The spine journal : official journal of the North American Spine Society
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Recently the financial relationships between industry and professional medical associations have come under increased scrutiny because of the concern that industry ties may create real or perceived conflicts of interest. Professional medical associations pursue public advocacy as well as promote medical education, develop clinical practice guidelines, fund research, and regulate professional conduct. Therefore, the conflicts of interest of a professional medical association and its leadership can have more far-reaching effects on patient care than those of an individual physician. ⋯ The NASS experience can provide a template for other professional medical associations to help manage their own possible conflicts of interest issues.
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Recent research describes the use of a nerve root sedimentation sign to diagnose lumbar spinal stenosis (LSS). The lack of sedimentation of the nerve roots (positive sedimentation sign) to the dorsal part of the dural sac is the characteristic feature of this new radiological parameter. ⋯ The sedimentation sign is a new measurement tool that can enable physicians to objectively assess and quantify spinal stenosis. The sign is most often present in patients who have clinically significant lumbar stenosis and require surgery.
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In patients with structural lumbar curves, several studies have shown the advantages of stopping fusion at L3 and saving L4. However, fusing the L4 may still be deemed necessary in a significant number of patients with structural lumbar curves (ie, Lenke types 3 and 6) when fusion levels are selected by using traditional flexibility X-ray (TXR) methods such as supine side bends and traction. ⋯ TrUGA may be an alternative method for selection of fusion levels and may help to save L4 when compared with traditional radiograph methods in surgical treatment of Lenke types 3 and 6 curves.
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Posterior spine fusion is associated with significant intra- and postoperative blood losses. When referring to the total blood loss during spine surgery, the standard is to measure the intraoperative bleeding plus the postoperative drainage. This ignores the "hidden" blood loss that was found to be significant in other fields of surgery. ⋯ After posterior spinal fusion, there may be a large amount of the hidden blood loss.
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Human recombinant bone morphogenetic protein-2 (BMP-2) is commonly used in spinal surgery to augment arthrodesis, and a number of potential complications have been documented. ⋯ This is the first reported case of a symptomatic calcified perineural cyst developing after a fusion procedure in which BMP-2 was used. The presence of connective tissue with metaplastic bone formation and maturation within the lesion suggests that formation of the cyst was secondary to application of BMP-2, as it possesses both osteogenic and chondrogenic capabilities.