Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note.

After performing anterior cervical corpectomy or discectomy for cervical spondolytic myelopathy or radiculopathy, iliac crest bone graft and fibular auto- or allograft is often used to achieve arthrodesis in the cervical spine. The purpose of this study was to evaluate the use of a cylindrical titanium mesh and locking plate system as an alternative technique in achieving anterior cervical fusion and maintaining lordosis. Hospital records and radiographs of 38 patients who underwent anterior cervical discectomies (28 patients) or corpectomies (10 patients) from 1995 to 1997 were reviewed retrospectively. All patients had undergone arthrodesis in which autograft and a cylindrical titanium mesh and anterior locking plate fixation were used after discectomy or corpectomy. There were 20 men and 18 women (mean age 46.1 years; range 34-72 years). Presenting symptoms included radiculopathy (61%), myelopathy (37%), and neck pain (2%). Preoperative and postoperative radiographs were studied, and data were obtained on the following: overall lordosis or kyphosis of the cervical spine, segmental lordosis or kyphosis at each surgically treated level, and evidence of fusion. In all of the patients in whom lordosis was present preoperatively, lordosis was maintained during the follow-up period. The overall fusion rate was 100%. The average change in overall lordosis or kyphosis related to the fixation devices was 1.2 degrees (range 1-5 degrees) the average segmental change was 2.3 degrees (range 0-5 degrees); and the mean follow up was 16 months (range 12-36 months). Anterior cervical fusion with cylindrical titanium mesh and cervical locking plate system is an effective method of achieving arthrodesis and maintaining alignment in the cervical spine. The construct may provide additional load-sharing function, and it avoids the use of cadaveric bone or the need for harvesting tricortical iliac crest autograft.

Incidence of acute care complications in vertebral column fracture patients with and without spinal cord injury.

STUDY DESIGN: This study retrospectively analyzed vertebral column fractures in trauma patients during a 2-year period. Data from a multicenter trauma registry were used. OBJECTIVES: The purpose of this study was to ascertain and describe the initial in-hospital morbidity and mortality rates for patients with vertebral column fractures with and without spinal cord injury. SUMMARY OF BACKGROUND DATA: Patients with vertebral fractures and associated spinal cord injuries experience more medical complications than those without spinal cord injuries. However, the precise incidence and relative risk of complications during acute care hospitalization for these two groups are not well documented. METHODS: Vertebral column fractures in 419 adolescent and adult trauma patients hospitalized during a 2-year period were retrospectively analyzed using data from a multicenter trauma registry. RESULTS: Of the 419 patients, 104 (24.8%) had an associated spinal cord injury. More than half of the spinal cord injury patients (52.9%) and 20.6% of those without spinal cord injury had one or more complications during their hospitalization. Complications resulted in an average of 33.1 extra hospital days, which extrapolates nationally into 1.5 million additional days annually. The four complications differing most significantly in incidence between the spinal cord injury group and the non-spinal cord injury group were: urinary tract infections (24.0% vs. 8.6%), respiratory (23.1% vs. 8.6%), cardiac (11.5% vs. 3.2%), and decubitus ulcer (7.7% vs. 1.0%). Pneumonia, although not statistically different, was high in both groups (13.5% vs. 7.3%). CONCLUSIONS: The incidence of the 25 types of medical complications reported here provides specific and relevant information to assist health professionals in treating patients during their acute care. We estimate that complications during initial hospitalization add $1.5 billion annually to the cost of caring for patients with vertebral fractures in the United States.

Oxalosis: cause of degenerative spinal stenosis. A case report and review of the literature.

The case presented illustrates an unusual entity. The differential diagnosis of degenerative spinal stenosis is voluminous, although incomplete without including oxalosis. Oxalosis as a cause of spinal stenosis has not yet been reported in the orthopedic literature.

Atlantoaxial rotatory fixation after decompressive laminectomy. A case report.

A case of atlantoaxial rotatory fixation and kyphosis in an 8.5-year-old boy following decompressive laminectomy for spinal cord tumor is described. Halo gravity traction was used to reduce the deformity, and then stabilization was performed from C1 through C5 via the anterior approach and with the use of iliac and fibular bone graft. The case is unique in that anterolateral rotatory fixation was combined with kyphosis in the upper cervical spine. It is reemphasized that all children who undergo decompressive laminectomy be observed closely or stabilized at the time of laminectomy.

Segmental spinal instrumentation in the management of neuromuscular spinal deformity.

Seventeen patients with progressive neuromuscular spinal deformity were critically analyzed. All patients were surgically managed by employing segmental spinal instrumentation with Luque rods accompanied by posterior spinal fusion to sacrum. Satisfactory correction of scoliosis, kyphosis, and lordosis was achieved. Furthermore, maintainence and production of physiologic postural curves was possible with this method of instrumentation. Head and trunk decompensation and pelvic obliquity were not well controlled in this series. Respiratory complications in this high-risk group were minimal. Partial postoperative immobilization with bivalved thoraco-lumbosacral orthoses (TLSO) was employed in the majority of patients. Segmental spinal instrumentation provides significant benefits to justify its continued use and development.

Severe lumbosacral spondylolisthesis in adolescents and children. Reduction and staged circumferential fusion.

Using a new surgical regimen, fourteen patients with lumbosacral spondylolisthesis and more than 50 per cent slipping were treated by reduction of the slip with two Harrington distraction rods extending from the first lumbar laminae to the sacral alae and bilateral posterolateral fusion from the fourth lumbar to the second sacral segment. Then, at a second procedure, thirteen had an anterior lumbosacral fusion using two bicortical wedge-shaped iliac grafts. The distraction rods were removed six to twelve months later. At follow-up, correction of the slips ranged from 70 to 100 per cent. In four of the thirteen patients the reduction was improved by 10 to 13 per cent during the anterior procedure. In one patient, a twenty-one-year-old women with a slip of more than 100 per cent, a cauda equina syndrome developed after the reduction and posterolateral fusion, and this necessitated removal of th rods and cancellation of the anterior fusion. This patient recovered completely and her final result was a solid posterolateral fusion in situ, with her abnormal posture and gait unchanged. The other thirteen patients, after follow-up ranging from two years to six years and seven months, had solid fusion, normal spinal alignment, normal anatomy of the spinal canal, and normal posture and gait. Only one patient had loss of correction during follow-up, which amounted to 7 per cent. We concluded that correction of severe spondylolisthesis (50 per cent or more) in properly selected patients can be accomplished by this two-stage procedure without risk of further slipping, pseudarthrosis, persistent deformity, or recurrence of the slip due to late remodeling.

Spondylitis caused by Brucella abortus.

A case of severe chronic spondylitis of the lumbar spine caused by Brucella abortus is presented. Infection was probably associated with ingestion of raw cow's milk. A technetium bone scan provided evidence of activity as early as two years before the radiographic abnormalities were evident. Although rarely seen in brucellosis, a large left psoas abscess formed. After extensive resection and debridement of all necrotic tissue, along with prolonged use of oral doxycycline, the patient recovered completely. The clinical, laboratory, therapeutic, and pathogenic aspects of Brucella spondylitis are discussed.

Congenital atlantoaxial fusion. A case report.

An adult patient, after a minor fall, had a painful neck, and roentgenograms of the affected area showed a separate odontoid with the remnant fused to the anterior ring of the atlas. The multiple nature of the anomalies, coupled with the lack of significant trauma, indicated that the finding was that of congenital atlantoaxial fusion.

Cutaneous rhizopus infection associated with elastoplast wound dressing.

A case of primary zygomycosis due to Rhizopus spp associated with Elastoplast bandage use in a young, healthy surgical patient is reported. Lesions resolved without complications after removal of the bandage from the wound and a short course of amphotericin B. Rhizopus spp was recovered from material obtained by scraping the lesions, and from unused Elastoplast bandage retrieved from the operating room.Epidemiological, clinical, diagnostic and therapeutic aspects of the condition are discussed.