The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Sep 2011
CommentRisk factors for complications and mortality after spine surgery assessed with the NSQIP database: where do we go from here? Commentary on an article by Andrew J. Schoenfeld, MD, et al.: "Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program".
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Approximately 50% of patients with aneurysmal bone cyst of the spine are in the pediatric age group. Aneurysmal bone cyst is considered a locally aggressive benign tumor that may involve the posterior and anterior elements of the spine. Intralesional extended curettage and bone-grafting is the mainstay of treatment of aneurysmal bone cysts involving the long bones. However, the proximity to neurovascular structures and the potential remaining growth of the spine make its management in the spine more challenging. We evaluated the clinical presentation and the results of surgical treatment, following complete intralesional curettage along with spinal arthrodesis in pediatric patients with aneurysmal bone cysts of the cervical spine. ⋯ Preoperative arterial embolization, complete tumor excision by intralesional curettage and burring, followed by local spinal fusion, yield satisfactory results with a low rate of complications and low recurrence in children with an aneurysmal bone cyst of the cervical spine.
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J Bone Joint Surg Am · Aug 2011
Bone contusion and associated meniscal and medial collateral ligament injury in patients with anterior cruciate ligament rupture.
The present study examined the prevalence of bone contusions in patients with anterior cruciate ligament (ACL) injury as well as its association with tears of the lateral meniscus, medial meniscus, and medial collateral ligament (MCL). ⋯ Bone contusions were prevalent in patients with ACL ruptures, and injuries of the menisci and the MCL tended to increase with the progression of bone contusion. The contrecoup mechanism of bone contusion on the medial compartment resulting from an ACL injury was supported. These results suggest that a higher-energy injury led to a more extensive bone contusion and a greater prevalence of associated injury of other anatomic structures in the knee.
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J Bone Joint Surg Am · Aug 2011
Lumbar plexus anatomy within the psoas muscle: implications for the transpsoas lateral approach to the L4-L5 disc.
The transpsoas lateral surgical approach has been advocated as an alternative to direct anterior approaches for less invasive or minimally invasive access to the spine. Postoperative thigh pain, paresthesia, and/or weakness have been described after the use of this surgical approach. The purpose of this cadaveric anatomic study is to provide a description of the lumbar plexus as it relates to the transpsoas lateral surgical approach. ⋯ Because of the proximity of the neural elements, in particular the femoral nerve, to the center of the disc space, the transpsoas lateral surgical approach to the L4-L5 disc space will likely cause intraoperative displacement of neural structures from their anatomic course during retractor dilation. Careful attention should be paid to retractor placement and dilation time during transpsoas lateral access surgery, particularly at the L4-L5 disc.