Functional outcome of traumatic spinopelvic instabilities treated with lumbopelvic fixation.

The aim of this study was to assess the functional outcome after lumbopelvic fixation (LPF) using the SMFA (short musculoskeletal functional assessment) score and discuss the results in the context of the existing literature. The last consecutive 50 patients who underwent a LPF from January 1st 2011 to December 31st 2014 were identified and administered the SMFA-questionnaire. Inclusion criteria were: (1) patient underwent LPF at our institution, (2) complete medical records, (3) minimum follow-up of 12 months. Out of the 50 recipients, 22 questionnaires were returned. Five questionnaires were incomplete and therefore seventeen were included for analysis. The mean age was 60.3 years (32-86 years; 9m/8f) and the follow-up averaged 26.9 months (14-48 months). Six patients (35.3%) suffered from a low-energy trauma and 11 patients (64.7%) suffered a high-energy trauma. Patients in the low-energy group were significantly older compared to patients in the high-energy group (72.2 vs. 53.8 years; p = 0.030). Five patients (29.4%) suffered from multiple injuries. Compared to patients with low-energy trauma, patients suffering from high-energy trauma showed significantly lower scores in "daily activities" (89.6 vs. 57.1; p = 0.031), "mobility" (84.7 vs. 45.5; p = 0.015) and "function" (74.9 vs. 43.4; p = 0.020). Our results suggest that patients with older age and those with concomitant injuries show a greater impairment according to the SMFA score. Even though mostly favorable functional outcomes were reported throughout the literature, patients still show some level of impairment and do not reach normative data at final follow-up.

Does treadmill training with Hybrid Assistive Limb (HAL) impact the quality of life? A first case series in the United States.

Introduction: Recently published studies show remarkable improvements in functional mobility after treadmill training with HAL® in patients with spinal cord injuries. The aim of this study was to evaluate the impact of HAL®-assisted treadmill training on quality of life. Patient/Method: A case series of six patients participating in a single-centre prospective, interventional pilot study, who were suffering neurologic motor deficits. The quality of life was assessed using the EQ-5D questionnaire and mobility was assessed using the PROMIS v1.2 Physical Function - Mobility Score before treadmill training, at 12-weeks, and at 6-months. Results: Five out of six patients showed improvement in the PROMIS v1.2 Physical Function - Mobility score. Four patients did not show changes in the EQ-5D at 6 months follow-up, relative to baseline. The EQ-5D score of one patient worsened while improved in another patient at 6 months follow-up compared to the baseline. Conclusion: Our study details the first experience in a larger series regarding the effects of HAL®-assisted treadmill training on quality of life. Whereas five out of six patients showed improvements in mobility scores, only one patient showed improvement of life quality at 6 months follow-up. Life quality is influenced by a multitude of factors and lager randomized trials are needed to assess the effect of HAL®-assisted training on quality of life. Implications for Rehabilitation Treadmill training with HAL is safe and feasible for patients with neurologic disorders Treadmill training with HAL improved the functional mobility Improvements in the quality of life were unverifiable.

Neuroanatomy of Anxiety: A Brief Review.

Anxiety disorders are among the most prevalent psychological issues worldwide, displaying the youngest age of onset and greatest chronicity of any mood or substance abuse disorder. Given the high social and economic cost imposed by these disorders, developing effective treatments is of the utmost importance. Anxiety disorders manifest in a variety of symptomatic phenotypes and are highly comorbid with other psychological diseases such as depression. These facts have made unraveling the complex underlying neural circuity an ever-present challenge for researchers. We offer a brief review on the neuroanatomy of anxiety disorders and discuss several currently available therapeutic options.

S2 Alar-Iliac Screw Insertion: Technical Note with Pictorial Guide.

BACKGROUND: The S2 alar-iliac (S2AI) screw is a modification of the iliac fixation technique using the space between the neuroforamina of S1 and S2 as an insertion point to fix the sacrum to the ilium. To our knowledge, an anatomic review of the S2AI technique has not been described and the insertion point is vague and angles differ in reports from the literature. The purpose of the current anatomic illustration is to provide step-by-step techniques with fluoroscopic imaging to help confirm the safe placement of S2AI screws. METHODS: The procedure was performed on the left and rights sides of a fresh, frozen, and thawed predissected male cadaver in a surgical training facility through a standard posterior midline exposure for placement of the S2AI screws. All screws were placed by a fellowship-trained spine surgeon and an attending spine surgeon. RESULTS: The specimen was placed prone, and a midline incision begun at the L4 or L5 spinous process. Using the anteroposterior and inlet views, the S1 dorsal sacral foramen, the S1 endplate, and the sacroiliac joint can be identified. The insertion point is 10 mm laterally between the S1 and S2 foramina and near to the sacroiliac joint. Aim toward the anterior inferior iliac spine is ensured by using a 30°-40° lateral angulation in the transverse plane and 20°-30° caudal angulation in the sagittal plane depending on the sacral angulation. Using lateral fluoroscopy, the acetabulum and greater sciatic notch can be identified and screw misplacement can be avoided. The screw length is measured and is usually between 60 and 90 mm (8- to 9-mm diameter). An elevator is used to identify the outer sacral cortex. Anteroposterior, obturator-outlet, and teardrop views are used to ensure correct screw insertion. CONCLUSIONS: Fluoroscopic guidance is crucial for optimal S2AI screw placement. Using the described technique allows a safe and correct insertion of the S2AI screw.

Wound Closure After Posterior Multi-level Lumbar Spine Surgery: An Anatomical Cadaver Study and Technical Note.

Meticulous attention to wound closure in posterior lumbar spine surgery is an important principle in reducing surgical site infections. We detail standardized wound closure used for posterior lumbar spine surgery at a tertiary care referral center and illustrate this as a step-by-step cadaveric dissection. The lumbar spine of a cadaveric specimen (male, 73 years at death) was used for dissection. Standardizing wound closure in posterior lumbar spine surgery may help limit wound complications and infection. Some key points of our technique, as demonstrated on a cadaveric specimen, include separating fascial compartments, avoiding suture abscesses, and creating a tension-free wound.

Hematoma in the Bucco-Mandibular Space: First Case Report.

Our previous studies based on intraoral dissection of fresh cadavers revealed that the fissure and loose connective tissues deep to the mucosa between the incisivus labii inferioris muscle and buccinator muscle form the entrance of the newly discovered bucco-mandibular space. To support the clinical significance of this space, we report the finding of a hematoma within this space in an adult fresh cadaver. Such a finding lends credence to studying the bucco-mandibular space and might help better understand the spread of some infections in the oral region.

Anatomical Study and Comprehensive Review of the Incisivus Labii Superioris Muscle: Application to Lip and Cosmetic Surgery.

Objectives The incisivus labii superioris muscle, which originates from the floor of the incisive fossa of the maxilla, has previously been described, it is not well understood. The purpose of this study was to investigate the incisivus labii superioris muscle with detailed dissection. Methods Twenty-six halves from thirteen fresh frozen cadaveric Caucasian heads were used in this study. First, the incisivus labii superioris muscle was dissected to reveal its origin and insertion, and its relationship to other mimetic muscles. Secondly, the distance from the midline to the innermost part of the bony attachment of the muscle was measured. The literature describing the incisivus labii superioris muscle was reviewed. Results The incisivus labii superioris muscle consisted of two parts, inferior and superior. The former merged into the orbicularis oris and the latter into the nasalis. The mean distance from the midline to the innermost part of the bony attachment of the incisivus labii superioris muscle was 4.8 ± 1.7 mm on the right side and 4.9 ±1.7 mm on the left. Conclusions The results of the present study suggest that the inferior part of the incisivus labii superioris should be considered as an accessory muscle of the orbicularis oris complex, and the superior part is the nasalis muscle.

Internal Hernia of the Greater Omentum: Cadaveric Findings of a Previously Unreported Variant.

Transomental hernias (TOHs) are a rare finding, constituting a fraction of all intestinal hernias. Here, we report the cadaveric discovery of a spontaneous TOH involving the sigmoid colon in an 82-year-old female and discuss the relevant literature. To our knowledge, a TOH involving the sigmoid colon has not been previously reported.

Nerve root anomalies: making sense of a complicated literature.

INTRODUCTION: Nerve root anomalies (NRAs) are a set of well-described congenital irregularities for which several classification systems have been devised over the years. CONCLUSION: This comprehensive review examines the anatomy and characteristics of NRAs; their surgical, radiographic, and cadaveric prevalence rates; clinical and radiographic presentations; and surgical management. In addition, the top 5 NRA classification systems are presented and related.

Absence of the Lumbosacral Trunk.

The lumbosacral trunk, typically comprised of part of the fourth lumbar ventral rami and the entirety of the fifth lumbar ventral rami, serves as a connection between the lumbar and sacral plexuses. Developmental differences underlie the variable relative contributions of L4 and L5 to the lumbosacral trunk. Herein, we report a rare case in which dissection of an adult male cadaver revealed no L4 contribution to the lumbosacral plexus. We discuss the surgical and clinical implications of such an anatomic variation.