The spine journal : official journal of the North American Spine Society
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Clinical Trial
Routine insertion of the lateral mass screw via the posterior arch for C1 fixation: feasibility and related complications.
To our knowledge, there is no clinical study analyzing the feasibility and complications of the routine insertion of the lateral mass screw via the posterior arch for C1 fixation in a live surgical setting. ⋯ Routine insertion of the lateral mass screw via the C1 posterior arch was feasible in even those with a small posterior arch, ponticulus posticus, or persistent first intersegmental artery. Although cortical perforation or vertical splitting of the posterior arch was often inevitable, it did not lead to significant weakening of the fixation or nonunion. Vertical split could be minimized by overdrilling the posterior arch. Vertebral artery injury was preventable by mobilization before screw insertion. Occipital neuralgia was not uncommon but thought to be unrelated to screw placement in most cases.
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Previous studies have demonstrated significant changes in red blood cell (RBC) transfusion practice over several decades. ⋯ In this retrospective review, we report a significant change in blood management strategies in pediatric patients undergoing elective scoliosis surgery. We demonstrated a shift from utilization of allogeneic RBC transfusion toward preoperative donation and intraoperative autotransfusion. Although transfusion triggers were significantly lower in the recent practice group, we were unable to demonstrate a difference in major morbidity or mortality. Utilization of autologous RBC transfusion was safe and effective in reducing allogeneic RBC transfusions in this study. The advantages of autologous blood transfusion may be in preserving a relatively scarce resource (ie, allogeneic blood), rather than mitigating transfusion-related complications.
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Spinous process fracture is a recognized complication associated with interspinous process spacer (IPS) surgery. Although occasionally identified by plain radiographs, computed tomography (CT) appears to identify a higher rate of such fractures. Although osteoporotic insufficiency fracture is considered a contraindication for IPS surgery, a formal risk factor analysis for this complication has not previously been reported. ⋯ Degenerative spondylolisthesis appears strongly associated with the occurrence of spinous process fracture after IPS surgery. There is a trend toward increased fracture risk in patients with decreased bone mineral density as measured by both DXA scan and CT-based volume averaging of Hounsfield units, but osteoporosis appears to be a relatively weaker risk factor. The association between spondylolisthesis and fracture observed in this study may account for the relatively poorer outcome of IPS surgery in patients with spondylolisthesis that has been reported in previous series.
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Case Reports
Percutaneous cement augmentation of a lytic lesion of C1 via posterolateral approach under CT guidance.
Percutaneous vertebroplasty (PV) can provide pain relief and biomechanical stabilization of lytic metastasis of the spine in selected patients. Percutaneous vertebroplasty of the atlas has been reported in only five cases and has been performed with different techniques and approaches. ⋯ Computed tomography-guided PV of C1 lytic lesion with posterolateral approach was effective in the described case for pain control and stabilization, and it may be a therapeutic option in selected patients to avoid occipitocervical fusion. This procedure requires good understanding of the anatomy and rigorous technique to avoid potential complications.