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There is currently no structured classification system to quantitate heterotopic bone formation after artificial disk replacement procedures. The purpose of this work was to develop a method of classifying heterotopic bone formation that is reliable between investigators with different levels of training and easy to remember with only five gradations of severity. One hundred one radiographs of clinical patients and 17 microradiographs from nonhuman primates having undergone various types of disk replacement were classified by seven independent reviewers. The kappa statistics were calculated for interobserver variation between the seven participants with various levels of spinal training and the intraobserver error based on two assessments made at least 2 months apart. The interobserver reliability correlation coefficient for seven raters calculated using the intraclass kappa correlation coefficient and the Kish rho was r = 0.9683 (P < 0.0001). The intraobserver reliability based on readings at two time intervals at a minimum of 2 months apart was r = 0.8949 (P = 0.01). This classification of heterotopic ossification, periannular calcification, and ectopic bone formation associated with total disk arthroplasty proved to be highly reliable and reproducible.

SUMMARY: MR imaging of peripheral nerves has been described in relation to abnormalities such as nerve injury, entrapment, and neoplasm. Neuroma formation is a known response to peripheral nerve injury, and here we correlate the MRN appearance of postinjury neuroma formation with intraoperative findings. We also present the MR imaging features of surgical treatment with a synthetic nerve tube and nerve wrap on postoperative follow-up imaging.ABBREVIATIONS: MRN ϭ MR neurography; NIC ϭ neuroma in continuity; SPACE ϭ sampling perfection with application optimized contrasts by using different flip angle evolutions; SPAIR ϭ spectral adiabatic inversion recovery; STIR ϭ short tau inversion recovery P eripheral nerve injuries and entrapments may lead to formation of NIC, neuroma in completely severed nerves, and amputation neuroma. These lesions also demonstrate unique MRN appearances. This article presents MRN and surgical correlations of various posttraumatic neuromas with relevant case examples.

Many surgeons operating on patients with tarsal tunnel syndrome do not decompress the respective medial plantar and lateral plantar nerves and excise the septum. The authors' study validates the hypotheses that patients who are clinically suspected of having chronic compression of the tibial nerve and its branches at the ankle have higher tunnel pressures and that releasing these structures decreases the pressures.

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Both qualitative and quantitative criteria should be used to suggest the MRN diagnosis of sciatic neuropathy.

Purpose: To evaluate whether the addition of the threedimensional diffusion-weighted reversed fast imaging with steady state free precession (3D DW-PSIF) sequence improves the identification of peripheral nerves in the distal extremities.Materials and Methods: Twelve MR neurography (MRN) studies of the distal upper extremity and 12 MRN studies of distal lower extremity were evaluated. From the 24 subjects who were enrolled, 10 had clinically suspected peripheral neuropathy, whereas 14 suffered from various orthopedic diseases and had no clinical signs of neuropathy. In each examination, the ability to identify each peripheral nerve on T2-weighted and 3D DW-PSIF sequences was evaluated using a semi-quantitative (0-2) scale. Thereafter, a total certainty score was registered for each sequence.Results: Combining the results of all studies, the mean certainty score was 1.92 6 0.28 on the 3D DW-PSIF images and 1.50 6 0.72 on the T2-weighted images (P < 0.001). In the upper extremity studies, the corresponding certainty scores were 2.0 and 1.70 6 0.55, respectively (P ¼ 0.008), and in the lower extremity studies, 1.86 6 0.35 and 1.36 6 0.79, respectively (P < 0.001). Conclusion:The 3D DW-PSIF images provide improved identification of the nerves compared with the T2-weighted images, and should be incorporated in the MRN protocol, whenever accurate nerve localization and/or presurgical evaluation are required.

Jejunoileal diverticulosis is a rare entity. Jejunoileal diverticulosis is not a disease that surgeons see often in clinical practice; however, it should remain on the differential diagnosis for any patient with an acute abdomen or gastrointestinal bleeding of unknown origin. It can present with a wide range of clinical scenarios and when patients experience chronic symptoms such as bloating, abdominal pain, nausea, bacterial overgrowth, or malabsorption, medical therapy is successful in most patients. However, when patients present with acute symptoms of bleeding, inflammation, perforation, or obstruction, surgical resection and primary anastomosis is often the treatment of choice. If patients are asymptomatic, they are better left alone, even when discovered incidentally in the operating room. In closing, the possibility of a patient having jejunal diverticular disease should be suspected whenever the symptoms of obscure abdominal pain, anemia, dilated jejunal loops on abdominal radiographs, a history of colonic diverticuli, and a history of acute appendicitis.