of HO. 4
62. Gruskay JA, Webb ML, Grauer JN. Methods of evaluating lumbar and cervical fusion. [Review]. Spine J. 14(3):531-9, 2014 Mar 01. Review/Other-Dx N/A To review the methods of evaluating lumbar and cervical fusion. No results stated in abstract. 4
63. Ghiselli G, Wharton N, Hipp JA, Wong DA, Jatana S. Prospective analysis of imaging prediction of pseudarthrosis after anterior cervical discectomy and fusion: computed tomography versus flexion-extension motion analysis with intraoperative correlation. Spine (Phila Pa 1976). 2011;36(6):463-468. Observational-Dx 22 patients To prospectively compare motion analyzed flexion/extension radiographs to CT to predict pseudarthroses. Define motion thresholds on flexion/extension radiographs to define pseudarthroses. Using greater than 4 degrees of measured motion on flexion/extension radiographs resulted in a Spearman correlation P-value of 0.096 (95% CI, -0.06 to 0.66). Using greater than 1 degrees of motion, the Spearman correlation P<0.0001 (95% CI, 0.54-0.90). The PPV using 4 degrees of motion as the criterion was 100%, indicating a high specificity. The NPV was 52%, indicating a low sensitivity. Using greater than 1 degrees of motion, the PPV was 100% and the NPV was 73%. Findings from CT showed an identical PPV and NPV to assessments made using greater than 1 degrees of rotation. Specificity and PPV were 100% for all criteria. Using a lack of bridging on CT or more than 1 degrees of intervertebral motion during flexion/extension increased the sensitivity to 85% and the NPV to 85%. 3
64. Hong JT, Sung JH, Son BC, Lee SW, Park CK. Significance of laminar screw fixation in the subaxial cervical spine. Spine (Phila Pa 1976). 2008;33(16):1739-1743. Review/Other-Tx 11 patients To describe the technique and surgical results of translaminar screw placement in the subaxial cervical spine. The mean follow-up period was 5.7 months, at which time there was no significant complications from laminar screw placement, except for 2 asymptomatic breaches of the dorsal lamina cortex. Sound bone fusion was identified in cases where arthrodesis was the goal. No screw pullout or avulsion was identified in the laminoplasty cases. 4
65. Hwang IC, Kang DH, Han JW, Park IS, Lee CH, Park SY. Clinical experiences and usefulness of cervical posterior stabilization with polyaxial screw-rod system. J Korean Neurosurg. Soc 2007;42(4):311-316. Review/Other-Tx 32 patients To investigate the safety, surgical efficacy, and advantages of a polyaxial screw-rod system for posterior occipitocervicothoracic arthrodesis. A total of 189 screws were implanted in 32 patients. Fixation was carried out over an average of 3.3 spinal segments (range, 2 to 7). The mean follow-up interval was 20.2 months. This system allowed for screw placement in the occiput, C1 lateral mass, C2 pars, C3-7 lateral masses, as well as the lower cervical and upper thoracic pedicles. Satisfactory bony fusion and reduction were achieved and confirmed in postoperative flexion-extension lateral radiographs and CT scans in all cases. Revision surgery was required in 2 cases due to deep wound infection. One case needed a skin graft due to necrotic change. There was one case of kyphotic change due to adjacent segmental degeneration. There were no other complications, such as cord or vertebral artery injury, cerebrospinal fluid leak, screw malposition or back-out, or implant failure, and there were no cases of postoperative radiculopathy due to foraminal stenosis. 4
66. Ryu WH, Kowalczyk I, Duggal N. Long-term kinematic analysis of cervical spine after single-level implantation of Bryan cervical disc prosthesis. Spine J. 2013;13(6):628-634. Observational-Dx 20 patients To characterize the long-term segmental kinematic outcomes after cervical arthroplasty. Biomechanics of the implanted artificial cervical disc was maintained up to 5 years with no significant changes in range of motion, functional spinal unit angle, disc height, sagittal translation, and center of rotation values when compared with early postoperative performance. Artificial discs were able to adequately restore and maintain preoperative kinematics. Early differences seen in disc height and functional spinal unit angle did not change during the duration of follow-up. No significant kyphotic changes or decrease in range of motion were seen at the adjacent spinal levels. 3
67. Grammatico L, Baron S, Rusch E, et al. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002-2003. Epidemiol Infect. 2008;136(5):653-660. Review/Other-Dx N/A To estimate the incidence of Vertebral osteomyelitis (VO) in France for 2002-2003, national hospital-discharge data were used. Hospital stays were categorized as definite, probable or possible VO. No results stated in abstract. 4
68. Arbelaez A, Restrepo F, Castillo M. Spinal infections: clinical and imaging features. Top Magn Reson Imaging. 2014;23(5):303-314. Review/Other-Dx N/A To review the clinical and imaging features of spinal infections. No results stated in abstract. 4
69. Tali ET, Oner AY, Koc AM. Pyogenic spinal infections. [Review]. Neuroimaging Clin N Am. 25(2):193-208, 2015 May. Review/Other-Dx N/A To review the Pyogenic spinal infections. No results stated in abstract. 4
70. Sans N, Faruch M, Lapegue F, Ponsot A, Chiavassa H, Railhac JJ. Infections of the spinal column--spondylodiscitis. Diagn Interv Imaging. 2012;93(6):520-529. Review/Other-Dx N/A To review the Infections of the spinal column No results stated in abstract. 4
71. Kouijzer IJE, Scheper H, de Rooy JWJ, et al. The diagnostic value of (18)F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis - a prospective study. Eur J Nucl Med Mol Imaging 2018;45:798-805. Observational-Dx 32 patients To determine the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis. For 18F-FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18F-FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%). 2
72. Palestro CJ. Radionuclide imaging of osteomyelitis. Semin Nucl Med. 2015;45(1):32-46. Review/Other-Dx N/A To review radionuclide imaging of osteomyelitis. (18)F-FDG is the radionuclide test of choice for spinal infection. The test is sensitive, with a high negative predictive value, and reliably differentiates degenerative from infectious vertebral body end-plate abnormalities. Data on the accuracy of (18)F-FDG for diagnosing diabetic pedal osteomyelitis are contradictory, and its role for this indication remains to be determined. Initial investigations suggested that (18)F-FDG accurately diagnoses prosthetic joint infection; more recent data indicate that it cannot differentiate infection from other causes of prosthetic failure. Preliminary data on the PET agents gallium-68 and iodine-124 fialuridine indicate that these agents may have a role in diagnosing osteomyelitis. 4
73. Palestro CJ, Torres MA. Radionuclide imaging in orthopedic infections. Semin Nucl Med 1997;27:334-45. Review/Other-Dx N/A N/A No results stated in the abstract 4
74. Love C, Patel M, Lonner BS, Tomas MB, Palestro CJ. Diagnosing spinal osteomyelitis: a comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. Clin Nucl Med. 2000;25(12):963-977. Observational-Dx 22 patients To compare the accuracies of bone and Ga-67 scintigraphy and magnetic resonance imaging (MRI) for diagnosing spinal osteomyelitis and to determine the optimal radionuclide approach to this disorder. Eleven sites of spinal osteomyelitis were identified. Tracer uptake in two contiguous vertebrae, as noted on SPECT, was the most accurate bone scan criterion for detecting spinal osteomyelitis (71 %). SPECT bone/Ga-67 was significantly more accurate (92%) than both planar bone/Ga-67 (75%) and bone SPECT (P = 0.15 and P = 0.2, respectively). SPECT Ga-67 was as accurate as SPECT bone/Ga-67 and as sensitive as MRI (91 %); the radionuclide study was slightly but not significantly more specific (92% vs. 77%) than MRI. Of 11 sites of extraosseous infection, 10 were identified on MRI, 9 on SPECT Ga-67, 7 on planar Ga-67, and none on bone scintigraphy. 3
75. Palyo RJ, Sinusas AJ, Liu YH. High-Sensitivity and High-Resolution SPECT/CT Systems Provide Substantial Dose Reduction Without Compromising Quantitative Precision for Assessment of Myocardial Perfusion and Function. J Nucl Med 2016;57:893-9. Observational-Dx 30 patients To demonstrate the capability of a hybrid CZT SPECT/64-slice CT system for dose reduction and to determine the maximal reduction possible without compromising image quality or the quantification precision of clinical MPS. For patients with normal MPS results, there were no differences in defect size, LV volume, or ejection fraction, regardless of whether 50% or 75% reduction was used. For patients with abnormal MPS results, at a 50% reduction there was a significant difference in global defect size but not in regional defect size in the left anterior descending, left circumflex, and right coronary artery territories, whereas at a 75% reduction the difference was statistically significant in all territories, including the difference in global defect size. Nonetheless, differences in the defect size were minimal. The LV end-diastolic and end-systolic volumes and LV ejection fraction were not significantly different, regardless of whether 50% or 75% dose reduction was used. 2
76. Modic MT, Feiglin DH, Piraino DW, et al. Vertebral osteomyelitis: assessment using MR. Radiology. 1985;157(1):157-166. Observational-Dx 19 men; 18 women To compare the accuracy of MR images with plain radiographs and radionuclide scans. 23 patients were believed to have osteomyelitis. MR examinations consisted of at least a sagittal image (TE = 30 msec, TR = 0.5 sec) and an image obtained at TE = 120 msec, TR = 2-3 sec. All patients underwent radiographic and MR examinations, 36 underwent technetium 99m-HDP bone scanning, and 20 patients underwent gallium 67 scanning. Nineteen patients underwent both bone and gallium scanning. The imaging studies were reviewed independently by investigators blinded to the final diagnoses. MR had a sensitivity of 96%, specificity of 92%, and accuracy of 94%. Combined gallium and bone scan studies (19 cases) had a sensitivity of 90%, specificity of 100%, and accuracy of 94%. Bone scans alone had a sensitivity of 90%, specificity of 78%, and accuracy of 86%. Plain radiographs had a sensitivity of 82%, specificity of 57%, and accuracy of 73%. 2
77. Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA. MR imaging findings in spinal infections: rules or myths? Radiology. 2003;228(2):506-514. Observational-Dx 44 patients To systematically evaluate magnetic resonance (MR) imaging findings described as being indicative of spinal infection in patients with proven spinal infection. In the 44 patients with disk infection, MR imaging criteria with good to excellent sensitivity included presence of paraspinal or epidural inflammation (n  43, 97.7% sensitivity), disk enhancement (n  42, 95.4% sensitivity), hyperintensity or fluid-equivalent disk signal intensity on T2-weighted MR images (n  41, 93.2% sensitivity), and erosion or destruction of at least one vertebral endplate (n  37, 84.1% sensitivity). Effacement of the nuclear cleft was only applicable in 18 patients (n  15, 83.3% sensitivity). Criteria with low sensitivity included decreased height of the intervertebral space (n  23, 52.3% sensitivity) and disk hypointensity on T1-weighted MR images (n  13, 29.5% sensitivity). Involvement of several spinal levels occurred in seven (16%) patients. Other spinal infections included isolated vertebral osteomyelitis (n  1) and primary epidural abscess (n  1). 2
78. Mahnken AH, Bucker A, Adam G, Gunther RW. [MRI of osteomyelitis: sensitivity and specificity of STIR sequences in comparison with contrast-enhaned T1 spin echo sequences]. Rofo. 2000;172(12):1016-1019. Observational-Dx 79 patients To evaluate the need for additional MR sequences including administration of Gd-DTPA after inconspicuous Short-Tau Inversion-Recovery (STIR) sequence to exclude the diagnosis of osteomyelitis. In 53 cases osteomyelitis was diagnosed, while the remaining 59 cases suffered from another disease. The sensitivity of the STIR sequence was 100% while the specificity for osteomyelitis was 49.2%. The specificity increased to 79.7% by including T1 SE images into the analysis and reached 83.1% after considering the contrast enhanced images. T2-weighted images yielded no additional information. 2
79. Mahnken AH, Wildberger JE, Adam G, et al. Is there a need for contrast-enhanced T1-weighted MRI of the spine after inconspicuous short tau inversion recovery imaging? Eur Radiol. 2005;15(7):1387-1392. Observational-Dx 172 patients To assess the use of contrast- enhanced T1-weighted images in comparison with short t inversion recovery (STIR) images for the detection of vertebral bone marrow abnormalities. The PPV and the NPV of STIR images for detection of vertebral bone marrow abnormalities were 99.3 and 95.9%. In the case of normal STIR images no relevant additional information was found with contrastenhanced T1-weighted images, while in the case of abnormal STIR images significant supplementary information was obtained. There was no difference in the diagnostic value when comparing combined assessment of STIR and contrast-enhanced T1-weighted images with combined evaluation of T2-weighted and contrast-enhanced T1-weighted images. Normal STIR images allow contrast-enhanced T1- weighted images for detection of bone marrow abnormalities to be omitted, whereas further imaging is needed in case of abnormal STIR images. 3
80. Longo M, Granata F, Ricciardi K, Gaeta M, Blandino A. Contrast-enhanced MR imaging with fat suppression in adult-onset septic spondylodiscitis. Eur Radiol. 2003;13(3):626-637. Review/Other-Dx N/A To review the Contrast-enhanced MR imaging with fat suppression in adult-onset septic spondylodiscitis. No results stated in abstract. 4
81. Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am. 2001;39(2):329-342. Review/Other-Dx N/A To review the  Imaging of musculoskeletal and spinal tuberculosis. No results stated in abstract. 4
82. Varma R, Lander P, Assaf A. Imaging of pyogenic infectious spondylodiskitis. Radiol Clin North Am. 2001;39(2):203-213. Review/Other-Dx N/A To review the Imaging of pyogenic infectious spondylodiskitis. No results stated in abstract. 4
83. Dang L, Liu X, Dang G, et al. Primary tumors of the spine: a review of clinical features in 438 patients. J Neurooncol. 2015;121(3):513-520. Review/Other-Dx N/A To review the Primary tumors of the spine No results stated in abstract. 4
84. Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am. 2004;15(4):365-373. Review/Other-Dx N/A To review the epidemiology, pathophysiology, and evaluation of patients with Metastatic spine disease. No results stated in abstract. 4
85. Wong DA, Fornasier VL, MacNab I. Spinal metastases: the obvious, the occult, and the impostors. Spine (Phila Pa 1976). 1990;15(1):1-4. Review/Other-Dx N/A To review the obvious, the occult, and the impostors of Spinal metastases. No results stated in abstract. 4
86. Bristow AR, Agrawal A, Evans AJ, et al. Can computerised tomography replace bone scintigraphy in detecting bone metastases from breast cancer? A prospective study. Breast. 2008;17(1):98-103. Observational-Dx 77 patients To determine whether bone scans (BS) can be avoided if pelvis was included in computed tomography (CT) thorax and abdomen to detect bony metastases from breast cancer. CT detected metastatic bone lesions in 43 (98%) of 44 patients with bone metastases. The remaining patient had a solitary, asymptomatic bony metastasis in shaft of femur. BS was positive in all patients with bone metastases. There were 11 cases of false positive findings on BS. 2
87. Buhmann Kirchhoff S, Becker C, Duerr HR, Reiser M, Baur-Melnyk A. Detection of osseous metastases of the spine: comparison of high resolution multi-detector-CT with MRI. Eur J Radiol. 69(3):567-73, 2009 Mar. Observational-Dx 79 patients To evaluate the diagnostic accuracy of multi-slice-computed tomography (MDCT) for the detection of vertebral metastases in comparison to magnetic resonance imaging (MRI). 201/639 vertebral bodies were defined as metastatically affected by the gold standard. In MDCT 133/201 lesions, in MRI 198/201 lesions were detected. 68 vertebral bodies were false negative in MDCT, whereas 3 false negatives were found in MRI. 3 false positive results were obtained in MDCT, 5 in MRI. Sensitivity was significantly lower for MDCT (66.2%) than for MRI (98.5%) (p<0.0001). Specificity was not significantly different for both methods (MDCT: 99.3%; MRI: 98.9%). The diagnostic accuracy resulted in 88.8% for MDCT and 98.7% for MRI. 3
88. Heindel W, Gubitz R, Vieth V, Weckesser M, Schober O, Schafers M. The diagnostic imaging of bone metastases. [Review]. Dtsch. Arztebl. int.. 111(44):741-7, 2014 Oct 31. Review/Other-Dx N/A To detect skeletal metastases early, whenever they are suspected on the basis of clinical or laboratory findings or in patients who are at high risk. Other important issues include assessment of the risk of fracture and the response to treatment. Projectional radiography (plain films) is still useful for the immediate investigation of symptomatic bone pain and for the assessment of stability. Skeletal scintigraphy, the classic screening test for patients with cancer who do not have bone pain (specificity 81%, sensitivity 86%), has now been supplemented-in some cases, replaced-by other techniques. CT, including lowdose CT, is used to detect changes in bone structure due to metastases of some types of primary tumor (specificity 95%, sensitivity 73%); whole-body MRI, to detect metastases in the bone marrow and extraosseous soft tissues, e.g., metastases compressing the spinal cord (specificity 95%, sensitivity 91%); PET-CT, to detect metabolically active tumors (specificity 97%, sensitivity 90%). 4
89. Muindi J, Coombes RC, Golding S, Powles TJ, Khan O, Husband J. The role of computed tomography in the detection of bone metastases in breast cancer patients. Br J Radiol. 1983;56(664):233-236. Observational-Dx 11 patients To review the role of computed tomography in the detection of bone metastases in breast cancer patients. Five of these patients had no evidence of extra-skeletal recurrent disease. Follow-up at eight of these sites showed healing, sclerosis or progression, all of which correlated well with clinical findings. CT showed benign causes of radionuclide accumulation in three patients (7 sites) but no abnormality in six patients (8 sites). None of these patients has subsequently developed bone metastases. 3
90. Kulshrestha RK, Vinjamuri S, England A, Nightingale J, Hogg P. The Role of 18F-Sodium Fluoride PET/CT Bone Scans in the Diagnosis of Metastatic Bone Disease from Breast and Prostate Cancer. J Nucl Med Technol. 2016;44(4):217-222. Review/Other-Dx N/A To review the Role of 18F-Sodium Fluoride Positron Emission Tomography Computed Tomography (PET/CT) Bone Scans in the Diagnosis of Metastatic Bone Disease from Breast and Prostate Cancer. No results stated in abstract. 4
91. Usmani S, Marafi F, Ahmed N, Esmail A, Al Kandari F, Van den Wyngaert T. Diagnostic Challenge of Staging Metastatic Bone Disease in the Morbidly Obese Patients: A Primary Study Evaluating the Usefulness of 18F-Sodium Fluoride (NaF) PET-CT. Clin Nucl Med. 2017;42(11):829-836. Observational-Dx 212 patients To assess the diagnostic efficacy of sodium fluoride positron emission tomography computed tomography (F-NaF PET-CT) in the evaluation of bone metastases in obese cancer patients. F-NaF PET-CT was definitely benign in 145, possibly benign in 3, equivocal in 4, possibly malignant in 13, and definitely malignant in 47 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-NaF PET-CT were 93.1%, 96.1%, 90%, 97.3%, and 95.2%, respectively (95% confidence interval). 2
92. Ak I, Sivrikoz MC, Entok E, Vardareli E. Discordant findings in patients with non-small-cell lung cancer: absolutely normal bone scans versus disseminated bone metastases on positron-emission tomography/computed tomography. Eur J Cardiothorac Surg. 2010; 37(4):792-796. Review/Other-Dx 19 patients Retrospective study to compare the sensibility of FDG-PET/CT for the detection of bone metastasis in patients with NSCLC whose Tc-99m MDP bone scans were absolutely normal. Discordant findings of skeletal metastasis between Tc-99m MDP bone scans and FDG-PET/CT imaging may be seen in 20% of the patients with NSCLC. FDG-PET/CT could detect metastatic bone involvement more accurately than bone scintigraphy. Bone scans are insensitive to early bone marrow neoplastic infiltration. Assessment of glucose metabolism with FDG-PET/CT can represent a more powerful tool to detect early bone metastases in lung cancer than with traditional bone scans. 4
93. Chang CY, Gill CM, Joseph Simeone F, et al. Comparison of the diagnostic accuracy of 99 m-Tc-MDP bone scintigraphy and 18 F-FDG PET/CT for the detection of skeletal metastases. Acta Radiol. 2016;57(1):58-65. Observational-Dx 202 patients To compare the accuracy of Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) with bone scan for the detection of skeletal metastases. The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, and 98%, respectively, and of bone scan were 83%, 98%, and 93%, respectively. The lesions that bone scan most commonly missed were located in the pelvis, spine, and sacrum. FDG PET/CT missed mostly lesions that were outside of the field of view, but in all of these cases the patient had additional sites of skeletal metastatic disease. Bone scan falsely identified six metastatic lesions and FDG PET/CT falsely identified three metastatic lesions. 2
94. Vassiliou V, Chow E, Kardamakis D. Bone Metastases: A Translational and Clinical Approach. Netherlands: Springer; 2014. Review/Other-Dx N/A To review the Translational and Clinical Approach of Bone Metastases. No results stated in abstract. 4
95. O'Sullivan GJ, Carty FL, Cronin CG. Imaging of bone metastasis: An update. World J Radiol. 2015;7(8):202-211. Review/Other-Dx N/A To review the Imaging of bone metastasis No results stated in abstract. 4
96. Groch MW, Erwin WD. SPECT in the year 2000: basic principles. J Nucl Med Technol 2000;28:233-44. Review/Other-Dx N/A To review the basic principles of SPECT. No results stated in the abstract. 4
97. Layer G. Skelettmetastasen. In: Stabler A, ed. Handbuch diagnostische Radiologie. Berlin: Heidelberg: Springer; 2005:327-338. Review/Other-Dx N/A To review the knowledge of diagnostic radiology. No results stated in abstract. 4
98. . Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 38(1):1-211, 2018 Jan. Review/Other-Dx N/A To review the classifications headache disorders. No results stated in the abstract 4
99. Bogduk N. The neck and headaches. Neurol Clin. 2014;32(2):471-487. Review/Other-Dx N/A To review the neck and headaches. No results stated in abstract. 4
100. Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(4 Suppl 2):16S-22S. Review/Other-Dx N/A To review the diagnostic and treatment strategies of Cervicogenic headache. No results stated in abstract. 4
101. Silbert PL, Mokri B, Schievink WI. Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology. 1995;45(8):1517-1522. Review/Other-Dx 161 patients To study the characteristics of headaches in consecutive symptomatic patients with spontaneous dissections of the internal carotid artery or the vertebral artery. A history of migraine was present in 18% of the ICAD group and in 23% of the VAD group. Headache was reported by 68% of the patients with ICAD and by 69% of those with VAD, and, when present, it was the initial manifestation in 47% of those with ICAD and in 33% of those with VAD. Ten percent of patients with ICAD had eye, facial, or ear pain without headache. The median interval from onset of headache to development of other neurologic manifestations was 4 days for the ICAD group and 14.5 hours for the VAD group. For all dissections, headaches typically were ipsilateral to the side of dissection. In the ICAD group, headaches were limited to the anterior head in 60% of patients and were steady in 73% and pulsating in 25%. In the VAD group, headaches were distributed posteriorly in 83% of patients and were steady in 56% and pulsating in 44%. Neck pain was present in 26% of patients with ICAD (anterolateral) and in 46% of those with VAD (posterior). The median duration of the headache in patients with VAD and ICAD was 72 hours, but headaches became prolonged, persisting for months to years, in four patients with ICAD. 4
102. Sturzenegger M. Headache and neck pain: the warning symptoms of vertebral artery dissection. Headache. 1994;34(4):187-193. Review/Other-Dx 14 patients To review the warning symptoms of vertebral artery dissection. Pain started suddenly, was of sharp quality and severe intensity, different from any previously experienced headache. Following acute onset, the time course of pain was monophasic with gradual remission of a persistent headache lasting one to three weeks. A delay between onset of head or posterior neck pain and onset of neurologic dysfunction was noted in 12 patients and was less than one day and between one day and three weeks in six each. Report of this distinct type of pain, although nonspecific as an isolated symptom, should raise suspicion of an underlying vertebral artery dissection. 4
103. Fredriksen TA, Fougner R, Tangerud A, Sjaastad O. Cervicogenic headache. Radiological investigations concerning head/neck. Cephalalgia. 1989;9(2):139-146. Review/Other-Dx 11 female patients To present the results of the diagnostic, radiological procedures with relation to the head/neck in our patients. All the patients were female with a mean age of 43 years (range 25-59) at the onset of the study. Cerebral and cervical computer tomography as well as standard X-ray of the spine were carried out in all patients. Six patients underwent cerebral angiography and six cervical myelography. The different investigations showed no typical characteristic pathology in the group. No indication of a common therapeutic approach in this group of patients could therefore be derived from these investigations. 4
104. Coskun O, Ucler S, Karakurum B, et al. Magnetic resonance imaging of patients with cervicogenic headache. Cephalalgia. 2003;23(8):842-845. Observational-Dx 22 patients; 20 control patients To evaluate cervical structures in patients with Cervicogenic headache (CH) using magnetic resonance imaging (MRI). In this study, cervical MRI were studied in 22 patients with cervicogenic headache and 20 control patients who did not have any disease which may effect the bone and muscle structures of cervical region. MRI imaging of cervical vertebra showed a disc bulging in 10 (45.4%) out of 22 patients with CH and in 9 (45.0%) of 20 controls (P > 0.05). The distribution of pathological lesions in patients and controls were not significantly different (P > 0.05). As a result, MRI may not be an adequate method to detect pathological findings underlying the aetiology of CH such as nerve roots, intervertebral joints and periosteum. 2
105. Van den Wyngaert T, Strobel K, Kampen WU, et al. The EANM practice guidelines for bone scintigraphy. Eur J Nucl Med Mol Imaging 2016;43:1723-38. Review/Other-Dx N/A To evaluate the distribution of active bone formation in the skeleton related to malignant and benign disease, as well as physiological processes No results stated in the abstract 4
106. Makki D, Khazim R, Zaidan AA, Ravi K, Toma T. Single photon emission computerized tomography (SPECT) scan-positive facet joints and other spinal structures in a hospital-wide population with spinal pain. Spine J. 2010;10(1):58-62. Review/Other-Dx 534 patients To evaluate the prevalence of SPECT scan-positive facet joints and other spinal areas in different age groups in a hospital-wide population with spinal pain. A total of 486 patients (91.1%) had at least one positive abnormality on SPECT scan; 81.3% had increased uptake in different structures and regions of the spine. This included 42.8% increased uptake in the facet joint 29.8% in the vertebral bodies/end plates, and 5.9% in sacroiliac joints. The prevalence of increased uptake in the lumbosacral and cervical spine was 44% and 37%, respectively. When patients were divided into five age groups (below 40, 40-49, 50-59, 60-69, and 70 years and older), there was a significantly higher increased prevalence in advancing age groups. 4
107. Binder AI. Cervical spondylosis and neck pain. BMJ. 2007;334(7592):527-531. Review/Other-Dx N/A Review diagnosis of cervical spondylosis and the evidence available for the different treatments. The diagnosis of cervical spondylosis is usually based on clinical symptoms. The best treatments are exercise, manipulation, and mobilization, or combinations thereof. 4
108. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine. 11(6):521-4, 1986 Jul-Aug. Observational-Dx 200 patients To determine the incidence and severity of degenerative changes seen on lateral roentgenograms in 200 asymptomatic men and women in five age groups with an age range of 20-65 years and to determine the normal values of cervical lordosis and spinal canal sagittal diameters and their relationship to degenerative changes It was found that by age 60-65, 95% of the men and 70% of the women had at least one degenerative change on their roentgenograms. A small sagittal diameter correlated with the presence of degenerative changes at the same disc level, and the strongest correlation was with the size of the posterior osteophytes at C5-6 (r = 0.52). Cervical lordosis measurements did not relate to degenerative changes except for subjects over age 50 with moderate or severe intervertebral narrowing. It is important to realize that although roentgenographic abnormalities represent structural changes in the spine, they do not necessarily cause symptoms. 2
109. Freedman MK, Overton EA, Saulino MF, Holding MY, Kornbluth ID. Interventions in chronic pain management. 2. Diagnosis of cervical and thoracic pain syndromes. Arch Phys Med Rehabil. 2008;89(3 Suppl 1):S41-46. Review/Other-Dx N/A To discuss the differential diagnoses for investigation of common cervical and thoracic conditions and cervicogenic headache. Indications for diagnostic tests including MRI, CT, bone scan, discography, radiographs, diagnostic injections, and electrodiagnostic studies are discussed with the idea that testing should be performed and interpreted with the specific clinical presentation in mind. 4
110. Anderberg L, Annertz M, Brandt L, Saveland H. Selective diagnostic cervical nerve root block--correlation with clinical symptoms and MRI-pathology. Acta Neurochir (Wien). 2004;146(6):559-565; discussion 565. Review/Other-Dx 20 patients To assess the ability of cervical selective diagnostic nerve root block to correlate with clinical symptoms and MRI findings in patients with cervical radicular pain. For the whole group mean visual analog scales arm pain reductions were 86% and mean visual analog scales neck pain reductions were 65%. When the results from the provocation were added all patients had a positive block. 18 were operated on by an anterior procedure and all 18 were free from radicular pain at follow up. The block procedure seems relevant for revealing a relationship between radiological pathology and clinical symptoms and signs. 4
111. Boutin RD, Steinbach LS, Finnesey K. MR imaging of degenerative diseases in the cervical spine. Magn Reson Imaging Clin N Am. 2000;8(3):471-490. Review/Other-Dx N/A Review the role of MRI in evaluating patients with chronic neck pain. MRI is single best test to detect and distinguish between the various clinical diagnostic possibilities that may cause neck pain. 4
112. Okada E, Matsumoto M, Ichihara D, et al. Aging of the cervical spine in healthy volunteers: a 10-year longitudinal magnetic resonance imaging study. Spine (Phila Pa 1976). 2009;34(7):706-712. Observational-Dx 223 subjects To clarify normal aging process of cervical spine and correlation between progression of disc degeneration and development of clinical symptoms. Progression of degenerative findings was observed in 189 subjects (81.1%). Progression of decrease in signal intensity of disc was observed in 59.6%, anterior compression of dura and spinal cord in 61.4%, posterior disc protrusion in 70.0%, disc space narrowing in 26.9%, and foraminal stenosis in 9.0%. Logistic regression analysis revealed that incidence of progression of posterior disc protrusion; foraminal stenosis was higher in elderly subjects. There were no correlations between any degenerative MRI findings and sex, smoking, alcohol, sport, or body mass index. Neck pain, shoulder stiffness, and numbness in upper extremities were recognized in 9.9%, 30.0%, and 4.0% of subjects, and 1 or more clinical symptoms have developed in 34.1% during 10 years. 3
113. Fryer G, Adams JH. Magnetic resonance imaging of subjects with acute unilateral neck pain and restricted motion: a prospective case series. Spine J. 2011;11(3):171-176. Review/Other-Dx 5 subjects To investigate the presence of periarticular tissue inflammation and zygapophysial joint synovitis in the cervical region using MRI in subjects with acute unilateral cervical pain and limited motion (acute "crick in the neck" <48 hours from onset), as well as the feasibility of recruiting these subjects. Subjects presented with mean current pain of 4.8 (SD, 1.6; visual analog scale, 0-10), worst pain since onset of 7.0 (SD, 0.7), and duration of symptoms of 12.4 hours (SD, 14.1). The plane of active motion most commonly limited was rotation to the painful side, followed by side bending to the painful side and extension. No MRI findings demonstrated clear evidence of synovial effusion or inflammation around the joints of the cervical spine. In some individuals, signs of muscle edema, altered alignment, disc and facet arthrosis, and spinal stenosis were noted, but these did not appear to be related to the side of pain or symptomatic level. 4
114. Patel TK, Weis JC. Acute neck pain in the ED: Consider longus colli calcific tendinitis vs meningitis. Am J Emerg Med. 2017;35(6):943 e943-943 e944. Review/Other-Dx 1 case To report a case of calcific tendinitis of the longus collimuscle in which a patient was initially worked up and treated for meningitis, and a brief review of literature. No results stated in abstract. 4
115. Urrutia J, Contreras O. Calcium hydroxyapatite crystal deposition with intraosseous penetration involving the posterior aspect of the cervical spine: a previously unreported cause of neck pain. Eur Spine J. 2017;26(Suppl 1):53-57. Review/Other-Dx Case report To report a case of calcium hydroxyapatite crystal deposition involving the posterior cervical spine eroding the bone cortex. A CT-guided needle biopsy was performed; it showed vascularized connective tissue with inflammatory histiocytic infiltration and multinucleated giant cells; Alizarin Red stain confirmed the presence of hydroxyapatite crystals. The patient was treated with anti-inflammatories for 2 weeks. She has been asymptomatic in a 6-month follow-up; a CT scan at the last follow-up revealed reparative remodeling of bone erosions. 4
116. Hitselberger WE, Witten RM. Abnormal myelograms in asymptomatic patients. Journal of Neurosurgery. 28(3):204-6, 1968 Mar. Review/Other-Dx N/A To review the abnormal myelograms in asymptomatic patients. No results state din the abstract 4
117. Ohtsuka K, Terayama K, Yanagihara M, et al. An epidemiological survey on ossification of ligaments in the cervical and thoracic spine in individuals over 50 years of age. Nihon Seikeigeka Gakkai Zasshi. 1986;60(11):1087-1098. Review/Other-Dx N/A To review An epidemiological survey on ossification of ligaments in the cervical and thoracic spine in individuals over 50 years of age. There were 325 cases (30.7%) of ossification of the anterior longitudinal ligament (OALL) of stage II or above by Forestier's classification in the region from the cervical to thoracic vertebrae, and these cases included a significantly greater number of men. Ossification of the ligamenta flava (OLF) was observed in 48 cases (4.5%). As for the coexistence of ossification of these ligaments, 364 individuals (34.4%) had at least one instance of OPLL and OALL (stage II or above) in the region from the cervical to thoracic spine, and OLF in the thoracic spine. 4
118. Fujimori T, Le H, Hu SS, et al. Ossification of the posterior longitudinal ligament of the cervical spine in 3161 patients: a CT-based study. Spine. 40(7):E394-403, 2015 Apr 01. Observational-Dx 3161 patients To examine the prevalence of ossification of the posterior longitudinal ligament (OPLL) and ossification of the nuchal ligament (ONL) of the cervical spine in the San Francisco area. Of the 3161 patients (mean age, 51.2 +/- 21.6 yr; 66.1% male), there were 1593 Caucasians (50.4%), 624 Asians (19.7%), 472 Hispanics (14.9%), 326 African Americans (10.3%), 62 Native Americans (2.0%), and 84 Others (2.7%). The prevalence of cervical OPLL was 2.2% (95% confidence interval [CI]: 1.7-2.8). The adjusted prevalence was 1.3% in Caucasian Americans (95% CI: 0.7-2.3), 4.8% in Asian Americans (95% CI: 2.8-8.1), 1.9% in Hispanic Americans (95% CI: 0.9-4.0), 2.1% in African Americans (95% CI: 0.9-4.8), and 3.2% in Native Americans (95% CI: 0.8-12.3). The prevalence of OPLL in Asian Americans was significantly higher than that in Caucasian Americans (P = 0.005). ONL was detected in 346 patients and the prevalence was 10.9% (95% CI: 10.0-12.0). The adjusted prevalence of ONL was 7.3% in Caucasian Americans (95% CI: 5.8-9.3), 26.4% in Asian Americans (95% CI: 21.9-31.5), 7.4% in Hispanic Americans (95% CI: 5.2-10.5), 2.5% in African Americans (95% CI: 1.2-4.9), and 25.8% in Native Americans (95% CI: 16.5-37.5). ONL was significantly more common in Asian Americans than in Caucasian Americans, Hispanic Americans, and African Americans (P = 0.001). 2
119. Sohn S, Chung CK, Yun TJ, Sohn CH. Epidemiological survey of ossification of the posterior longitudinal ligament in an adult Korean population: three-dimensional computed tomographic observation of 3,240 cases. Calcif Tissue Int. 2014;94(6):613-620. Review/Other-Dx 3,240 subjects To investigate the prevalence of cervical Ossification of the posterior longitudinal ligament (OPLL) on the basis of three-dimensional computed tomography (3D CT) and features of OPLL distribution in an adult Korean population. The OPLL prevalence rate was 5.7%. The standardized prevalence rate was 4.60%. The standardized prevalence rates in men and women were 6.43 and 3.61%, respectively. The over-70 age group had the highest OPLL prevalence. Age and prevalence rate were positively correlated in men and women (correlation coefficient 0.991 and 0.991, P<0.001 and P<0.0001, respectively). Among OPLL types, the multiple segmental type was most frequent (37.3%). The most commonly involved level was C5 (4.8% in men, 2.2% in women), C4 (4.6% in men, 1.2% in women), and C6 (3.7% in men, 2.4% in women) segments, in decreasing order. 4
120. Kudo H, Yokoyama T, Tsushima E, et al. Interobserver and intraobserver reliability of the classification and diagnosis for ossification of the posterior longitudinal ligament of the cervical spine. Eur Spine J. 2013;22(1):205-210. Review/Other-Dx 16 observers To investigate the interobserver and intraobserver reliability of the classification and diagnosis for OPLL by radiographs and CT images. Interobserver reliability of the classification with radiographs only showed moderate agreement, but interobserver reliability with both radiographs and CT images showed substantial agreement. Intraobserver of reliability the classification was also improved by additional CT images. Interobserver reliability of the diagnosis with both radiographs and CT images was almost similar to with radiographs only. Intraobserver reliability of the diagnosis was improved by additional CT images. 4
121. Yoshii T, Yamada T, Hirai T, et al. Dynamic changes in spinal cord compression by cervical ossification of the posterior longitudinal ligament evaluated by kinematic computed tomography myelography. Spine. 39(2):113-9, 2014 Jan 15. Observational-Dx 51 patients To investigate the dynamic causative factor in the pathogenesis of myelopathy in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using kinematic computed tomography (CT) myelography. The neurological condition of the patients evaluated by Japanese Orthopaedic Association scores were 10.8 +/- 2.4 points. The mean range of motion at C2-C7 and at the most compressed segment were 23.1 +/- 11.7 and 7.0 +/- 4.4 degrees , respectively. Both the anterior-posterior diameter and the CSA at the most compressed levels were significantly decreased during neck extension compared with flexion. Interestingly, the anterior-posterior diameter and the CSA were decreased during neck flexion in 13.7% (7/51) of the patients. All 7 of these patients had massive OPLL with an occupying rate 60% or more. The dynamic change rate of CSA (flexion/extension) was significantly smaller in patients with an OPLL occupying rate 60% or more compared with patients with an occupying rate less than 60%. 3
122. Otake S, Matsuo M, Nishizawa S, Sano A, Kuroda Y. Ossification of the posterior longitudinal ligament: MR evaluation. AJNR Am J Neuroradiol. 1992;13(4):1059-1067; discussion 1068-1070. Observational-Dx 147 patients To investigate the MR appearance of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. In the sagittal plane, proton-density images identified the ossified lesions more clearly than did T1- and T2-weighted images. All axial sequences identified the lesions much frequently. T1-weighted images often showed areas of increased intensity within the lesions of the continuous and mixed type, especially within the thick lesions. Fat images by Dixon technique demonstrated same areas of increased intensity, which strongly suggested fatty marrow formation. On conventional tomograms, configurations of radiolucent areas within the lesions corresponded to areas of increased intensity on T1-weighted images. 3
123. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4