The spine journal : official journal of the North American Spine Society
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Bone morphogenetic proteins (BMPs) induce osteogenesis, making them useful for decreasing time to union and increasing union rates. Although the advantages of BMP-2 as a substitute for iliac crest graft have been elucidated, less is known about the safety profile and adverse events linked to their use in spinal fusion. An accumulation of reactive edema in the epidural fat may lead to neural compression and significant morbidity after lumbar spinal fusion. Bone morphogenetic protein has never been implicated as a cause of spinal epidural lipedema. ⋯ We present a case of rapid accumulation of edematous adipose tissue causing cauda equina syndrome after a lumbar decompression and fusion surgery. The acute nature and extensive development of the lipedema presented in this case indicate an intense inflammatory reaction. We hypothesize that there may be a link between the use of BMP-2 and the accumulation of this edematous tissue. A thorough understanding of the mechanisms of BMP-2 and specific guidelines for their role in spinal surgery may improve functional outcomes and reduce the number of preventable complications. To the best of our knowledge and after a thorough literature search, this is the only reported case of epidural lipedema causing cauda equina syndrome.
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Lateral interbody fusion (LIF) is a minimally invasive procedure that is designed to achieve a solid interbody fusion while minimizing the damage to the surrounding soft tissue. Although short-term results have been promising, few data have been published to date regarding its risks and complication rate. ⋯ Hip flexion was weakened immediately after the LIF procedure, which may be attributed to psoas muscle injury during the procedure. However, this damage was temporary, with almost complete return to baseline values by 2 weeks.
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Facet supplementation stabilizes after facetectomy and undercutting laminectomy. It is indicated in degenerative spondylolisthesis with moderate disc degeneration and dynamic stenosis. ⋯ This study suggests that the AFS stabilizes L4-L5 in axial rotation after facetectomy and undercutting laminectomy as fusion does. This is because of the cross-link that generates an increased annulus stress in axial rotation at adjacent levels. With imposed displacements, without in vivo compensation of the hips, the solicitation at adjacent levels' discs and facet joints is higher with fusion compared with AFS. Fusion decreases intradiscal stress at the instrumented level.
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Anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PPF) provides successful surgical outcomes to isthmic spondylolisthesis patients with indirect decompression through foraminal volume expansion. However, indirect decompression through ALIF followed by PPF may not obtain a successful surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or foraminal sequestrated disc herniation. Thus far, there has been no report of foraminal decompression through anterior direct access in the lumbar spine. ⋯ The microscopic anterior foraminal approach provides successful foraminal decompression. Combined with ALIF and PPF, this approach shows a good surgical outcome in patients with isthmic spondylolisthesis accompanied by foraminal stenosis caused by a posterior osteophyte or those with foraminal sequestrated disc herniation.
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The management of postoperative spinal wound complication remains a challenge, with surgical site infection (SSI) incidence rates ranging from 0.4% to 20% after spinal surgery. Negative pressure wound therapy (NPWT) has been highlighted as an intervention that may stimulate healing and prevent SSI. However, the wound healing mechanism by NPWT and its effectiveness in spinal wounds still remain unclear. ⋯ Published reports are limited to small retrospective and case studies, with no reports of NPWT being used as a prophylactic treatment. Larger prospective RCTs of NPWT are needed to support the current evidence that it is effective in treating spinal wound complications. In addition, future studies should investigate its use as a prophylactic treatment to prevent infection and report data relating to safety and health economics.