Journal of spinal disorders & techniques
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J Spinal Disord Tech · Apr 2004
Long-term clinical manifestations of retained bullet fragments within the intervertebral disk space.
A retrospective review of 12 patients who were victims of penetrating trauma with a bullet or bullet fragments lodged within the intervertebral disk space was conducted. The objective of the review was to evaluate the potential systemic effects of lead resorption at long-term follow-up. Literature regarding the potential for lead toxicity due to retained bullet fragments within the intervertebral disk space is lacking. ⋯ The patient subsequently underwent a partial laminectomy and diskectomy with excision of the bullet fragments. The patient's complaints, specific for plumbism, resolved 2 months postoperatively. We conclude that patients with retained lead-based bullet fragments in the intervertebral disk should be educated about the rare potential for plumbism due to partial bullet fragment resorption and that long-term observation for this disorder is recommended.
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J Spinal Disord Tech · Apr 2004
Case ReportsPosterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note.
Rigid screw fixation of the axis, for either atlantoaxial fixation or for incorporation of C2 into subaxial cervical constructs, provides significant stability and excellent long-term fusion results but remains technically demanding due to the danger of injury to the vertebral artery. Anatomic variability of the foramen transversarium in the body of the axis can preclude safe transarticular C1-C2 screw placement in up to 20% of patients. Although more recent methods of C2 screw fixation with pedicle screws allow safer fixation in a higher number of patients, there remains a significant risk to the vertebral artery with C2 pedicle screw placement. ⋯ This technique has been successfully used by the author in cases of craniocervical and atlantoaxial fixation as well as for incorporation of C2 into subaxial fixations. The technique is illustrated, and the author's initial experience in treating 10 patients with crossing, bilateral C2 aminar screws for indications of trauma, neoplasm, pseudarthrosis, and degenerative disease is reviewed. The possible advantages of C2 fixation with C2 laminar screws are discussed.