354 Journal Reports / The Spine Journal 12 (2012) 352–355

Reprinted from: Kamper SJ, Maher CG, Menezes Costa Lda C,

McAuley JH, Hush JM, Sterling M. Does fear of movement mediate

the relationship between pain intensity and disability in patients follow-

ing whiplash injury? A prospective longitudinal study. Pain 2012;

153(1):113–9. Epub 2011 Nov 3. This abstract has been reproduced with

permission of the International Association for the Study of Pain�(IASP�). The abstract may not be reproduced for any other purpose

without permission.

doi: 10.1016/j.spinee.2012.04.007

Analysis of the three United States Food and Drug Administration

investigational device exemption cervical arthroplasty trials.

Upadhyaya CD, Wu JC, Trost G, et al. J Neurosurg Spine

2012;16(3):216–28. Epub 2011 Dec 23

OBJECT: There are now 3 randomized, multicenter, US FDA investiga-

tional device exemption, industry-sponsored studies comparing arthroplasty

with anterior cervical discectomy and fusion (ACDF) for single-level cervi-

cal disease with 2 years of follow-up. These 3 studies evaluated the Prestige

ST, Bryan, and ProDisc-C artificial discs. The authors analyzed the com-

bined results of these trials.

METHODS: A total of 1213 patients with symptomatic, single-level

cervical disc disease were randomized into 2 treatment arms in the

3 randomized trials. Six hundred twenty-one patients received an arti-

ficial cervical disc, and 592 patients were treated with ACDF. In the

three trials, 94% of the arthroplasty group and 87% of the ACDF

group have completed 2 years of follow-up. The authors analyzed

the 2-year data from these 3 trials including previously unpublished

source data. Statistical analysis was performed with fixed and random

effects models.

RESULTS: The authors’ analysis revealed that segmental sagittal motion

was preserved with arthroplasty (preoperatively 7.26� and postopera-

tively 8.14�) at the 2-year time point. The fusion rate for ACDF at 2 years

was 95%. The Neck Disability Index, 36-Item Short Form Health Survey

Mental, and Physical Component Summaries, neck pain, and arm pain

scores were not statistically different between the groups at the 24-month

follow-up. The arthroplasty group demonstrated superior results at

24 months in neurological success (RR 0.595, I(2)50%, p50.006).

The arthroplasty group had a lower rate of secondary surgeries at the

2-year time point (RR 0.44, I(2)50%, p50.004). At the 2-year time

point, the reoperation rate for adjacent-level disease was lower for the

arthroplasty group when the authors analyzed the combined data set us-

ing a fixed effects model (RR 0.460, I(2)52.9%, p50.030), but this find-

ing was not significant using a random effects model. Adverse event

reporting was too heterogeneous between the 3 trials to combine for

analysis.

CONCLUSIONS: Both anterior cervical discectomy and fusion as well as

arthroplasty demonstrate excellent 2-year surgical results for the treatment of

1-level cervical disc disease with radiculopathy. Arthroplasty is associated

with a lower rate of secondary surgery and a higher rate of neurological

success at 2 years. Arthroplasty may be associated with a lower rate of adja-

cent-level disease at 2 years, but further follow-up and analysis are needed to

confirm this finding.

PMID: 22195608 [PubMed - indexed for MEDLINE. Available at: http://

www.ncbi.nlm.nih.gov/pubmed/22195608].

Reprinted with permission from: Upadhyaya CD, Wu JC, Trost G, et al.

Analysis of the three United States Food and Drug Administration in-

vestigational device exemption cervical arthroplasty trials. J Neurosurg

Spine 2012;16(3):216–28. Epub 2011 Dec 23. Available at: www.

thejns.org.

doi: 10.1016/j.spinee.2012.04.008

Lumbar facet joint effusion in MRI: a sign of instability in

degenerative spondylolisthesis? Lattig F, Fekete TF, Grob D,

Kleinst€uck FS, Jeszenszky D, Mannion AF. Eur Spine J

2012;21(2):276–81. Epub 2011 Sep 20

PURPOSE: The term ‘‘segmental instability’’ of the lumbar spine is not

clearly defined, especially as it relates to degenerative spondylolisthesis

(DS) and rotational translation (RT). We investigated whether facet joint

effusion on conventional supine MRI indicated increased abnormal motion

in DS and RT.

METHODS: 160 patients (119 female, 41 male, mean age 68.8 years,

range 38.8-89.3 years) who had undergone decompression only or de-

compression with instrumented fusion for degenerative spondylolisthesis

with different degrees of narrowing of the spinal canal were identified

retrospectively from our spine surgery database. All had preoperative

upright X-rays in AP and lateral views as well as supine MRI. The im-

aging studies were assessed for the following parameters: percent of

slippage, absolute value of facet joint effusion, facet angles, degree of

facet degeneration and spinal canal central narrowing, disc height, pres-

ence of facet cysts and the presence of rotational translation in the AP

X-ray.

RESULTS: 40/160 patients showed no facet joint effusion, and in these

the difference in the values for the % slip on upright X-ray and % slip

on supine MRI was #3%. A further 12 patients also showed a difference

#3%, but had some fluid in the joints (0.4460.38 mm). In 108 patients,

the difference in the % slip measured on X-ray and on MRI was O3%

(mean 10.6%, range 4–29%) and was associated with a mean facet effusion

size of 2.1560.85 mm. The extent of effusion correlated significantly with

the relative slippage difference between standing and supine positions

(r50.64, p!0.001), and the extent of the left/right difference in effusion

was associated with the presence of rotational translation (RT

1.3160.8 mm vs. no-RT 0.2360.17 mm, p!0.0001).

CONCLUSIONS: Facet joint effusion is clearly correlated with sponta-

neous reduction of the extent of slippage in the supine position com-

pared to the upright position. Also, the greater the difference in right

and left facet effusion, the higher the likelihood of having a RT. Future

studies should assess whether analysis of facet joint effusion measured

on routine MRI can help in decision-making regarding the optimal sur-

gical treatment to be applied (decompression alone or combined with

fusion).

PMID: 21932065 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/21932065].

Reprinted with permission from: Lattig F, Fekete TF, Grob D, Kleinst€uck FS,

Jeszenszky D, Mannion AF. Lumbar facet joint effusion in MRI: a sign

of instability in degenerative spondylolisthesis? Eur Spine J 2012

Feb;21(2):276–81. Epub 2011 Sep 20. Available at: http://www.springerlink.

com/content/y2g116120x42l017/?MUD5MP.

doi: 10.1016/j.spinee.2012.04.009

Simple foot tapping test as a quantitative objective assessment of

cervical myelopathy. Numasawa T, Ono A, Wada K, et al. Spine

2012;37(2):108–13

STUDY DESIGN: A clinical and cohort study.

OBJECTIVE: The first purpose of this study was to investigate the stan-

dard value of a simple foot tapping test (FTT) in a large healthy population.

The second purpose was to elucidate the validity of FTT as a quantitative

assessment of lower extremity motor function for cervical compressive

myelopathy.

SUMMARY OF BACKGROUND DATA: Several clinical performance

tests have been reported as objective assessments for the severity of cervi-

cal myelopathy. The FTT is the simplest and easiest method for