The spine journal : official journal of the North American Spine Society
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Intracranial hypotension causing postural headaches has been described after occult and postsurgical cerebrospinal fluid (CSF) leaks and rarely isolated lumbar punctures. The occurrence of a CSF-pleural communication is much rarer, and a high level of suspicion aids in prompt recognition. ⋯ Severe headaches with a recurrent pleural effusion after thoracic spinal surgery may indicate presence of a CSF-pleural fistula, an unusual complication of thoracic spinal surgery.
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Three-dimensional (3D) fluoroscopy-based image guidance system using an isocentric C-arm (Iso-C) fluoroscope was shown to be as effective as computed tomography-based systems in guiding the accurate percutaneous placement of lumbar pedicle screws in cadavers. To date, however, no description is available of the intraoperative use of 3D fluoroscopy to guide lumbar pedicle screw placement in an actual spinal fusion procedure. ⋯ The present case is the first case to demonstrate the intraoperative use of a 3D fluoroscopy-based image-guidance system for accurate navigation during lumbar pedicle screw placement.
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In patients with spinal osteoporosis, the early achievement and maintenance of a biological bond between the pedicle screw and bone is important to avoid screw loosening complications. There are few reports of in vivo investigations involving biomechanical and histological evaluations in the osteoporotic spine. ⋯ The results of this study showed that the resistance to the pull-out force of HA-PS is 1.6 times that of Ti-PS. Furthermore, HA-PS has superior biological bonding to the surrounding bone, as early as 10 days after surgery in this osteoporotic spine model. Thus, in patients with osteoporosis, coating of the pedicle screw with HA may provide better stability and bonding between the pedicle screw and bone in the early postoperative period.