The spine journal : official journal of the North American Spine Society
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Currently, pedicle screw segmental fixation of the spine is considered a standard of care for a number of conditions. Most surgeons employ a free-hand technique using various intraoperative modalities to improve pedicle screw accuracy. Despite continued improvements in technique, pedicle breach remains a frequent occurrence. Once a breach is detected intraoperatively, the most common corrective maneuver is to medially redirect the pedicle screw into the pedicle. To our knowledge, the biomechanical impact of medially redirecting a pedicle screw after a lateral pedicle breach has not been examined. ⋯ Compared with a CC lumbar pedicle screw, an RD lumbar pedicle screw placed after a lateral wall breach is significantly weaker in terms of maximal insertional torque, seating torque, screw loosening force, and axial pullout strength. These significant decreases in biomechanical properties are clearly important when RD pedicle screws are placed at the cephalad or caudal end of a long construct. In this situation, augmentation of the RD screw is an option.
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Iatrogenic dural tears are common complications encountered in spine surgery with known ramifications. There is little information, however, with respect to the implications and complications of traumatic dural tears. ⋯ Traumatic dural tears occurred in 11.6% of patients with operatively managed traumatic spine injuries at a regional Level 1 trauma center. In total, 83% had a neurologic injury and 49% had complete spinal cord injuries. Patients with traumatically induced dural tears have a low likelihood of developing a complication attributable to the dural tear.
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Comparative Study
Degenerative lumbar scoliosis in elderly patients: dynamic stabilization without fusion versus posterior instrumented fusion.
Posterolateral fusion with pedicle screw instrumentation is currently the most widely accepted technique for degenerative lumbar scoliosis in elderly patients. However, a high incidence of complications has been reported in most series. Dynamic stabilization without fusion in patients older than 60 years has not previously been compared with the use of posterior fusion in degenerative lumbar scoliosis. ⋯ In elderly patients with degenerative lumbar scoliosis, pedicle screw-based dynamic stabilization was less invasive with shorter operative duration, less blood loss, and lower adverse event rates than instrumented posterior fusion. Scoliosis curve reduction and lumbar lordosis were superior after fusion; however, dynamic stabilization achieved satisfying values of both these parameters, and these results were stable after an average follow-up of more than 5 years. Furthermore, there was no difference between the two techniques in terms of functional clinical outcomes at the last follow-up.
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The Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA grade) are useful for predicting morbidity and mortality for a variety of disease processes. ⋯ American Society of Anesthesiologists and CCI scores are useful comorbidity indices for the spine patient population, although neither was completely predictive of complication occurrence. A spine-specific comorbidity index, based on ICD-9-CM coding that could be easily captured from patient records, and which is predictive of patient likelihood of complications and mortality, would be beneficial in patient counseling and choice of operative intervention.
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Case Reports
Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases.
Extracorporeal shock wave therapy (ECSWT) has been used widely for musculoskeletal conditions; however, no reports are available about its use for coccydynia. ⋯ Extracorporeal shock wave therapy relieved pain of coccydynia in our patients.