The spine journal : official journal of the North American Spine Society
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Case Reports
A novel alternative for removal of the AxiaLif (TranS1) in the setting of pseudarthrosis of L5-S1.
Minimally invasive spine surgery continues to be a growing trend for orthopedic and neurosurgical spinal interventions. Technological advances have allowed surgeons to perform L5-S1 fusions via posterolateral or anterior approaches through less invasive techniques. The development of the AxiaLIF system (TranS1, Inc., Wilmington, NC) is predicated on the application of minimally invasive techniques to attain fusion at L5-S1 and L4-S1 levels with a novel corridor of approach, described as the presacral "safe zone." ⋯ This novel technique of avoiding a scarred down presacral corridor in the hands of surgeons unfamiliar with the technique allows for safe removal of the AxiaLif (TranS1) implant coupled with revision to anterior lumbar interbody fusion through the same incision.
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Lumbar facet joint synovial cysts are benign degenerative abnormalities of the lumbar spine. Previous reports have supported operative and nonoperative management. Facet joint steroid injection with cyst rupture is occasionally performed, but there has been no systematic evaluation of this treatment option. ⋯ This study presents the largest clinical series of nonsurgical treatment for lumbar facet joint synovial cysts. Lumbar facet joint steroid injection with attempted cyst rupture is correlated with avoiding subsequent surgery in half of treated patients. Successful cyst rupture does not appear to have added benefit, and it was associated with worse disability 3 years postinjection. Long-term outcomes are similar, regardless of subsequent surgery.
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Case Reports
Salmonella osteomyelitis of multiple ribs and thoracic vertebra with large psoas muscle abscesses.
Salmonella vertebral osteomyelitis is a well-known complication of sickle cell disease. However, it has been infrequently reported in immunologically normal people or diabetic patients. ⋯ Vertebral osteomyelitis caused by Salmonella is uncommon in diabetic patients. Salmonella can cause multiple bone infections and large abscesses of psoas muscles in patients without sickle cell disease. Correct diagnosis can be confirmed by blood, biopsy, or abscess culture. Appropriate antibiotic treatment was effective.
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Morbidity associated with autologous bone graft harvest is an important factor in determining the utility of expensive alternatives such as recombinant bone morphogenic protein. The most frequently reported complication associated with graft harvest is chronic pain. ⋯ There is a significant rate of persistent pain and morbidity from iliac crest bone graft harvest when associated with elective spine surgery. Mean pain scores progressively decline over the first postoperative year. Nevertheless, harvest site pain remains functionally limiting in a significant percentage of patients 1 year after surgery. Rates of functional limitation are higher than previously reported and may be because of increased sensitivity of the prospective study design and targeted investigation of these specific symptoms. Validity of these findings is necessarily limited by patient ability to discriminate harvest site pain from alternative sources of back and buttock pain.
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Biomechanical studies have demonstrated increased motion in motion segments adjacent to instrumentation or arthrodesis. The effects of different configurations of hook and pedicle screw instrumentation on the biomechanical behaviors of adjacent segments have not been well documented. ⋯ The use of sublaminar hooks to stabilize the motion segment above a circumferential lumbar fusion reduced motion at the next cephalad segment compared with a similar construct using pedicle screws. The semiconstrained hook enhancement may be considered if a patient is at a risk of adjacent segment disorders.