Spondyloarthropathies That Mimic Ankylosing Spondylitis: A Narrative Review.

Ankylosing spondylitis is the most common type of seronegative inflammatory spondyloarthropathy often presenting with low back or neck pain, stiffness, kyphosis and fractures that are initially missed on presentation; however, there are other spondyloarthropathies that may present similarly making it a challenge to establish the correct diagnosis. Here, we will highlight the similarities and unique features of the epidemiology, pathophysiology, presentation, radiographic findings, and management of seronegative inflammatory and metabolic spondyloarthropathies as they affect the axial skeleton and mimic ankylosing spondylitis. Seronegative inflammatory spondyloarthropathies such as psoriatic arthritis, reactive arthritis, noninflammatory spondyloarthropathies such as diffuse idiopathic skeletal hyperostosis, and ochronotic arthritis resulting from alkaptonuria can affect the axial skeleton and present with symptoms similar those of ankylosing spondylitis. These similarities can create a challenge for providers as they attempt to identify a patient's condition. However, there are characteristic radiographic findings and laboratory tests that may help in the differential diagnosis. Axial presentations of seronegative inflammatory, non-inflammatory, and metabolic spondyloarthropathies occur more often than previously thought. Identification of their associated symptoms and radiographic findings are imperative to effectively diagnose and properly manage patients with these diseases.

Management of Radiation-induced Tissue Injuries: A Review of Current Treatment Strategies.

Although radiation therapy remains an integral component in cancer treatment, the sequela of tissue damage can result in long-term morbidity and mortality for patients. This article aimed to perform a comprehensive review of the current literature for both nonsurgical and surgical management strategies for radiation-induced injuries. Methods: A literature search was performed on PubMed to review the current described management and treatment options for radiation-induced injuries. Patient demographics, medical diagnoses, complications, strategies of management care, and outcomes were reviewed. Results: The most commonly described management options and reconstructive techniques of radiation wounds were analyzed and reported. Conclusions: Consideration of current techniques and outcomes in the management of radiation-induced wounds demonstrates that impaired wound healing remains a major problem. This literature review provides a detailed overview of the most frequently used therapies with recommendations for surgeons.

Diabetes and Impaired Fracture Healing: A Narrative Review of Recent Literature.

PURPOSE OF THE REVIEW: Diabetes mellitus is a chronic metabolic disorder commonly encountered in orthopedic patients. Both type 1 and type 2 diabetes mellitus increase fracture risk and impair fracture healing. This review examines complex etiology of impaired fracture healing in diabetes. RECENT FINDINGS: Recent findings point to several mechanisms leading to orthopedic complications in diabetes. Hyperglycemia and chronic inflammation lead to increased formation of advanced glycation end products and generation of reactive oxygen species, which in turn contribute to the disruption in osteoblast and osteoclast balance leading to decreased bone formation and heightening the risk of nonunion or delayed union as well as impaired fracture healing. The mechanisms attributing to this imbalance is secondary to an increase in pro-inflammatory mediators leading to premature resorption of callus cartilage and impaired bone formation due to compromised osteoblast differentiation and their apoptosis. Other mechanisms include disruption in the bone's microenvironment supporting different stages of healing process including hematoma and callus formation, and their resolution during bone remodeling phase. Complications of diabetes including peripheral neuropathy and peripheral vascular disease also contribute to the impairment of fracture healing. Certain diabetic drugs may have adverse effects on fracture healing. The pathophysiology of impaired fracture healing in diabetic patients is complex. This review provides an update of the most recent findings on how key mediators of bone healing are affected in diabetes.

Clinical presentation and surgical anatomy of sympathetic nerve injury during lumbar spine surgery: a narrative review.

Background and Objective: To highlight the surgical anatomy, procedural variations, presentation, and management of sympathetic nerve injury after surgery of the lumbar spine. Methods: PubMed and Google Scholar were searched for publications that were completed between 1951 and 2021. Relevant full-text articles published in the English language were selected and critically reviewed. Key Content and Findings: Sympathetic injury is a highly variable postsurgical complication with a greater incidence after an anterior or oblique approach to the lumbar spine compared to posterior and lateral approaches. The direct and extreme lateral approaches reduce the need to disturb sympathetic nerves thus reducing the risk of complications. It can present in multiple manners, including complex regional pain syndrome (CRPS) and retrograde ejaculation. These complications can be transient and resolve spontaneously or be treated with medications, physical therapy, and spinal blocks. The severity of the conditions and extent of recovery can vary drastically, with some patients never fully recovering. Conclusions: To access the lumbar spine, there are operational approaches and techniques that should be used to decrease the risk of intraoperative injury. It is crucial to understand the advantages and risks to different approaches and take the necessary steps to minimize complications. Early identification of dysfunction and adequate management of symptoms are imperative to effectively manage patients with lumbar sympathetic trunk and sympathetic nerve fiber injuries.

Spondylodiscitis secondary to Mycobacterium chelonae: a case report.

Background: Spondylodiscitis secondary to Mycobacterium chelonae (M. chelonae) is a rare primary infection of the spine, with a few case reports highlighted. Treatment of this infection is not well established but here we discuss a case where a patient recovered well following early aggressive surgical intervention and antibiotic treatment. Case Description: A 32-year-old male presented with a 3-month history of worsening low back pain, Horner's syndrome, dysphagia, lower extremity weakness, and a 5-day history of bowel and bladder incontinence. The patient had an extensive orthopedic history but no recent trauma or history of spinal surgery. He had no known prior medical conditions that would suggest immunocompromise. Magnetic resonance imaging (MRI) scan showed lumbar spondylodiscitis, and blood cultures did not show any growth. The patient underwent L4-S1 decompression and fusion with iliac crest bone grafting, and intraoperative biopsy. Intraoperative tissue cultures grew M. chelonae. Repeat computerized tomography (CT)-guided biopsy confirmed the pathogen. The patient was initially treated with vancomycin and piperacillin-tazobactam. Numerous alterations in antibiotic regimen occurred secondary to medication adverse effects and noncompliance, and he was ultimately treated with azithromycin and tigecycline. Interval follow-up demonstrated gradual improvement of bilateral lower extremity strength and return of bowel and bladder function. Follow-up at 16 months post-operatively demonstrated significant improvement in pain and neurological symptoms, with no signs of infection recurrence. Conclusions: This case demonstrates the importance of aggressive surgical management of M. chelonae spondylodiscitis. Early aggressive surgical management in combination with antibiotics may improve clinical outcomes for these patients.