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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Septic cervical facet joints arthritis is a rare pathology, usually revealed by fever and neck pain. As symptoms may be indolent, a high index of suspicion needs to be maintained. Magnetic resonance imaging (MRI) is effective for early diagnostic, looking for local spread and guiding potential preoperative planning. We present a case exhibiting an uncommon pathology with possible significant morbidity if misdiagnosed. ⋯ Atlantoaxial septic arthritis is an under reported and severe infection. Early use of MRI should avoid delayed diagnosis and would guide the practitioner in choosing an appropriate therapy. Early surgical treatment for uncontrolled sepsis is also a critical element of the prognosis.
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Comparative Study
Fusion in degenerative spondylolisthesis: comparison of osteoconductive and osteoinductive bone graft substitutes.
The emergent widespread options of bone graft substitutes for spinal fusion procedures vary in their osteobiologic activity. A majority of current literature focuses on the comparison of osteoinductive (OI) or osteoconductive (OC) bone graft substitutes individually against ICBG. These studies have demonstrated the legitimacy of bone graft substitutes, but despite the widespread use in spinal fusion procedures there is a dearth in the current literature in the direct comparison of OC and OI substitutes. This retrospective comparative analysis compares the efficacy of OI vs. solely OC agents in producing radiographic fusion on patients with DS. ⋯ With the vastly growing market for OI and OC materials commonly used in lumbar spinal fusions, the options for surgical treatment for degenerative spondylolisthesis are ever expanding. No significant difference was found when comparing fusion rates between the two types of materials in this retrospective analysis. Interestingly, TLIF procedures provided lower fusion rates than posterolateral fusion procedures. This may be due to a small sample size but the association with a minimally invasive technique warrants investigation. Due to the substantial difference in price between the OI and OC materials and the lack of evidence supporting higher fusion rates with more expensive OI agents, it is incumbent on the spine community to consider and reassess the products that are routinely used.
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Systematic review. ⋯ The grading system based on 2 mm increments seems to be the most widely accepted method for determining pedicle screw placement accuracy. All grading systems were based on imaging alone without taking into account the direction of the breach or patient's symptoms.
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Spinal metastases are common in patients with cancer. Following lung and liver, spine is the most common site for cancers to metastasize. Many of them are hypervascularized. These cases are a particular challenge for the surgeon and represent a significant danger of massive blood loss during surgery. Hypervascularized metastases of the cervical spine also include the risk of postoperative bleeding with severe neurological impairment. We report a case of a 67-year-old women with breast cancer (BC) metastasis within the vertebral bodies of C3 and C4 with nearly complete bony destruction of the ventral column and intraspinal tumor masses compressing the spinal cord at level C3 and C4. The hypervascularized tumor was supplied by multiple minor vessels from both vertebral arteries, too small to be coiled individually. Due to an allergy to aspirin, intravascular stenting of the vertebral arteries was not an option. We decided to perform a preoperative direct injection of onyx-18 for embolization of the tumor. ⋯ Presurgical direct injection of Onyx-18 for treating hypervascular spinal metastases of breast cancer seems to be an effective and safe technique and reduces intraoperative bleeding to a minimum.
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Review Meta Analysis
Effects of transplantation of olfactory ensheathing cells in chronic spinal cord injury: a systematic review and meta-analysis.
The debate on the effects and outcome of olfactory ensheathing cell (OEC) transplantation for the treatment of spinal cord injury (SCI) has remained unresolved for nearly 20 years. This study aimed to evaluate the safety and efficacy of OEC transplantation in chronic SCI patients. ⋯ Given the results from our study, we conclude that OEC transplantation appears to be safe, although the evidence for efficacy is modest and requires the support of prospective, randomized trials in larger cohorts of patients. Further randomized controlled trials utilizing strict therapy programs and implanted cell selections are needed to confirm these findings.