Single-Position Synchronal Management of Metastatic Prostate Cancer of the Spine and Femur Using Prone Nailing: A Case Report.

CASE: A 71-year-old man with castration-resistant Stage IVB prostate cancer developed symptomatic oligometastatic disease in the lumbar spine and bilateral proximal femurs. He was treated with a single-position L2-L4 kyphoplasty with concomitant prone left-sided femoral prophylactic cephalomedullary nailing. Six months later when he again lost the ability to ambulate, he was treated with a single-position L4-L5 laminectomy for an epidural tumor with prone right-sided femoral prophylactic cephalomedullary nailing. CONCLUSION: Single-position prone surgery of the spine and prone femoral nailing is feasible and improves on traditional multiposition approaches, eliminating the need to reposition or change tables during management.

Case report: Multiple sclerosis diagnosis after anterior lumbar interbody fusion and presumed COVID-19 infection.

Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system that may present with a wide variety of clinical presentations. However, there can be substantial overlap between symptoms from MS and those caused by lumbar spondylosis and/or postviral plexopathies. Case Description: A 33-year-old female with a history of an L5-S1 anterior lumbar interbody fusion and exposure to the SARS-CoV-2 virus developed postoperative worsening of her symptoms interpreted as "radiculopathy." Despite a subsequent L5-S1 fusion, she continued to neurologically deteriorate and was ultimately diagnosed with MS. Conclusion: The initial symptoms/signs of MS may mimic lumbar radiculopathy and or postviral plexopathy (i.e., due to recent COVID-19). This report should serve as a warning to future spinal surgeons to better differentiate between radicular and other "complaints," sufficient to avoid unnecessary repeated spinal surgery.

Posterior resection of sacral osteosarcoma utilizing cement-infused chest tube interbody reconstruction and lumbopelvic fusion.

BACKGROUND: Primary osteosarcoma (OS) of the spine is very rare. En bloc resection of spinal OS is challenging due to anatomical constraints. Surgical planning must balance the benefits of en bloc resection with its potential risks of causing a significant neurological deficit. In this case, we successfully performed a posterior-only approach for decompression with S1 reconstruction via a cement-infused chest tube interbody device, along with a navigated L4 to pelvis fusion. CASE DESCRIPTION: A 49-year-old female presented with a primary sacral OS. Computed tomography (CT) and magnetic resonance (MR) imaging revealed an S1 lytic vertebral body lesion with severe stenosis and progressive L5 on S1 anterior subluxation. Surgical decompression with tumor resection and S1 corpectomy with S1 reconstruction via a cement-infused 32-French chest tube interbody device accompanied by L4 -pelvis fusion utilizing S2-alar-iliac screws was completed. 6 months postoperatively, the patient continues to have significant pain relief and the instrumentation remains intact. CONCLUSION: A 49-year-old female with an S1 OS successfully underwent a posterior-only approach that included an S1 corpectomy with anterior column reconstruction via a cement-infused chest tube interbody plus a navigated L4 to pelvis fusion.

Discovery of thoracic osteoma after elective lumbar spinal surgery: a case report.

Osteoma is a benign, bone-producing tumor typically found within the skull. Rare case reports have been identified within the spine, and even fewer have been identified in the thoracolumbar region. When present, these benign tumors usually present during the second and third decade of life. A history of trauma is usually present and may trigger neurologic symptoms. The authors report a case of a thoracic osteoma discovered incidentally after lumbar spinal surgery where symptoms of the intra-canal osteoma were believed to be incited by the primary decompression. Pathology results from resection of the mass revealed it to be an osteoma, though the diagnosis was not suspected at the time of the operation. Recurrence of neurological deficit after excision of symptomatic osteoma is rare. In the follow-up period, our patient has remained asymptomatic. The pertinent literature regarding spinal osteomas is reviewed.

Development of Postoperative Spinal Arteriovenous Fistula After Lumbar Laminectomy, Decompression, and Posterior Spinal Fusion.

Spinal dural arteriovenous fistulas are a rare cause of low back pain, bilateral lower extremity weakness, or pain with sensory changes. They are typically found in males in the fifth and sixth decades of life, associated with a progressive decline in symptoms that make initial diagnosis challenging in some patients. We present a case report and literature review of an 80-year-old woman with a long-standing history of progressively worsening back pain and lower extremity pain that has limited her daily activities. When preoperative MRI of the lumbar spine showed high-grade stenosis and listhesis of L4-L5, the patient was taken to the operating room for an L4-L5 laminectomy, decompression, facetecomy, and instrumented fusion. Her postoperative course did not show improvement of symptoms, which in fact worsened, leading to gait imbalance and instability. Postoperative MRIs of the patient were concerning for a spinal dural arteriovenous fistula, which was confirmed and treated by spinal angiography and embolization.

Efficacy of linezolid versus vancomycin in the treatment of methicillin-resistant Staphylococcus aureus discitis: a controlled animal model.

STUDY DESIGN: A rabbit model was used to assess the efficacy of linezolid and vancomycin for the treatment of discitis due to methicillin-resistant Staphylococcus aureus (MRSA). Nontreated controls were used for comparison. OBJECTIVE: The purpose of this study was to determine if there was a therapeutic difference between using linezolid and vancomycin in the treatment of MRSA discitis. SUMMARY OF BACKGROUND DATA: Vancomycin is currently the gold standard treatment for medical management of MRSA discitis. Linezolid is a relatively new drug that has been approved for treatment of MRSA infections, but currently there is no research demonstrating its efficacy at treating infections of the disc space. METHODS: Twenty-four rabbits were inoculated with MRSA at two adjacent lumbar disc spaces via an anterior retroperitoneal approach. Six rabbits were to receive only pain medication and to serve as controls. Ten rabbits were assigned to a 5-day course of intravenous vancomycin, and 8 were assigned to a 5-day course of intravenous linezolid. Disc spaces were sent for quantitative culture after the 5-day treatment course. RESULTS: The mean culture growth for the disc spaces was not statistically different between the linezolid treated group and the nontreated controls. While vancomycin treatment did lead to lower bacterial loads when compared with controls, the reduction was not statistically significant. When bacterial counts for the vancomycin group and linezolid group were compared, vancomycin treatment resulted in less bacterial growth. This difference was statistically significant. CONCLUSIONS: Linezolid is a clinically attractive alternative to vancomycin due to its mild side effect profile and oral bioavailability. However, in this MRSA discitis model with a short treatment course, vancomycin was superior to linezolid.