Spine
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A retrospective clinical review of 20 children seen during a 7-year period who had atlantoaxial rotatory subluxation. ⋯ Optimal management of atlantoaxial rotatory subluxation entails early diagnosis with plain cervical radiographs and dynamic computed tomography. Closed reduction with cervical traction followed by rigid immobilization accomplished reduction in 15 of 16 patients (94%) and was curative in 10 of 16 patients (63%). Although reduction was achieved more rapidly and effectively with traction than with a collar, there may be a role for simple immobilization without reduction in patients with a short duration of symptoms. There does not appear to be a correlation between cause of atlantoaxial rotatory subluxation, age, or sex and the likelihood of recurrence.
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A retrospective review was completed on 21 patients who had a "least invasive" (one or two level) microdecompression and uninstrumented single-segment lumbar fusion for spinal canal stenosis with degenerative spondylolisthesis. ⋯ In this retrospective study, a "least invasive" surgical approach to lumbar degenerative spondylolisthesis with spinal canal stenosis causing claudicant leg pain produced acceptable results.
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Case Reports
Fatal cardiac tamponade associated with posterior spinal instrumentation. A case report.
Case report of a fatal complication of pedicle screw instrumentation and review of the literature. ⋯ There are numerous possible intraoperative complications in posterior pedicle screw fixation, such as nerve root and spinal cord injuries. This case of a fatal heart tamponade after transpedicular screw insertion is rare. It shows that the surgeon must be aware of potential risks associated with such a procedure and have a comprehensive three-dimensional understanding of the anatomic structures involved.
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Radiologic and operative findings of intravertebral cleft in the osteoporotic spine were investigated and the pathomechanism discussed. ⋯ The unstable cleft in the affected vertebral body of the osteoporotic spine with magnetic resonance findings of low intensity on the T1-weighted scans and high intensity on the T2-weighted scans suggests that the cleft is a false joint lined by fibrocartilaginous tissue with notable movement consistent with pseudarthrosis.
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A prospective cohort design with two groups of patients representing short-term or long-term disability (n = 497) who were selected from a larger cohort (n = 938) of consecutively treated spinal disorder patients with chronic compensation injuries. ⋯ This study suggests that early tertiary nonoperative care, once patients with chronic spinal disorders are identified as having potentially high-cost chronic pain and disability, is efficacious in achieving goals of better work return and work retention. Such early rehabilitation may also prevent significant indemnity expense, as well as some late surgical interventions sought by progressively more desperate patients. However, individuals with long-term disability achieve respectable work return and retention rates, while faring no worse on other socioeconomic outcomes that represent major "cost drivers" to the workers' compensation system. Early intervention is not a panacea or a necessary condition for the successful rehabilitation of workers with disabling chronic spinal disorders.