The spine journal : official journal of the North American Spine Society
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The true incidence of symptomatic spinal epidural hematoma (SEH) after surgery of the posterior cervical spine and risk factors for its development remain unclear. ⋯ Symptomatic SEH may occur in up to 1.5% of patients undergoing posterior cervical spine surgery. Patients with a higher level of comorbid disease appear to be at increased risk of development of a symptomatic SEH, although avoidance of postoperative NSAIDs may decrease the risk of its development.
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Instrumentation failure is a recognized complication after complex spinal reconstruction and deformity correction. Rod fracture (RF) is the most frequent mode of hardware failure in long-segment spinal fusion surgery. This complication can negatively impact the clinical outcome by producing spinal pain, functional compromise, instability, and loss of deformity correction. ⋯ The risk of rod failure is substantial in the setting of long-segment spinal arthrodesis and corrective osteotomy. Efforts to increase the mechanical strength of posterior constructs may reduce the occurrence of this complication. The outrigger rod technique increases spinal construct stiffness and may improve the longevity of the construct. This technique should reduce the rate of device failure during maturation of posterior fusion mass and limit the need for supplemental anterior column support.
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Bone metastasis (BM) occurs frequently in patients with lung cancer (LC). The most affected are the bones of the spine, increasing the risk of developing metastatic spinal cord compression (MSCC). Although MSCC is one of the most disabling complications, few studies have reported relevant results related to its frequency and prognosis among patients with LC. ⋯ In this study, a high incidence of MSCC was observed in patients with BM. The study suggests that patients with three or more involved vertebrae per metastasis are more likely to develop MSCC. No alteration in the overall survival time was noticed among the patients with or without MSCC.
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Using diagnostic anesthetic blocks, the lumbar zygapophysial (facet) joint has been shown to be the primary cause of pain in approximately 15% of patients with chronic low back pain. Radiofrequency neurotomy (RFN) of the lumbar medial branch innervating the zygapophysial joint has been shown to provide a significant decrease in pain in patients selected by dual comparative anesthetic blocks, but quantitative improvements in mobility have not been fully elucidated. A theoretical concern with RFN is that the multifidus muscle, a stabilizing paraspinal muscle, is also denervated during this procedure, which may have adverse effects on mobility and spine stability. ⋯ The results of this pilot study are the first to show quantitative positive changes in gait and muscle activity post-RFN, suggesting that the relationship between this procedure and mobility warrant further investigation.