BACKGROUND CONTEXT: The accurate determination of a patient's functional status is necessary for therapeutic decision-making and to critically appraise treatment efficacy. Current subjective patient-reported outcome measure (PROM)-based assessments have limitations and can be complimented by objective measures of function. PURPOSE: To systematically review the literature and provide an overview on the available objective measures of function for patients with degenerative diseases of the lumbar spine. STUDY DESIGN/SETTING: Systematic review of the literature. METHODS: The PRISMA guidelines were followed. Two reviewers independently searched the PubMed, Web of Science, EMBASE and SCOPUS databases for permutations of the words "objective", "assessment", "function", "lumbar" and "spine", including articles on human subjects with degenerative diseases of the lumbar spine that reported on objective measures of function, published until September 2018. No funding was received. The authors report no conflicts of interest. RESULTS: Of 2389 identified articles, 82 were included in the final analysis. There was a significant increase of 0.12 per year in the number of publications dealing with objective measures of function since 1989 (95% CI 0.08-0.16, p<0.001). Some publications studied multiple diagnoses and objective measures. The US was the leading nation in terms of scientific output for objective outcome measures (n=21; 25.6%), followed by Switzerland (n=17; 20.7%), Canada, Germany and the United Kingdom (each n=6; 7.3%). Our search revealed 21 different types of objective measures, predominantly applied to patients with lumbar spinal stenosis (n=67 publications; 81.7%), chronic/unspecific low back pain (n=28; 34.2%) and lumbar disc herniation (n=22; 26.8%). The Timed-Up-and-Go (TUG) test was the most frequently applied measure (n=26 publications; 31.7%; cumulative number of reported subjects: 5181), followed by the Motorized Treadmill Test (MTT; n=25 publications; 30.5%, 1499 subjects) and with each n=9 publications (11.0%) the Five-Repetition Sit-To-Stand test (5R-STS; 955 subjects), as well as accelerometry analyses (336 subjects). The reliability and validity of many of the less-applied objective measures was uncertain. There was profound heterogeneity in their application and interpretation of results. Risk of bias was not assessed. CONCLUSIONS: Clinical studies on patients with lumbar degenerative diseases increasingly employ objective measures of function, which offer high potential for improving the quality of outcome measurement in patient-care and research. This review provides an overview on available options. Our findings call for an agreement and standardization in terms of test selection, conduction and analysis to facilitate comparison of results across cohorts. (2019). Objective measures of functional impairment for degenerative diseases of the lumbar spine: a systematic review of the literature. Abstract 1 Background Context: The accurate determination of a patient's functional status is 2 necessary ...

The TAS 1 MG procedures provided the highest stability. The MG method alone may not be adequate for atlantoaxial arthrodesis, because it does not provide sufficient stability in lateral bending and rotation modes. The C2 pedicle screw and C2 ILS techniques are biomechanically less stable than the TAS 1 MG. In the C1 lateral mass-C2 pedicle screw fixation, the use of a short pedicle screw may be an alternative when other screw fixation techniques are not feasible.

Object Tumors involving the cervicothoracic junction can have a high propensity for causing instability, with kyphosis and spinal cord compression resulting. Treatment with decompression only can lead to further instability and worsening neurological status. In this article, the authors review their surgical experience in the treatment of 19 patients with tumors involving the cervicothoracic junction. The various approaches and instrumentation techniques involved in decompression and stabilization of the cervicothoracic junction are also reviewed. Methods Aggressive instrumentation-augmented fusion after decompression of the cervicothoracic region can provide for immediate stabilization and early rehabilitation. Recent development of new hardware such as dual-diameter transition rods, polyaxial screws, and interlocking devices have enhanced the ability to fashion a strong construct for stabilization of the cervicothoracic junction. Conclusions Familiarity with complex instrumentation techniques and various surgical approaches to the cervicothoracic junction will be required for effective treatment of tumors causing instability of this region.

Regarding stability, PLIF provides a higher immediate stability compared with that of TLIF, especially in lateral bending. Based on our findings, however, PLIF and TLIF, each with posterolateral fusions, have similar biomechanical properties regarding ROM, IDP, and laminar strain at the adjacent segments.