ABSTRACT
Posterior spinal incisions that are made through skin and have been compromised by radiation or prior incisions can be difficult to obtain stable closure. In addition, if a wound has developed a postoperative infection or wound dehiscence caused by poor wound healing, severe complications can develop. The technique of expanding adjacent normal skin with implantable tissue expanders has been used in select cases with success. The techniques and indications for tissue expansion in posterior lumbar wounds is reviewed and several case reports presented.
Subject(s)
Spinal Diseases/surgery , Surgical Wound Dehiscence/surgery , Surgical Wound Infection/surgery , Tissue Expansion Devices , Adult , Child , Cicatrix/surgery , Female , Humans , Male , Middle Aged , Necrosis/etiology , Reoperation , Skin/pathology , Spinal Fusion/adverse effects , Surgical Wound Dehiscence/etiology , Surgical Wound Dehiscence/prevention & control , Surgical Wound Infection/etiology , Surgical Wound Infection/prevention & control , Tissue Expansion Devices/adverse effectsABSTRACT
Back pain questionnaires were completed by a study group of 103 idiopathic scoliosis patients fused with Harrington rods from L3 or lower and a control group of 29 patients fused to L2 or above. Minimum time to follow-up examination was 2 years. The study group had a higher rate of secondary surgeries for complications or late disc disease below the fusion, a higher back pain score, more difficulties with normal daily activities, needed more regular pain medications, and had more episodes of back pain. Patients older than 30 years at surgery had more of these problems if fused to L3 or more caudally. The amount of remaining lumbar lordosis correlated significantly with the difficulty of normal daily activities.
Subject(s)
Back Pain/etiology , Lumbar Vertebrae , Scoliosis/surgery , Spinal Fusion/adverse effects , Activities of Daily Living , Adolescent , Adult , Age Factors , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
Prior irradiation and scarring can complicate wound closure following spinal surgery. Implanted tissue expanders were used six times in four patients to aid skin closure. Three patients had prior irradiation for cancer, and one had myelomeningocele. The average interval between placement and removal of the expanders was 46 days. Two late failures occurred because of prominent hardware. These expanders may provide adequate myocutaneous covers following spinal surgery in difficult cases.
Subject(s)
Postoperative Complications/prevention & control , Spine/surgery , Tissue Expansion Devices , Adult , Child , Female , Humans , Laminectomy/adverse effects , Male , Middle Aged , Radiation Injuries/complications , Radiation Injuries/therapyABSTRACT
Gaucher's disease is an uncommon lipid storage disease sometimes associated with bone pain that can mimic an acute pyarthrosis or osteomyelitis. A case report with two incidences of pseudo-osteomyelitis with two-year follow-up is presented along with a literature review. Recommendations for evaluation and differentiation from a true infection are given. In general a needle biopsy for culture is preferable to any open biopsy or drainage if the diagnosis is in doubt.
Subject(s)
Gaucher Disease/complications , Osteomyelitis/complications , Adolescent , Bone and Bones/diagnostic imaging , Diagnosis, Differential , Humans , Male , Osteomyelitis/diagnosis , Osteomyelitis/diagnostic imaging , RadiographyABSTRACT
We have presented an overview of basic orthopedic rehabilitative exercises, techniques, and modalities. As our athletic population has become more insistent on performance enhancement techniques, the orthopedic surgeon has adopted a more aggressive approach to rehabilitation of the injured athlete. Many of the rehabilitation techniques and modalities outlined are very inexpensive and require little space; others are very expensive and space-demanding. As our knowledge base expands, we hope we will be able to apply these scientific principles toward better treatment of the injured athlete.
