The spine journal : official journal of the North American Spine Society
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Recombinant human bone morphogenetic protein 2 (rh-BMP-2) is frequently used in an off-label fashion. Its application for posterior interbody fusion appears intuitive because its use obviates the need for iliac crest bone graft and shows higher fusion rates than with the use of local autologous bone graft. To date, there is no report of adverse outcomes with such use of rh-BMP-2. ⋯ Vertebral osteolysis can occur with the use of rh-BMP-2 in posterior lumbar interbody fusions. Violation of the end plate during decortication may be a contributing factor. Symptoms often resolve spontaneously.
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Spinal manipulation (SM) is a form of manual therapy used clinically to treat patients with low back and neck pain. The most common form of this maneuver is characterized as a high-velocity (duration <150 ms), low-amplitude (segmental translation <2 mm, rotation <4 degrees , and applied force 220-889 N) impulse thrust (high-velocity, low-amplitude spinal manipulation [HVLA-SM]). Clinical skill in applying an HVLA-SM lies in the practitioner's ability to control the duration and magnitude of the load (ie, the rate of loading), the direction in which the load is applied, and the contact point at which the load is applied. Control over its mechanical delivery is presumably related to its clinical effects. Biomechanical changes evoked by an HVLA-SM are thought to have physiological consequences caused, at least in part, by changes in sensory signaling from paraspinal tissues. ⋯ The results indicate that the duration and amplitude of a spinal manipulation elicit a pattern of discharge from paraspinal muscle spindles different from slower mechanical inputs. Clinically, these parameters may be important determinants of an HVLA-SM's therapeutic benefit.
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This injury has not been reported previously in the thoracic spine. All previous open fracture dislocations of the spine have been reported in the lumbosacral spine with three posterior and two anterior dislocations. ⋯ Open thoracic spinal fracture dislocations can be effectively treated with primary open reduction and fusion with instrumentation.