The spine journal : official journal of the North American Spine Society
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The integrity of the posterior ligamentous complex (PLC) has been proposed to be an integral aspect in the treatment algorithm for spinal trauma. Magnetic resonance imaging (MRI) has been reported as the ideal tool to determine the integrity of the PLC. The ability to assess disruption of the PLC by reviewers of differing levels of training has not been described. In addition, the MRI sequence most suggestive of injury for each component of the PLC has not been clearly determined. ⋯ The interpretation of traumatic MRI is very sensitive and accurate regardless of years of training of the observer. The attending-level spine surgeon was statistically more specific in the evaluation of injury MRIs. The fluid-weighted STIR sagittal sequences are most useful in determining injury to the SSL, ISL, LF, and cervical facets capsules. Lumbar facet capsules are best evaluated with axial T2 MRI. The evaluation of the PLC on MRI can be accurately and efficiently interpreted by physicians at multiple levels of training, thus providing a key imaging modality in determining stability and need for stabilization.
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Several fusion techniques are used to treat atlantoaxial instability. Recent literature suggests that intralaminar screw (LS) fixation and pedicle screw (PS) fixation offer similar stability and comparable pullout strength. No studies have compared these characteristics after cyclic loading. ⋯ Our data suggest that a C1LM and C2LS construct has similar biomechanical stability when compared with a C1LM and C2PS construct after 1,000 cycles of axial rotation. Furthermore, PSs had higher pullout strength when compared with LSs; however, this result was not statistically significant.
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Despite improvements through the use of prophylactic systemic antibiotics, surgical site infections remain a significant problem in the treatment of traumatic spine injuries. Infection rates as high as 10% have been reported in this population. The impact on patients and cost of treating such infections is profound. Local delivery of antibiotics has been found to be efficacious in animal and human studies as an adjunct to systemic antibiotics in surgical site infection prophylaxis. ⋯ The use of vancomycin powder in surgical wounds may significantly reduce the incidence of infection in patients with traumatic spine injuries treated with instrumented posterior spine fusion. Applying vancomycin powder to surgical wounds is a promising means of preventing costly and harmful postoperative wound infections in high-risk populations.