ABSTRACT
CASE: The accordion phenomenon is defined as the difference in the disc space observed on x-ray or computed tomography images taken in both standing and supine positions, which results in a discrepancy of local spinal alignment. Oblique lateral interbody fusion (OLIF) is a less invasive method of potentially correcting both coronal and sagittal spinal alignment. We present the case of a 66-year-old woman with rheumatoid arthritis treated with OLIF for degenerative disc disease presenting with hyperlordosis and negative sagittal vertical axis (SVA) because of the accordion phenomenon. CONCLUSION: OLIF for severe degenerative disc disease presenting with hyperlordosis and negative SVA because of the accordion phenomenon may be effective.
Subject(s)
Intervertebral Disc Degeneration , Lordosis , Spinal Fusion , Aged , Female , Humans , Intervertebral Disc Degeneration/diagnostic imaging , Intervertebral Disc Degeneration/surgery , Lordosis/diagnostic imaging , Lumbar Vertebrae , Radiography , Spinal Fusion/methodsABSTRACT
Background and Objectives: Measured blood loss frequently underestimates true blood loss; this discrepancy is called hidden blood loss (HBL). The purpose of the present study was to measure HBL in oblique lateral interbody fusion (OLIF). Materials and Methods: Patients who underwent two-stage OLIF at our institute from September 2017 to September 2021 were retrospectively reviewed. Total blood loss (TBL) and HBL were calculated using the gross formula. The age, sex, body mass index (BMI), operation time, measured blood loss, the number of fused segments, hematocrit (HCT), anticoagulant or platelet medication, blood transfusion, days of hospitalization, pre-/postoperative Japanese Orthopedic Association (JOA) score, and JOA recovery rate were compared. Results: A total of thirteen patients were included in the study. The average age, BMI, number of fused segments, operation time, estimated blood loss, and blood transfusion were 69.5 years, 23.3, 2.5, 250 min, 122 mL, and 230 mL, respectively. Five patients received anticoagulant or platelet therapy. Days of hospitalization, pre-/postoperative JOA score, and JOA recovery rate were 14.9 ± 5.1, 19.9 ± 2.7, and 18.0 ± 43.4%, respectively. The TBL and HBL were 688 and 797 mL, respectively. Stepwise multiple regression analysis revealed that younger age (p = 0.01), female sex (p = 0.01), and number of fused segments (p = 0.02) were significantly associated with higher HBL. Conclusions: The HBL in OLIF was 797 mL, which was more than other previously reported procedures. Therefore, OLIF may not be less invasive in terms of HBL. Blood loss after surgery should be considered, especially when patients are younger, are female, and have a greater number of fused segments.
Subject(s)
Spinal Fusion , Aged , Anticoagulants , Blood Loss, Surgical , Female , Humans , Lumbar Vertebrae/surgery , Male , Retrospective Studies , Spinal Fusion/adverse effects , Spinal Fusion/methodsABSTRACT
Clavicular fractures are common, accounting for 4% of all adult fractures. However, simultaneous medial and lateral fractures occurring in the same clavicle (the so-called 'bipolar clavicle fracture') are rare. Treatment for this type of fracture is not well established. Herein, we report our experience of the operative management of a bipolar clavicle fracture using two anatomical locking plates. The patient was an 82-year-old woman who presented with left-sided clavicle pain after falling to the ground. Plain radiography revealed midshaft and distal clavicular fractures. Open reduction and internal fixation were performed using two different plates, the VA-LCP anterior clavicle plate (DePuy Synthes, West Chester, PA, USA) for the midshaft fracture and the LCP superior anterior clavicle plate with lateral extension (DePuy Synthes) for the distal clavicle fracture. Bony union was achieved 4 months postoperatively without any complications. In conclusion, dual plating is an effective surgical procedure for treating bipolar clavicle fractures.
