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1.
J Spinal Disord ; 13(6): 515-8, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11132983

RESUMO

The authors directly the compared biomechanical pullout strength of screws placed in the cervical lateral masses to that of screws placed across the facet joints. Posterior cervical fixation with lateral mass plates is an accepted adjunctive technique for cervical spine fusions. Altered anatomy resulting from congenital malformation, tumor, trauma, infection, or failed lateral mass fixation may limit traditional screw placement options. Transfacet screw placement, which has been studied extensively in the lumbar spine, may offer an alternative when posterior cervical fusion is required. Ten fresh human cadaveric cervical spines (postmortem age range, 69 to 91 years) were harvested. On one side, transfacet screws were placed at the C3-4, C5-6, and C7-T1 levels. On the other side, lateral mass screws were placed at the C3, C5, and C7 levels. The screw insertion technique at each level was randomized for right or left. After screw placement, each set of vertebral bodies were dissected and mounted in a custom jig for axial pullout testing using a servohydraulic testing machine. The load-displacement curves were obtained for each screw pullout. The mean pullout strength for the screws placed across the facets was 467 N (range, 192 to 1,176 N). This compares with 360 N (range, 194 to 750 N) for the lateral mass screws (p = 0.008). At each level, transfacet screws exhibited greater pullout resistance compared with the lateral mass placement, but the difference was most pronounced at the C7-T1 level (lateral mass = 373 N, transfacet = 539 N, p = 0.042). Cervical transfacet screw placement provides pullout resistance that is comparable to, if not greater than, lateral mass placement. This type of placement, although technically difficult, may be an alternative to lateral mass screws in cases with unusual anatomy, stripped screws, or when additional intermediate points of fixation are desired.


Assuntos
Parafusos Ósseos/estatística & dados numéricos , Vértebras Cervicais/cirurgia , Fixadores Internos/estatística & dados numéricos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Articulação Zigapofisária/cirurgia , Fenômenos Biomecânicos , Parafusos Ósseos/efeitos adversos , Parafusos Ósseos/normas , Vértebras Cervicais/anatomia & histologia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Fixadores Internos/efeitos adversos , Fixadores Internos/normas , Radiografia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Suporte de Carga/fisiologia , Articulação Zigapofisária/anatomia & histologia
2.
Acta Orthop Scand ; 70(1): 47-50, 1999 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10191748

RESUMO

We prospectively studied orthopedic patients with either large or small blood loss who also received vancomycin prophylaxis to determine the effect of intraoperative volume shifts on serum vancomycin concentrations. There were 6 index patients in the large blood loss group (greater than 2 L), and 7 in the control group (less than 2 L). Mean estimated blood loss for index and controls was 4.4 L and 1.0 L, respectively. Mean intraoperative fluid resuscitation, excluding blood products, was 12.4 L and 5.1 L, respectively. There was a modest inverse correlation between blood loss and intraoperative serum half-life of vancomycin. Although controls maintained slightly higher intraoperative vancomycin concentrations at each time-point, there was no statistically significant difference between the groups with regard to absolute concentrations or rate of decline. After 8 hours, the serum vancomycin concentration exceeded the MIC-90 for Staphylococcus aureus by approximately eightfold in all but one case patient. This was a morbidly obese patient with massive blood loss. Thus, blood loss during orthopedic procedures has minimal effects on intraoperative kinetics of vancomycin. Redosing is rarely indicated, although a preoperative 1.5 gram-dose should be considered for patients weighing more than 90 kg.


Assuntos
Antibacterianos/sangue , Antibioticoprofilaxia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Procedimentos Ortopédicos , Vancomicina/sangue , Adulto , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Volume Sanguíneo , Peso Corporal , Monitoramento de Medicamentos , Hidratação/métodos , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Estudos Prospectivos , Ressuscitação/métodos , Fatores de Tempo , Vancomicina/farmacocinética , Vancomicina/uso terapêutico
3.
J South Orthop Assoc ; 6(2): 81-7, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9210125

RESUMO

Magnetic resonance imaging (MRI) is a useful procedure for the evaluation of spinal pathology in children. The high sensitivity of soft tissue changes may lead to misinterpretation of paravertebral swelling caused by inflammation. We present a report of three patients with paravertebral soft tissue swelling caused by disk space infection or intervertebral disk space calcification. The findings shown by MRI were initially interpreted as neoplasm or abscess, which led to surgical procedures either planned or done. Surgeons need to exercise extreme care when interpreting soft tissue changes shown by MRI.


Assuntos
Abscesso/diagnóstico , Erros de Diagnóstico , Discite/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias da Coluna Vertebral/diagnóstico , Abscesso/fisiopatologia , Abscesso/terapia , Criança , Pré-Escolar , Diagnóstico Diferencial , Discite/fisiopatologia , Discite/terapia , Humanos , Lactente , Masculino , Sensibilidade e Especificidade , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/fisiopatologia , Infecções dos Tecidos Moles/terapia , Neoplasias da Coluna Vertebral/fisiopatologia , Neoplasias da Coluna Vertebral/terapia , Tomografia Computadorizada por Raios X
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