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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Cervical artificial discs (CADs) represent an established surgical option in selected patients with cervical spinal disc degeneration. Though CADs have been available for many years, there is a lack of information concerning long-term safety, durability and implant-related failure rates. ⋯ As there is no standard regarding clinical and radiological follow-up for patients with CADs, radiological long-term follow-up investigations seem to be justified for exclusion of implant failure.
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Lumbar epidural injection is a popular treatment for degenerative lumbar disease. Although post-procedural epidural infection is rare, meningitis and epidural abscess are life-threatening conditions, and need additional medical and surgical intervention. The purpose of this article is to report a patient with fatal whole cerebrospinal axis infection after lumbar epidural injections. ⋯ 5.
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We herein describe a case of delayed union of a lumbar spine fracture in a 70-year-old patient with diffuse idiopathic skeletal hyperostosis (DISH). ⋯ This is the first report of successful use of TPTD to treat delayed union of a spine fracture in a patient with DISH without surgical intervention.
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Thoracic cord herniation is a well-established entity in the literature. Majority of the published literature deals with its surgical management in terms of "mere" detethering of cord. However, not much is written about the degree of herniation and ectopic cord tissue and its management. A 58-year-old male presented to us with progressive difficulty in walking. Imaging revealed a cord herniation at T7-8 level. Surgical detethering was planned. However, a significant amount of "ectopic" cord tissue was found outside the dural defect intra-operatively. Simple detethering and repositioning was difficult. Hence, the ectopic tissue was excised under neuro-physiologic monitoring and no major change was recorded intra-operatively/post-operatively. ⋯ Thoracic cord herniation surgery may be more than simple detethering and cord repositioning. If encountered in similar situations intra-operatively, surgeons should be able to excise ectopic tissue without grave post-operative deficits. Neuronal plasticity probably plays an important role in the pathophysiology of long-standing cord herniation.
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Pelvic and sacral surgeries are considered technically difficult due to the complex multidimensional anatomy and the presence of significant neurovascular structures. Knowledge of the key neurovascular anatomy is essential for safe and effective execution of partial and complete sacral resections. The goal of this anatomic, cadaveric study is to describe the pertinent neurovascular anatomy during these procedures. ⋯ Several sacrectomy techniques are available and selection often depends on the specific case and surgeon preference; nevertheless, anatomic knowledge is extremely important. Considering the highly variable anatomic relations of the vascular bundles, a preoperative evaluation with CT or MRI with vascular reconstruction may be helpful to decrease bleeding risk by preemptively binding the internal iliac vessels in cases where higher tumors are present. To decrease the risk of damaging nerve roots, it is recommended to perform the resection as close to the involved foramina as possible.