The spine journal : official journal of the North American Spine Society
-
Postoperative coronal decompensation in selective thoracic fusion was reported with derotation maneuvers when using the Cotrel-Dubousset (CD) system. Isola instrumentation is a multiple anchor system that corrects spine deformity with segmental vertebral translation to a predetermined contoured longitudinal member. ⋯ Fusion of the major thoracic curve using translational corrective technique (Isola) in patients with idiopathic scoliosis is an effective procedure that achieves high patient satisfaction while providing excellent correction of both the thoracic and lumbar curves. Unlike rotational corrective techniques (CD), clinical decompensation requiring further treatment did not occur in any patient treated with this method.
-
Coccydynia is a painful condition of the terminal portion of the spine often resulting from direct trauma, childbirth or unknown etiology. This is a relatively rare condition with no universally accepted treatment protocol. ⋯ Patients with coccydynia should be managed conservatively when possible. Treatment should include NSAIDs and local steroid injections. Patients will often require repeat injections over time. Surgery can offer reasonable results for patients failing conservative treatment, but they should be warned of the high rate of infection.
-
Spinal surgery carries risks of incidental spinal cord and nerve root injury. Neuroprotection, to minimize the extent of such injuries, is desirable. However, no neuroprotective strategies have been conclusively validated in nonvascular spinal surgery. Mild hypothermia resulting from general anesthesia is a readily achievable potential neuroprotective strategy. Mild hypothermia, however, has been associated with wound infection, increased operative blood loss and other complications. No previous studies have specifically evaluated whether mild hypothermia is associated with an increased risk of these complications in elective spinal surgery. ⋯ Operative blood loss was not linked to any index of the patient's temperature. Longer anesthesia durations were linked to complications and increased blood loss. Regarding mild hypothermia, neither mean nor nadir hypothermic temperatures were linked to complications, but the estimated total quantity of subbaseline temperature was linked, as was total fluctuation in temperature. Lengthy exposure to mild hypothermia appeared to be associated with wound infections. The use of mild hypothermia as a potential neuroprotective strategy during spinal surgery appears to be reasonably safe, but to avoid complications, the duration of hypothermic exposure should be minimized.
-
Comparative Study
Human lumbar facet joint capsule strains: II. Alteration of strains subsequent to anterior interbody fixation.
In cases of low back pain associated with biomechanical lumbar instability, anterior interbody fixation can be used as a surgical treatment, but its affect on facet joint capsule strains is unknown. ⋯ Restriction of a vertebral motion segment using a single ATLP increased adjacent capsular strains, which if suprathreshold for capsule nociceptors, could play a role in low back pain.
-
Somatosensory evoked potentials (SSEPs) monitor global spinal cord function, and the interpretation of motor loss is based on inferred rather than direct measurements. Therefore, SSEPs may not be useful for identifying motor function deficits caused by anterior spinal column injury or nerve root injury during decompression or placement of instrumentation. For these reasons, adjunctive methods for monitoring may be especially useful during cervical spine surgery. ⋯ The results illustrate the potential utility of intraoperative SSEPs and the tceMEPs for detection of changes in spinal cord function related to patient positioning and hemodynamic effects during anterior cervical fusion.