Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures.

OBJECTIVES: Document initial outcomes of balloon kyphoplasty. DESIGN: Retrospective analysis of the first 52 patients with 82 painful vertebral body compression fractures secondary to osteoporosis treated at our institution. SETTING: Operation on subacute painful fractures with office follow-up. PATIENTS/PARTICIPANTS: First 82 fractures in 52 patients treated. All patients had failed nonoperative treatment and had magnetic resonance imaging scans documenting edematous changes of the vertebral body. Forty-nine out of 52 patients presented for follow-up at an average of 37 weeks. INTERVENTION: Minimally invasive balloon reduction via bilateral transpedicular or extrapedicular approaches followed by polymethyl methacrylate fixation. MAIN OUTCOME MEASURES: Vertebral body height, Cobb angle, visual analogue pain scale, Roland-Morris Disability Survey, and complication rate. RESULTS: Mean length of follow-up was 9 months (37 weeks, range 4-99 weeks); improved height 4.6 and 3.9 mm in the anterior and medial columns, respectively (P > 0.05); Cobb angle increased 14% (P < 0.05), visual analogue pain scale score improved 7 points (P < 0.05); Roland-Morris Disability Survey improved 11 points (P < 0.05); no adverse medical or procedural complications; 9.8% cement leakage rate. CONCLUSION: Balloon kyphoplasty safely improves vertebral body height and patient quality of life.

Recurrent transverse myelitis after lumbar spine surgery: a case report.

STUDY DESIGN: A case of recurrent idiopathic transverse myelitis occurring after surgery is reported. OBJECTIVES: To present a case of idiopathic transverse myelitis recurring after surgery and to heighten awareness for the diagnosis and management of this disorder. SUMMARY AND BACKGROUND DATA: Transverse myelitis presenting with acute spinal pain and neurologic deficit must be considered along with structural causes of myelopathy by the spine specialist. This intramedullary spinal cord disorder may be caused by parainfectious and postvaccinal sequelae, multiple sclerosis, spinal cord ischemia, autoimmune disorders, and paraneoplastic syndromes. These various etiologies are often difficult to differentiate. However, a patient's history, clinical course, MRI studies, and laboratory findings often allow such classification. Determination of etiology provides pertinent information regarding potential recurrence, treatment, and prognosis. METHODS: The patient history, physical examination, radiologic and laboratory studies, and pertinent literature were reviewed. RESULTS: Thoracolumbar myelitis developed in the reported patient 6 weeks after lumbar spine surgery during an otherwise uncomplicated postoperative recovery. The workup did not identify a specific cause, and the patient recovered to ambulatory status. However, 4 months after surgery, acute transverse myelitis developed again, this time affecting the cervical spinal cord. Despite aggressive intervention with corticosteroids, the patient has remained nonambulatory with severe neurologic residua. In spite of an extensive workup, a definitive cause was not determined, although an autoimmune etiology was suspected. The patient has stabilized without recurrence using immunosuppressant therapies. CONCLUSIONS: Acute transverse myelitis is an intramedullary spinal cord disorder that may present to the spine specialist during the postoperative period. This diagnosis requires swift and aggressive diagnostic and treatment intervention. Although sometimes difficult, establishment of causation may help to determine therapy and prognosis.

Acute neurologic deficit associated with a posterior cervical drain: a case report.

STUDY DESIGN: Descriptive. OBJECTIVES: To document a rare complication involving the use of a wound drain after cervical laminectomy. SUMMARY OF THE BACKGROUND DATA: No previous reports describe spinal cord compression by a surgical drain resulting in a neurologic deficit. Most texts recommend the use of a drain following this procedure. METHODS: An 80-year-old female underwent cervical laminectomy for myelopathy with initial improvement in symptoms. Approximately 6 hours following surgery, she developed acute onset of quadriparesis when repositioning in bed. Magnetic resonance imaging revealed cord compression by the surgical drain, which was immediately removed. RESULTS: The patient experienced partial improvement of the neurologic deficit. At 18-month follow-up, left handed weakness, left leg spasticity, and neurogenic bladder persist. CONCLUSION: The development of neurologic deficits due to compression by a surgical drain can occur. This complication might be avoided by approximating the neck musculature before placement of the drain and closure of the fascia.

Intraoperative frozen section analysis in revision total joint arthroplasty.

A prospective study of the sensitivity, specificity, and predictive values for frozen sections against cultures obtained at the time of revision total joint replacement was done. One hundred twenty-one revision total joint replacements were done in 92 men and 29 women. A positive frozen section with more than 10 polymorphonuclear leukocytes per high power field was compared with the intraoperative cultures. Twenty-one patients who had revision surgery had greater than 10 polymorphonuclear leukocytes per high power field. Of these, 14 patients had positive cultures. The remaining 100 patients had less than 10 polymorphonuclear leukocytes per high power field, but seven had positive cultures. Statistical analysis of frozen sections for all total joint arthroplasties revealed a 67% sensitivity, 93% specificity, 67% positive predictive value, and 93% negative predictive value. Analysis of frozen sections for total hip arthroplasties revealed a 45% sensitivity, 92% specificity, 55% positive predictive value, and 88% negative predictive value. Analysis for total knee arthroplasties revealed 100% sensitivity, 96% specificity, 82% positive predictive value, and 100% negative predictive value. Comparisons of sensitivity, positive predictive value, and negative predictive value between total knee arthroplasty and total hip arthroplasty were significant. The results indicate that the use of intraoperative frozen section analysis with greater than 10 polymorphonuclear leukocytes per high power field as an indication of infection lacks the positive predictive value and sensitivity for accurate determination of prosthetic infection at the time of revision total hip arthroplasty. Frozen sections have an acceptable sensitivity and positive predictive value in total knee arthroplasty. The results of the current study show the limitation of using frozen sections as a diagnostic test for infection in revision total hip arthroplasty.

Upper cervical spine injuries.

The unique anatomy of the upper cervical spine and the typical mechanisms of injury yield a predictable variety of injury patterns. Traumatic ligamentous injuries of the atlanto-occipital joint and transverse atlantal ligament are relatively uncommon, have a poor prognosis for healing, and often respond best to surgical stabilization. Bony injuries, including occipital condyle fractures, atlas fractures, most odontoid fractures, and traumatic spondylolisthesis of the axis, generally respond well to nonsurgical management. Controversy in management remains, however, especially with type II odontoid fractures.