Multiple cervical spinous process fractures in a novice golf player.

Avulsion of spinous process, also called Clay-shoveler's fracture, is most prevalent among those engaged in hard physical labor. To the best of the author's knowledge, only one case of multiple spinous process fractures of the upper thoracic spine in a novice golfer has been reported. A 45-year-old female presented with intractable posterior neck pain. The patient experienced a sharp, sudden pain on the neck while swinging a golf club, immediately after the club head struck the ground. Dynamic cervical radiographic findings were C6 and C7 spinous process fractures. Magnetic resonance imaging revealed C6 and C7 spinous process fractures without spinal cord pathology. The patient was treated with pain medications and cervical bracing. The patient's pain gradually improved. The injury mechanism was speculated to be similar to Clay-shoveler's fracture. Lower cervical spinous process fractures can be associated with a golf swing. If the patient complains of long lasting neck pain and has a history of golf activity, further study should be conducted to rule out lower cervical spinous fracture.

Characterization of Enterococcus spp. from human and animal feces using 16S rRNA sequences, the esp gene, and PFGE for microbial source tracking in Korea.

Contamination from human and animal fecal waste is a primary cause of water pollution. Microbial source tracking (MST) may be a useful tool for high-quality environmental management and for assessing human health risks associated with water pollution. The goal of this study was to evaluate Enterococcus spp. as a target organism for MST. Thirty-four fecal samples were collected from five different sources (human, chicken, pig, cow, and goose) in South Korea. In total, 237 Enterococcus spp. were isolated from feces using membrane- Enterococcus indoxyl-beta-d-glucoside agar. The 16S rRNA gene and the whole genome were analyzed using nucleic acid sequencing and pulsed-field gel electrophoresis (PFGE), respectively. Both phylogenetic analysis and principal coordinate analysis using UniFrac were performed on the nucleic acid sequences of the 16S rRNA gene. According to P-tests from UniFrac, significant differences existed between Enterococcus spp. isolated from human feces and those from animal feces. In addition, we evaluated whether the esp gene of Enterococcus faecium could be a specific target for Enterococcus spp. isolated from human feces. Of 58 E. faecium isolates tested, only three were esp-positive. The specificity of the esp gene of E. faecium isolated from human feces was 100%, but the sensitivity was <10%. These results suggest that Enterococcus spp. have different molecular characteristics according to their fecal source and that these characteristics can be further identified by analyzing the esp gene and 16S rRNA sequences, whereas PFGE provides limited information on the fecal sources of Enterococcus spp.

Molecular characterization of bacteriophages for microbial source tracking in Korea.

We investigated coliphages from various fecal sources, including humans and animals, for microbial source tracking in South Korea. Both somatic and F+-specific coliphages were isolated from 43 fecal samples from farms, wild animal habitats, and human wastewater plants. Somatic coliphages were more prevalent and abundant than F+ coliphages in all of the tested fecal samples. We further characterized 311 F+ coliphage isolates using RNase sensitivity assays, PCR and reverse transcription-PCR, and nucleic acid sequencing. Phylogenetic analyses were performed based on the partial nucleic acid sequences of 311 F+ coliphages from various sources. F+ RNA coliphages were most prevalent among geese (95%) and were least prevalent in cows (5%). Among the genogroups of F+ RNA coliphages, most F+ coliphages isolated from animal fecal sources belonged to either group I or group IV, and most from human wastewater sources were in group II or III. Some of the group I coliphages were present in both human and animal source samples. F+ RNA coliphages isolated from various sources were divided into two main clusters. All F+ RNA coliphages isolated from human wastewater were grouped with Qbeta-like phages, while phages isolated from most animal sources were grouped with MS2-like phages. UniFrac significance statistical analyses revealed significant differences between human and animal bacteriophages. In the principal coordinate analysis (PCoA), F+ RNA coliphages isolated from human waste were distinctively separate from those isolated from other animal sources. However, F+ DNA coliphages were not significantly different or separate in the PCoA. These results demonstrate that proper analysis of F+ RNA coliphages can effectively distinguish fecal sources.

Anterior lumbar interbody fusion for lumbosacral junction in steep sacral slope.

STUDY DESIGN: Retrospective study of surgical technique and clinical outcome. OBJECTIVES: To examine the technique and outcomes of anterior lumbar interbody fusion (ALIF) surgery for a lumbosacral junction in a steep sacral slope. SUMMARY OF BACKGROUND DATA: There are no studies on the outcome and technical pitfalls on ALIF surgery for a lumbosacral junction in a steep sacral slope. MATERIALS AND METHODS: Six female patients (mean age of 55.67 y; range, 42 to 69) who had a steep sacral slope underwent ALIF surgery for degenerative (2 patients) and spondylolytic (4 patients) spondylolisthesis. The average follow-up duration was 29.33 months (range, 27 to 33 mo). The following parameters were used to assess the outcomes: slip angle, slip percentage, sacral inclination, lumbosacral angle, sacral slope, and distance from the upper margin of the pubis symphysis to the sacral plane. The level of pain was measured using the visual analog pain scale score. The function was assessed using the Oswestry Disability Index (ODI) score. Satisfaction surveys were also carried out. Statistical analysis was performed using a Friedman test. A P value <0.05 was considered significant. RESULTS: The mean sacral inclination, lumbosacral angle, sacral slope, and distance from the upper margin of the pubis symphysis to the sacral plane were 37.34 degrees (range, 28.55 to 48.92 degrees), 12.20 degrees (range, 5.09 to 16.5 degrees), 40.70 degrees (range, 30.54 to 49.98 degrees), and 22.06 cm (range, 16.13 to 29.72 cm), respectively. The mean correction of slip percentage and slip angle was 35.46%, and 9.3 degrees, respectively. The mean visual analog pain scale score decreased from 8.5 (back pain) and 7.3 (leg pain) to 1.8 (back pain) and 1.8 (leg pain) after surgery (P=0.001). The mean ODI scores also reflected the improved status (ODI of 64.7 before surgery to 8.5 after surgery; P=0.001). The patient's satisfaction was relatively high. All the patients had radiographically solid fusion at the latest follow-up. There were no significant complications encountered in this study. CONCLUSIONS: In selected cases, a steep sacral slope may not be an absolute contraindication of ALIF. Moreover, the C-arm-guided reduction and cage insertion method is a reliable way of treating spondylolisthesis in those with a steep sacral slope.

Venovertebral vein: morphometric analysis and significance for the transabdominal spine surgeon.

STUDY DESIGN: Prospective intraoperative findings review. OBJECTIVES: To describe the surgical anatomy of the innominate vessel, venovertebral vein, and consider its significance for transabdominal surgery. BACKGROUND DATA: It has not described in any anatomy textbook or reported papers. MATERIALS AND METHODS: In 50 patients who underwent anterior lumbar interbody fusion or total disc replacement, we found venovertebral vein in 37 patients (74%). The connection between venovertebral vein and the left common iliac vein was studied to determine where the venovertebral vein drained, and its relationship to the iliolumbar vein and middle sacral vein. All parameters were measured with vernier caliper and divider. RESULTS: All of the veins studied drained into the posterior margin of the left common iliac vein from the L5 vertebral body and were located between the iliolumbar vein and the middle sacral vein. The diagonal-vertical direction to the vertebral endplate was 64.8% (n=24). The mean diameter of venovertebral veins was 2.24+/-0.74 mm (range 1.0 to 3.8 mm). The mean length was 12.71+/-5.71 mm (range 5.45 to 35.10 mm). The distance from the L5 vertebral upper endplate to its origin ranged from 6.05 to 21.25 mm, with a mean of 12.51+/-3.36 mm. The distance of the 37 venovertebral veins studied from the middle sacral vein ranged from 0 to 10.6 mm, with a mean of 5.75+/-2.90 mm. The distance from the iliolumbar vein ranged from 14 to 38 mm, with a mean of 22.65+/-5.44 mm. The venovertebral vein was found to be closer to the middle sacral vein than to the iliolumbar vein statistically (P<0.05). CONCLUSIONS: The surgeon performing transabdominal spine surgery especially at the L4-5 level must remain alert to the existence of this innominate vein.