Journal of spinal disorders
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Continuous intraoperative monitoring of spinal cord function using somatosensory evoked potentials (SSEP) has gained nearly universal acceptance as a reliable and sensitive method for detecting and possibly preventing neurologic injury during surgical correction of spinal deformities. In several reports, spinal cord injury was identified successfully based on changes in SSEP response characteristics, specifically amplitude and latency. Less well documented and used, however, is monitoring of peripheral nerve function with SSEPs to identify and prevent the neurologic sequelae of prolonged prone positioning on a spinal frame. ⋯ A statistically significant reduction in ulnar nerve SSEP amplitude was observed in 18 limbs of the 500 patients (3.6%) reviewed. Repositioning the arm(s) or shoulders resulted in nearly immediate improvement of SSEP amplitude, and all awoke without signs of brachial plexopathy. This complication can be avoided by monitoring SSEPs to ulnar nerve stimulation for patients placed in the prone position during spinal surgery.
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This prospective study compares several roentgenographic parameters of the thoracic and lumbar spine in patients with beta-thalassemia and in healthy persons who served as controls. Eighty-four patients with beta-thalassemia and 84 age- and gender-matched healthy persons were examined clinically and radiologically (thoracic kyphosis, lumbar lordosis, and vertebral and sacral inclination). Although there was a significant difference in the vertebral inclination from T6 to L1, L4, and L5 between patients and controls, thoracic kyphosis and lumbar lordosis did not differ in the two groups. ⋯ There were no age- or gender-related differences in the magnitude of sacral inclination, thoracic kyphosis, or lumbar lordosis in the patients with beta-thalassemia compared with controls. Lumbar lordosis was significantly correlated with sacral inclination in both patients with beta-thalassemia and controls. Beta-thalassemia does not affect sagittal profile of the thoracic and lumbar spine but it is associated by structural changes on the frontal plane of the spine that are expressed as a high prevalence of scoliosis.
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Epidural hematoma after epidural anesthesia is a rare and uncommon complication in patients with peripheral vascular disease who require perioperative anticoagulation therapy. A low index of suspicion makes its diagnosis difficult and often delayed. ⋯ In this article, the authors report a case of epidural hematoma with secondary paraplegia after epidural anesthesia. Also described is an original technique for evacuating the epidural space.
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This study verified the efficacy of segmental pedicle screw fixation in restoring thoracic kyphosis in persons with hypokyphotic scoliosis. Fifty-one patients were divided into three groups by the degree of preoperative thoracic hypokyphosis and fixation method used: the hypokyphosis-hook (HH), hypokyphosis-screw (HS), and normal kyphosis-screw (NS) group. They were compared after a minimum follow-up period of 2 years. ⋯ The difference between the HH and HS groups was significant (p = 0.000). The HS and the NS groups did not differ (p = 0.16). This indicates that segmental pedicle screw fixation was more effective than multiple hooks in restoring kyphosis in patients with hypokyphotic scoliosis and created kyphosis similar to that in patients without preoperative hypokyphosis.
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The authors determined the cost-effectiveness of computed tomography (CT) of the inadequately visualized C7-T1 level on conventional radiography in a retrospective cohort study. Routine cervical spine radiography was performed in 360 trauma patients in whom the C7-T1 level was not adequately visualized, but there was no evidence of lower cervical spine injury. In these patients, CT of C7-T1 was performed and reviewed for the presence, location, and pattern of fracture. ⋯ Eleven of 360 fractures of C7-T1 were identified. The cost-effectiveness of CT for averting potential sequelae was $9,192 for each fracture identified, $16,852 identified for each potentially or definitely unstable fracture identified, and $50,557 for each definitely unstable fracture identified. Computed tomography of the inadequately visualized C7-T1 level on plain radiography is cost-effective, especially given the relatively young age of the trauma population and therefore the high associated morbidity of the sequelae of these injuries over time.