Spine
-
Systematic review. ⋯ Vascular injury in anterior lumbosacral surgery remains low, with reports being <5%. The consequences of injury seem rare, but may include thrombosis, pulmonary embolism, and prolonged hospitalization. Exposure and surgery at L4-L5 may be associated with a higher risk of injury than that at L5-S1, though the data are not consistent.
-
Systematic review. ⋯ The complication profile of BMP-2 for ALIF with LT-CAGE is well characterized. Because of the lack of substantive data, the same is not true for other types of lumbar fusions, or for cervical or thoracic fusion applications. BMP has been associated with a variety of unique complications in the ventral cervical and lumbar spines. The published data on BMP fail to precisely profile this product's use in fusion surgery; hence, it should be used only after a careful consideration of the relevant data. Well-designed and executed studies are necessary to completely define the incidence of various complications relative to type of BMP, type and region of fusion, surgical technique, dose, and carrier, and importantly, to define the natural history and management of associated complications.
-
Review
Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality?
Systematic Review. ⋯ Ideally, patients with unstable thoracic fractures should undergo early (<72 hours) stabilization of their injury to reduce morbidity and, possibly, mortality.
-
Systematic review. ⋯ Venous thromboembolism is uncommon after elective spine surgery. Trauma patients are at increased risk, and chemical prophylaxis should be considered. The safe timing of the administration of anticoagulation agents is unknown.
-
Systematic review. ⋯ Wrong site surgery may be preventable. We suggest that the North American Spine Society and JC checklists are insufficient on their own to minimize this complication. Therefore, in addition to these protocols, we recommend intraoperative imaging after exposure and marking of a fixed anatomic structure. This imaging should be compared with routine preoperative studies to determine the correct site for spine surgery.