The spine journal : official journal of the North American Spine Society
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Several studies report a favorable short-term outcome after nonoperatively treated two-column thoracic or lumbar burst fractures in patients without neurological deficits. Few reports have described the long-term clinical and radiological outcome after these fractures, and none have, to our knowledge, specifically evaluated the long-term outcome of the discs adjacent to the fractured vertebra, often damaged at injury and possibly at an increased risk of height reduction and degeneration with subsequent chronic back pain. ⋯ Nonoperatively treated burst fractures of the thoracic or lumbar spine in adults with or without minor neurological deficits have a predominantly favorable long-term outcome, and there seems to be no increased risk for subsequent disc height reduction in the adjacent discs.
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Anterior cervical plates are commonly used to provide immediate stabilization after a variety of cervical spine procedures. It has been assumed that the ideal position for anterior cervical spine plates is centered in the horizontal plane without significant angulation and without overlap of adjacent unfused levels. Nevertheless, postoperative radiographs often demonstrate actual plate position to be lateralized, rotated, or encroaching on the adjacent disc space. There have been no reported systematic studies examining the effect of variations in plate position in a large clinical population. ⋯ The use of anterior cervical plating by experienced spine surgeons is associated with variation in terms of plate position on postoperative radiographs. Within the range of positions analyzed in this study, no significant association was found between lateralized or rotated plates or plates placed in proximity to adjacent disc spaces and worse short-term clinical outcomes. It should be emphasized that these results and conclusions are based on relatively short-term clinical follow-up and that the long-term effects of variation in implant position remain unknown.
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Different atlantoaxial fusion techniques are used for instability. Transarticular screws are biomechanically superior to wiring techniques and equivalent to C1 lateral mass to C2 pedicle (C1LM-C2P) fixation. Recently, C1 lateral mass to C2 laminar (C1LM-C2L) fixation has been shown to have flexibility similar to C1LM-C2P fixation in flexion, extension, lateral bending, and axial rotation. ⋯ C1LM-C2P fixation is equivalent to C1LM-C2L fixation in flexion/extension and AP translation and superior in lateral bending and axial rotation.
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Spinal epidural abscess is an uncommon infection. There are few reports on extensive epidural abscesses. ⋯ A case of an extensive epidural abscess was successfully treated with limited laminectomies and antibiotics. This less invasive technique could treat the infection, and no late deformity has been observed.
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Paragangliomas are neuroendocrine tumors that most frequently arise in the adrenal medulla, carotid body, and glomus jugulare. However, they have been reported in many other sites throughout the body. Within the central nervous system, the overwhelming majority of paragangliomas arise intradurally in the area of the cauda equina. We report a case of a woman who presented with back pain and radiculopathy and was found to have an intraosseous sacral mass on magnetic resonance imaging (MRI). Operative biopsy revealed that this lesion was a paraganglioma. Chest, abdomen, and pelvis computed tomography scans revealed no other tumors. This lesion was treated with limited resection, decompression, stabilization, and radiation therapy. ⋯ Only two cases of primary intraosseous sacral paragangliomas were reported in the past. We believe that paragangliomas should be included in the differential diagnosis of intraosseous sacral tumors. Optimal treatment of the lesions can be difficult because of their hypervascular nature and the high morbidity associated with complete surgical resection. Treatment should combine preoperative embolisation, surgical resection if possible, and radiation therapy.