The spine journal : official journal of the North American Spine Society
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Metastatic osteolytic involvement of the second cervical vertebra (C2) is rare, but usually very painful. Percutaneous vertebroplasty has shown to be effective regarding pain control, but carries the risk of cement leakage. ⋯ In cases of metastatic C2 destruction, tumor excavation via an anterolateral approach and subsequent filling of the resection cavity with bone cement offers a safe and effective alternative to percutaneous approaches.
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Transforaminal lumbar interbody fusion (TLIF) is an increasingly used alternative fusion method over anterior and posterior lumbar interbody fusions. There are conflicting results on the optimal positioning of interbody devices. No study has addressed the lumbosacral segment, L5-S1, where the lordotic configuration presents unique challenges. ⋯ An interbody spacer with the addition of posterior instrumentation significantly enhances the mechanical stability of L5-S1 regardless of interbody position. There were noticeable increases in terms of construct stability and stiffness after both TLIF-ant and TLIF-post in comparison with the intact condition. A posteriorly placed interbody implant did result in the distraction of the neuroforamin. Positioning an interbody implant at L5-S1 for TLIF with posterior instrumentation should be at the discretion of the surgeon without consequence to biomechanical stability.
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Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue. ⋯ Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.
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Although several publications concerning the use of the biomarkers S100B and neuron-specific enolase (NSE) in vertebral spine fractures in animal experimental studies have proven their usefulness as early indicators of injury severity, there are no clinical reports on their effectiveness as indicators in patients with spinal injuries. As these biomarkers have been examined, with promising results, in patients with traumatic brain injury, there is a potential for their implementation in patients with vertebral spine fractures. ⋯ We observed a significant correlation not only between S100B serum levels and vertebral spine fractures but also between S100B serum levels and SCIs with neurologic deficit. These results may be meaningful in clinical practice and to future studies.
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C5 palsy is a debilitating postoperative complication of cervical decompression surgery. Although the prognosis is typically good, patients may be unable to perform basic activities of daily living, resulting in a decreased quality of life. No studies have investigated the quality-of-life and financial implications. ⋯ This study represents the first quantification of the impact of C5 palsy on patients' quality of life and the associated costs for care. We found that C5 palsy adds a significant burden on patients' quality of life and presents a financial burden to the health-care system.