Nonoperative Management of Chronically Subluxated Bilateral Cervical Facets with Bony Fusion: A Case Report.

CASE: We describe a case of a 65-year-old woman with bilateral chronically subluxated C6 to 7 facets with facet fusion, who presented for care for the first time 1 year after a motor vehicle accident. The patient was minimally symptomatic at the time of her evaluation; thus, nonoperative treatment was provided. At 3-year follow-up, our patient remained minimally symptomatic with no progression of neurologic deficits. CONCLUSION: Consistent with previous reports, conservative management was used rather than surgical fusion in a patient with stable osseous fusion complexes and minimal neurologic symptoms.

Superior Cluneal Nerve Stimulator Lead Displacement to the Thigh: A Case Report and Management Recommendations.

CASE: An 82-year-old man with a history of lumbar spinal stenosis and prior laminectomy presented with chronic lower back pain and was treated with placement of bilateral superior cluneal nerve stimulators. At the 2-week follow-up, the patient reported loss of efficacy and new-onset paresthesia of the left lower extremity. Fluoroscopic evaluation revealed lead breakage and distal migration of the left-sided stimulator lead to the left anteromedial thigh. CONCLUSION: Lead breakage and migration remains a challenge in peripheral nerve stimulation. This report illustrates the case of a nerve stimulator lead breakage and migration resulting in treatment failure and new-onset sensory disturbance.

A Rare Streptomyces griseus Infection of the Sacroiliac Joint: A Case Report.

A previously healthy 26-year-old female presented with one month of worsening low back pain radiating to the right lower extremity. Magnetic resonance imaging (MRI) without contrast of the lumbar spine demonstrated enhancement of the right sacroiliac joint. Sacroiliac joint aspiration followed by culture and microbiology revealed Streptomyces griseus as the cause of infectious sacroiliitis. Streptomyces griseus is a part of the normal human flora that produces a plethora of secondary metabolites applied in various medications such as streptomycin. This represents the first described case of infectious sacroiliitis due to Streptomyces griseus in the literature. It is critical for spinal surgeons to consider fastidious organisms, such as Streptomyces griseus, on the differential diagnosis of sacroiliac joint pain, especially in patients with systemic symptoms and elevated inflammatory laboratory markers.

The pathomechanics, pathophysiology and prevention of cervical spinal cord and brachial plexus injuries in athletics.

Cervical spinal cord injuries may occur with catastrophic sequelae (e.g. quadriplegia) in collision sport activities. The discovery was made that the head-down tackling technique in football straightens the spine into a position vulnerable for compression and, thus, is responsible for these incidents. This led to rule changes requiring head-up tackling, which in turn resulted in the reduction of the incidence of these injuries. However, the dramatic initial reduction in the occurrence - from 32 and 34 catastrophic injuries in 1975 and 1976, respectively, down to 12 in 1977 - has levelled off with ten and eight reported cases in 2006 and 2007, respectively. The football community has increased their efforts to prevent head-down tackling with additional rule changes. Brachial plexus injury prevention must rely on properly fitted shoulder pads and use of equipment such as 'cowboy' collars. Furthermore, physicians must take into consideration cervical cord neurapraxia, congenital stenosis and other risk factors in patients who wish to return to contact sports.

An electromyographic assessment of the "bear hug": an examination for the evaluation of the subscapularis muscle.

PURPOSE: The lift-off and belly-press tests are common tests for evaluation of the subscapularis. We compared these tests with the recently developed bear-hug test by assessing electromyographic (EMG) activity of the shoulder internal rotators during examination. METHODS: Twenty-one healthy male volunteers (mean age, 22.95 +/- 3.71 years; mean weight, 73.48 +/- 6.93 kg; mean height, 68.76 +/- 2.26 cm) with no previous history of shoulder surgery or injury participated in the study. Fine-wire and surface EMG activity of the glenohumeral joint internal rotators (i.e., upper and lower subscapularis, pectoralis major, and latissimus dorsi) was recorded while 5 subscapularis tests were being performed (bear hug at 0 degrees, 45 degrees, and 90 degrees; lift off; and belly press). Peak EMG values were normalized to the maximum voluntary isometric contraction (MVIC) for each muscle. A 4 (muscle) x 5 (test) analysis of variance with repeated measures on test was used to analyze peak EMG activity (percentage of maximum voluntary isometric contraction). Follow-up univariate analysis of variance and Tukey post hoc analyses were performed for each of the 5 tests. RESULTS: The bear-hug test performed at 45 degrees of shoulder flexion showed significantly greater peak EMG activity in the upper subscapularis (107.64% +/- 63.52%) and lower subscapularis (85.75% +/- 64.69%) compared with the pectoralis major (41.43% +/- 25.42%) and latissimus dorsi (20.32% +/- 15.70%) (P < .05). The bear-hug test performed at 90 degrees of shoulder flexion showed significantly greater peak EMG activity in the lower subscapularis (166.0% +/- 132.71%) compared with the upper subscapularis (97.23% +/- 70.78%), pectoralis major (50.63% +/- 29.60%), and latissimus dorsi (17.56% +/- 13.64%) (P < .05). The belly-press test showed significantly greater peak EMG activity in the upper subscapularis (77.88% +/- 53.23%) and lower subscapularis (71.82% +/- 46.49%) compared with the pectoralis major (18.49% +/- 14.85%) and latissimus dorsi (34.85% +/- 27.73%) (P < .05). CONCLUSIONS: The bear-hug examination performed at 45 degrees of shoulder flexion and the belly-press test may be valuable diagnostic tools in the clinical evaluation of the upper subscapularis muscle. In addition, the bear-hug test at 90 degrees of shoulder flexion may be a valuable diagnostic tool in assessing the clinical function of the lower subscapularis. CLINICAL RELEVANCE: The bear-hug examination performed at specific degrees of shoulder flexion may be a valuable way to assess the function of the subscapularis muscle.