European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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This prospective magnetic resonance imaging (MRI) study in chronic low-back pain (CLBP) patients evaluated the natural course of degenerative lumbar spine changes in relation to Modic 1 type changes (M1) within 1 year. ⋯ Endplate deformation, decreasing disc height and change of disc signal intensity appear essential features of accelerated degenerative process associated with M1.
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Case Reports
Minimally invasive lumbopelvic instrumentation for traumatic sacrolisthesis in an elderly patient.
We present a novel minimally invasive technique for lumbopelvic instrumentation in selected elderly patients suffering from traumatic sacrolisthesis. An 82-year-old female suffered from sacrolisthesis after a fall. She developed significant low back pain and bilateral lower extremity radiculopathy. Preoperative radiographs and magnetic resonance imaging sequences demonstrated the fracture dislocation between S1 and S2 with compromise of the spinal canal. Lumbopelvic instrumentation was sought to offer fixation and allow mobilization; however, open lumbopelvic instrumentation techniques have significant morbidity, especially in this patient population of elderly patients with medical comorbidities. ⋯ The patient tolerated the procedure well without any complications or morbidity. At the last follow-up of 14 months, she was ambulating without assistance with near total resolution of back pain and radicular pain. Radiographs obtained at 8 months' follow-up demonstrated fusion across the fracture line. Although further follow-up data is still needed to establish the durability of this technique in the long-term, this minimally invasive technique for lumbopelvic instrumentation can be considered as an option in elderly patients with traumatic sacrolisthesis, whose need for early mobilization and medical comorbidities preclude the use of an open lumbopelvic fixation procedure.
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The purpose of this study is to evaluate the effect of intraoperative powdered vancomycin on the rates of postoperative deep spinal wound infection. The use of intraoperative powdered vancomycin as a prophylactic measure in an attempt to reduce the incidence of postoperative spinal wound infection has not been sufficiently evaluated in the existing literature. A retrospective review of a large clinical database was performed to determine the rates of deep wound infection associated with the use of intraoperative operative site powdered vancomycin. ⋯ 15 of the 1,512 patients (0.99%) were identified as having evidence of postoperative deep wound infection. At least one pre-existing risk factor for deep infection was present in 8/15 pts (54%). Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) were the most commonly identified organisms (11/15 cases). The rate of deep wound infection was 1.20% (8/663) for instrumented spinal surgeries, and 0.82% (7/849) for uninstrumented surgeries. Deep infection occurred in only 1.23% (4/324) of multilevel instrumented posterior spinal fusions, 1.37% (1/73) of open PLIF procedures, and 1.23% (1/81) of single-level instrumented posterior fusions. Deep infection was not observed in any patient who had uninstrumented spinal fusion (0/64). The deep infection rate for revision surgeries was 1.15% (1/87) and 0.55% (1/183) for trauma surgery. Increased rates of complications related to powdered vancomycin use were not identified in this series. Conclusion In this series of 1,512 consecutive spinal surgeries, the use of 1 g of powdered intraoperative vancomycin placed in the wound prior to wound closure appears to associated with a low rate deep spinal wound infection for both instrumented and uninstrumented cases. Rates of deep infection for instrumented fusion surgery, trauma, and revision surgery appear to be among the lowest reported in the existing literature. Further investigation of this prophylactic adjunctive measure is warranted.
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Various ball and socket-type designs of cervical artificial discs are in use or under investigation. Many artificial disc designs claim to restore the normal kinematics of the cervical spine. What differentiates one type of design from another design is currently not well understood. ⋯ For both spherical and oval designs, the facet loads were lower for the designs with an inferior ball component. The capsule ligament strains were lower for the oval design with an inferior ball component. Overall, the oval design with an inferior ball component, produced motion, facet loads, implant stresses and capsule ligament strains closest to the intact spine, which may be key to long-term implant survival.
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Only 12 cases of musculoskeletal tuberculosis (TB) that occurred at the site of recent blunt trauma have been previously described. ⋯ In developing countries, where TB is still widely prevalent, there must be a heightened awareness of the risk of ST at recently fractured vertebrae, as demonstrated in this case.