Carole A. Miller, MD: Matriarch of the Ohio State University's Department of Neurosurgery.

Carole A. Miller, M.D., was born (May 7, 1939) and raised in Kalamazoo, Michigan. She obtained her undergraduate and medical degrees at the Ohio State University. She went on to complete her neurosurgical training at the Ohio State University Medical Center. After her first faculty role at the University of Michigan (1971), she returned to the Ohio State University Medical Center (1975) where she spent nearly 4 decades. She thrived in the specialty, achieving in every facet of academic practice including scientific contributions, graduate medical education, clinical care, and leadership roles within her academic department, locally, and at the national level of organized neurosurgery. Dr. Miller passed away peacefully, on October 28, 2015, after a courageous battle with cancer. Based on her essential programmatic and specialty-related contributions, she is remembered as the 'founding mother' of neurosurgery at the Ohio State University.

MR Elastography-derived Stiffness: A Biomarker for Intervertebral Disc Degeneration.

Purpose To determine the repeatability of magnetic resonance (MR) elastography-derived shear stiffness measurements of the intervertebral disc (IVD) taken throughout the day and their relationship with IVD degeneration and subject age. Materials and Methods In a cross-sectional study, in vivo lumbar MR elastography was performed once in the morning and once in the afternoon in 47 subjects without current low back pain (IVDs = 230; age range, 20-71 years) after obtaining written consent under approval of the institutional review board. The Pfirrmann degeneration grade and MR elastography-derived shear stiffness of the nucleus pulposus and annulus fibrosus regions of all lumbar IVDs were assessed by means of principal frequency analysis. One-way analysis of variance, paired t tests, concordance and Bland-Altman tests, and Pearson correlations were used to evaluate degeneration, diurnal changes, repeatability, and age effects, respectively. Results There were no significant differences between morning and afternoon shear stiffness across all levels and there was very good technical repeatability between the morning and afternoon imaging results for both nucleus pulposus (R = 0.92) and annulus fibrosus (R = 0.83) regions. There was a significant increase in both nucleus pulposus and annulus fibrosus MR elastography-derived shear stiffness with increasing Pfirrmann degeneration grade (nucleus pulposus grade 1, 12.5 kPa ± 1.3; grade 5, 16.5 kPa ± 2.1; annulus fibrosus grade 1, 90.4 kPa ± 9.3; grade 5, 120.1 kPa ± 15.4), and there were weak correlations between shear stiffness and age across all levels (R ≤ 0.32). Conclusion Our results demonstrate that MR elastography-derived shear stiffness measurements are highly repeatable, weakly correlate with age, and increase with advancing IVD degeneration. These results suggest that MR elastography-derived shear stiffness may provide an objective biomarker of the IVD degeneration process. © RSNA, 2017 Online supplemental material is available for this article.

Retropharyngeal abscess with secondary osteomyelitis and epidural abscess: proposed pathophysiological mechanism of an underrecognized complication of unstable craniocervical injuries: case report.

Because of the proximity of the oropharynx (a naturally contaminated region) to the spinal structures of the craniocervical junction, it is possible that small mucosal lacerations in the oropharynx caused by unstable traumatic craniocervical injuries may become contaminated and lead to secondary infection and osteomyelitis. In this report, the authors describe the case of a previously healthy and immunocompetent patient who developed a large retropharyngeal abscess with spinal osteomyelitis after a high-energy craniocervical injury. This unusual report of osteomyelitis with a delayed presentation after a high-energy traumatic injury of the craniocervical junction highlights the possibility of direct injury to a specific area in the oropharyngeal mucosa adjacent to the osteoligamentous structures of the craniocervical junction, an overall underrecognized complication of unstable craniocervical injuries.

A minimally invasive approach to defects of the pars interarticularis: Restoring function in competitive athletes.

OBJECTIVES: To understand that young athletes have a higher incidence of pars interarticularis defects than the general population. This may be due to an immature spine put under higher stress loads at an early age. Traditionally, surgery was reserved for those who failed conservative therapy, and consisted of open exposure, bone grafting and placement of pedicle screws. This leads to a long recovery period and limited ability to return to competitive sport. METHODS: Four collegiate and professional level athletes, three high school athletes, and one member of the National Guard presented with back pain from spondylolysis without spondylolisthesis. All underwent minimally invasive surgery (MIS) to directly repair the pars defect, for a total of sixteen pars defects repaired in eight patients. Described is an application of a MIS pars repair technique that has not previously been reported, which recreates the normal anatomy rather fusing across a motion segment. RESULTS: Five patients were discharged the day following surgery and three were discharged on postoperative day 2. Six of the patients returned to their previous level of competitiveness. Two were unable to achieve the same level of play, both of whom failed to fuse the spondylolysis. Patients all initially reported clinical improvement postoperatively and there was overall mean improvement on patient reported outcome measures (SF36 physical and mental component scores, visual analog scale, and Oswestry disability index). CONCLUSION: MIS advantages include less muscle tissue disruption and restoration of the natural anatomy. This leads to a more rapid recovery, decreased perioperative pain, minimal blood loss, earlier mobilization and decreased hospital length of stay. Overall this allows the athlete to start therapy earlier and return to competition sooner and at his/her pre-operative competitive level. The described MIS repair technique outcomes are similar to those that have been reported in the literature and have allowed a high rate of return to athletics in high performing patients; critical to their quality of life.